Comparative Outcome of Thai Pediatric Osteosarcoma Treated with Two Protocols: the Role of High-Dose Methotrexate (HDMTX) in a Single Institute Experience

Background: High-dose methotrexate (HD-MTX) is recognized as an efficient component of therapy againstpediatric osteosarcoma in combination with other drugs such as cisplatin (CDP), carboplatin (CBDCA),doxorubicin (ADM), etoposide (VP-16) and ifosfamide (IFO). Objectives: To demonstrate the feasibility andeffectiveness of the HD-MTX/CDP/DOX/VP-16/IFO [MTX(+)] protocol comparable to CDP/ADM/CBDCA/IFO[MTX(-)] for treating childhood osteosarcoma at Ramathibodi Hospital (1999-2014). Materials and Methods:A retrospective analysis was conducted of osteosarcoma patients aged less than 18 years treated with twochemotherapeutic regimens between 1999 and 2014. A total of 45 patients received the MTX(-) and 21 the MTX(+)protocol. Results: Overall limb-salvage and amputation rate were 12.9% and 77.7%, respectively. Kaplan-Meier analysis results for 3-year disease free survival (DFS) and overall survival (OS) regardless of treatmentregimens were 43.4±6.0% and 53.2±6.1% respectively. The 3-year DFS and OS were improved significantlywith the MTX(+) protocol compared to MTX(-) protocol (p=0.010 and p=0.009, log rank test) [69.8±10.5%,79.8±9.1% for MTX(+) and 31.1±6.9%, 42.2±7.4% for MTX(-) protocol, respectively]. Patients with metastaticosteosarcoma treated with the MTX(+) protocol had statistically significant higher 3-year DFS and OS thanthose treated with the MTX(-) protocol (66.7±13.6% and 15.0±8.0% for 3-year DFS, p=0.010, 73.3±13.2% and20±8.9% for 3-year OS, p=0.006, respectively). The independent risk factors for having inferior 3-year DFSand OS were poor histological response (tumor necrosis <90%) and treatment with the MTX(-) protocol. Themultivariate analysis identified only the treatment with the MTX(-) protocol as an independent predictor ofinferior OS with a hazard ratio (HR) of 3.53 (95% confidence interval of 1.2-10.41, p=0.022). Conclusions: Ourstudy demonstrated the tolerability, feasibility and efficacy of the HDMTX-based regimen improving the survivalrate in pediatric osteosarcoma cases, in line with reports from developed countries.     

Relapsed Childhood Acute Myeloid Leukemia: Experience from a Single Tertiary Center in Thailand

Background: Few studies have examined survival outcomes in relapsed childhood acute myeloid leukemia (AML) in resource-limited countries. This study aimed to evaluate the prognostic factors and survival outcomes of relapsed childhood AML in Thailand. Methods: The medical records of AML patients aged 0-15 years treated in a major tertiary center in Southern Thailand between December 1979 and December 2019 were reviewed retrospectively. The overall survival (OS) was calculated using the Kaplan-Meier method. Results: A total of 316 AML patients were included and relapse occurred in 98 (31%) patients. Of these, 57 (58.2%) and 41 (41.8%) patients had early [≤1 year from first complete remission (CR1)] and late (>1 year from CR1) relapses, respectively. Only 54 (55.1%) patients received chemotherapy after relapse. The 3-year OS of all relapsed patients was 3.5%. The 3-year OS of patients with early and late relapse were 0% and 8.5%, respectively (p=0.002). The 3-year OS of patients who received chemotherapy and those who did not were 6.5% and 0%, respectively (p <0.0001). The median survival time of patients who did not receive chemotherapy was 1.7 months. The 3-year OS of patients who achieved second complete remission (CR2) and those who did not were 12.6% and 0%, respectively (p <0.001). Conclusion: The relapsed AML rate was 31% and the survival outcome was poor with a 3-year OS of 3.5%. The adverse prognostic factors were early relapse, failure to achieve CR2 and those who did not receive chemotherapy after relapse.     

锌-α2-糖蛋白1在骨肉瘤组织中的表达及其临床意义

目的:探讨锌-α2-糖蛋白1(zinc-α2-glycoprotein 1,AZGP1)在骨肉瘤组织中的表达及其与患者临床病理特征和预后的关系.方法:选取2012年8月至2014年8月河南省南阳市第二人民医院骨科收治的62例骨肉瘤患者的癌及癌旁组织标本,用免疫组织化学染色法检测骨肉瘤组织中AZGP1表达.所有患者于术后...     

Evaluation of P-glycoprotein, HER-2/ErbB-2, p53, and Bcl-2 in primary tumor and metachronous lung metastases in patients with high-grade osteosarcoma

BACKGROUND: Investigation of the relation between primary tumor and metastatic disease is necessary for the identification of predictive factors for postrecurrence survival (PRS) in patients with recurrent osteosarcoma. METHODS: Cellular levels of P-glycoprotein, ErbB-2, p53, and Bcl-2 expression were evaluated in primary tumor biopsy and metachronous pulmonary metastasis specimens from 19 patients with high-grade osteosarcoma. Results were analyzed for differences between primary tumor and pulmonary metastases and for correlations between expression patterns and survival. RESULTS: Positive staining in lung metastases was noted in 68%, 53%, 32%, and 84% of patients for P-glycoprotein, ErbB-2, p53, and Bcl-2, respectively. These percentages were higher than those observed in primary tumor specimens for all genetic markers evaluated, with a significant difference in the percentage of patients with positive staining for P-glycoprotein (68% vs. 32%; P = 0.05) and a near-significant difference in the percentage of patients with positive staining for Bcl-2 (84% vs. 53%; P = 0.08). Patients with ErbB-2 expression in the primary tumor were more likely to have multiple metastases and shorter recurrence-free intervals compared with patients in whom ErbB-2 expression was not observed, whereas differences in P-glycoprotein, p53, and Bcl-2 expression were not related to differences in metastatic pattern. PRS was influenced by p53 expression levels in pulmonary metastases, with patients who had negative staining for p53 having a significantly better PRS rate relative to patients with positive staining for p53 (3-year PRS rate: p53-negative, 64%; p53-positive, 17%; P = 0.008). CONCLUSIONS: In the current study of patients with high-grade osteosarcoma, most patients exhibited increased cellular expression of P-glycoprotein, ErbB-2, and Bcl-2 in recurrent pulmonary metastases compared with primary tumor. Further studies aimed at investigating the relation between altered p53 expression in lung metastases and postrecurrence survival are recommended.     

Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery

PURPOSE: To report the outcome of patients with synchronous, solitary brain metastasis from non-small-cell lung cancer (NSCLC) treated with gamma knife stereotactic radiosurgery (GKSRS). PATIENTS AND METHODS: Forty-two patients diagnosed with synchronous, solitary brain metastasis from NSCLC were treated with GKSRS between 1993 and 2006. The median Karnofsky performance status (KPS) was 90. Patients had thoracic Stage I-III disease (American Joint Committee on Cancer 2002 guidelines). Definitive thoracic therapy was delivered to 26/42 (62%) patients; 9 patients underwent chemotherapy and radiation, 12 patients had surgical resection, and 5 patients underwent preoperative chemoradiation and surgical resection. RESULTS: The median overall survival (OS) was 18 months. The 1-, 2-, and 5-year actuarial OS rates were 71.3%, 34.1%, and 21%, respectively. For patients who underwent definitive thoracic therapy, the median OS was 26.4 months compared with 13.1 months for those who had nondefinitive therapy, and the 5-year actuarial OS was 34.6% vs. 0% (p < 0.0001). Median OS was significantly longer for patients with a KPS >or=90 vs. KPS < 90 (27.8 months vs. 13.1 months, p < 0.0001). The prognostic factors significant on multivariate analysis were definitive thoracic therapy (p = 0.020) and KPS (p = 0.001). CONCLUSIONS: This is one of the largest series of patients diagnosed with synchronous, solitary brain metastasis from NSCLC treated with GKSRS. Definitive thoracic therapy and KPS significantly impacted OS. The 5-year OS of 21% demonstrates the potential for long-term survival in patients treated with GKSRS; therefore, patients with good KPS should be considered for definitive thoracic therapy.     

14例骨肉瘤肺转移致自发性气胸的临床观察

目的 探讨骨肉瘤肺转移致自发性气胸患者的生存情况及影响预后的因素。方法 回顾性分析14例发生自发性气胸和40例同期未发生自发性气胸的骨肉瘤肺转移患者的临床资料,生存分析采用Kaplan-Meier法,多因素分析用Cox比例风险模型。结果 54例骨肉瘤肺转移患者均获随访。14例自发性气胸患者的中位无进展生存时间（PFS）为2个月,中位总生存时间（OS）为11个月,2年生存率为14.3％（2／14）,而未发生自发性气胸的40例骨肉瘤肺转移患者分别为2个月、16个月和35.0％（14／40）,两组OS的差异有统计学意义（P＜0.05）。气胸发生率及PFS与化疗情况无关（P＞0.05）。肺转移灶数目和自发性气胸是影响骨肉瘤肺转移患者OS的独立因素（HR=0.34,95％CI：0.15～0.79,P=0.01;HR=0.38,95％CI：0.16～0.87,P=0.02）。结论 自发性气胸的发生与骨肉瘤肺转移的不良预后有关。     

一线化疗联合三氧化二砷对肢体转移性骨肉瘤的疗效分析

  目的   通过回顾北京大学人民医院骨与软组织肿瘤中心十年以上的肢体骨肉瘤肺转移的病例,对其预后、治疗过程进行总结,以期发现三氧化二砷（arsenic trioxide,ATO）联合一线化疗药物对早期肺转移病例的疗效。  方法  回顾性分析北京大学人民医院骨肿瘤科自1998年3月至2014年12月收治的肢体骨肉瘤肺转移的连续病例,挑选出治疗过程中出现早期肺转移及初治肺转移曾经使用过ATO长期输液联合一线化疗药物（阿霉素、顺铂、大剂量氨甲喋呤和异环磷酰胺）进行治疗的病例。共计119例符合本研究条件,65例为初治肺转移,54例为治疗过程中发现肺转移。  结果   该组的病例经治疗,2年及5年总生存率分别为52.6%和30.9%。虽然仅20例接受了肺部切除手术（16.8%）,但本中心选择治疗后的病例5年总生存情况和国际上其他区域的的生存情况类似（意大利Rizzoli的5年生存率为37%）。通过比较各项临床病理学因素,发现骨转移、双侧肺转移、出现≥3个肺转移结节以及不完全切除肺内病灶,提示患者预后不佳。  结论  ATO合并一线化疗可能是一种有效且患者可耐受的新的治疗选择。肺切除手术应该严格挑选合适的病例,以获得最大的临床受益。      

分析吉非替尼有效的非小细胞肺癌患者骨转移对其生存期的影响及骨转移患者的预后因素

目的：研究吉非替尼有效的非小细胞肺癌患者,骨转移是否影响其生存期,并分析骨转移患者的预后因素。方法比较骨转移和无骨转移患者总生存、无进展生存、1年、2年及3年生存率,并分析影响骨转移患者预后的因素。结果无骨转移组44例,骨转移组32例。无骨转移组与有骨转移组总生存期（19．000±3．317月 vs．26．000±2．121月,P＝0．625）和无进展生存期（14．000±1．843月 vs．16．000±1．411月,P＝0．328）无统计学差异。前组患者1年生存率63．6％低于后者96．9％,2年和3年生存率分别为（34．1％vs．56．3％,P＝0．054）和（18．2％vs．18．4％,P＝0．950）,无统计学差异。对骨转移组进行单因素分析显示年龄＞60岁及有肺内进展者预后更差,多因素分析显示影响骨转移患者生存的有效因素为有肺内进展,而性别、病理、吸烟指数、是否合并脑转移、骨相关事件及是否应用放疗、双膦酸盐与骨转移患者中位生存时间均无明显相关性。结论吉非替尼治疗有效的非小细胞肺癌患者,骨转移可能不是影响其生存期的主要因素,肺内进展有可能是非小细胞肺癌骨转移者的主要死因,不能将骨转移作为停用吉非替尼的指征。     

349例食管癌IMRT为主的长期疗效分析

目的 观察食管癌IMRT为主的疗效和不良反应,探讨影响其预后因素。方法 回顾分析2006—2012年349例食管癌IMRT为主患者的近期疗效和急性不良反应,Kaplan-Mierer法计算1、3、5年LC率及OS率,Cox模型分析影响生存的因素。结果 3、5年样本数分别为174、63例。全组患者1、3、5年LC率分别为 72.9%、61.2%、58.4%,OS率分别为66.5%、39.1%、24.0%。亚组分析显示<54.73 cm³组1、3、5 年LC、OS率均高于≥54.73 cm³组(P=0.001、0.000);有无淋巴结转移的1、3、5年LC率相近(P=0.393),1、3、5年OS率分别为62.7%、35.9%、20.4%和83.1%、53.3%、38.3%(P=0.003);CR、PR、NR者1、3、5年LC率和OS率均不同(P=0.000、0.000)。≥2级急性RP发生率为11.3%,≥3级急性放射性食管炎发生率为9.0%。肿瘤体积、近期疗效、淋巴结转移是影响OS的因素(P=0.038、0.000、0.008)。结论 食管癌IMRT为主的疗效较好,不良反应较轻。随肿瘤体积增加和区域淋巴结转移出现,患者预后变差,近期疗效评价与LC和OS情况明显相关。     

骨肉瘤肺转移手术后的生存预测因素分析

目的：评估骨肉瘤患者肺部转移（ PM）完全切除（ CR）后的预后因素。方法回顾性分析62例转移性骨肉瘤患者接受治疗和随访的资料。单因素和多因素分析转移性骨肉瘤的人口统计学和疾病相关的特性对总体生存（ OS）的影响。结果总共有25例PM患者行完全切除,并纳入分析。5年OS和无病生存率分别为30％和21％。单变量分析较差的OS相关的因素包括软骨细胞亚型,后化疗原发肿瘤坏死＜90％,新辅助或辅助化疗期间检测到转移,病理识别肿瘤细胞达到任何切除结节的内脏胸膜表面。在多变量分析中,软骨细胞亚型是唯一的独立的不良预后因素（ HR＝4．6,95％CI：1．0～21．3,P＝0．044）。结论肿瘤生物学相关的因素,原发肿瘤坏死不彻底,化疗期间癌细胞转移,软骨细胞亚型和内脏胸膜受累都是手术预后差的相关因素。     

Association between obesity at diagnosis and weight change during induction and survival in pediatric acute lymphoblastic leukemia

For children with acute lymphoblastic leukemia (ALL), the impact of obesity at diagnosis and weight change during induction on survival is uncertain. Objectives of this study were to describe the relationship between obesity and weight change during induction and event-free survival (EFS) and overall survival (OS). Participants were children 2-18 years old with ALL diagnosed between January 2001 and September 2006. Univariate and multiple regression analyses were conducted. In total 238 children were included; 21 (8.8%) were obese at diagnosis. Obese patients, compared with non-obese patients, had lower 5-year EFS (62.2±12.1% vs. 83.6±2.6%; p =0.02) and OS (80.7±8.7% vs. 92.9±1.9%; p =0.005). In univariate analysis, weight gain during induction was associated with better EFS (hazard ratio [HR] =0.89, 95% confidence interval [CI] 0.82-0.97; p =0.009) and OS (HR =0.81, 95% CI 0.74-0.90; p <0.0001). Obese pediatric patients with ALL have inferior survival while increased weight during induction may be associated with better survival. Causes of weight loss during induction should be aggressively managed.     

Relapsed Childhood Acute Lymphoblastic Leukemia: Experience from a Single Tertiary Center in Thailand

Background: The outcomes of relapsed childhood acute lymphoblastic leukemia (ALL) in developed countries have improved over time as a result of risk-adapted, minimal residual disease-directed therapy, hematopoietic stem cell transplantation, and immunotherapy. There are few studies that have examined survival in relapsed childhood ALL in resource-limited countries. Therefore, this study aimed to assess the prognostic factors and survival outcome of relapsed childhood ALL in a major tertiary center in Southern Thailand. Methods: The medical records of patients with ALL aged <15 years between January 2000 and December 2019 were retrospectively reviewed. The Kaplan-Meier method was used to depict the overall survival (OS). Results: A total of 472 patients with ALL were enrolled and relapsed ALL was found in 155 (32.8%) patients. Of these, 131 (84.5%) and 24 (15.5%) had B-cell and T-cell phenotypes, respectively. One hundred thirteen (72.9%) and 42 (27.1%) patients had early and late relapses, respectively. The most common site of relapse was bone marrow in 102 patients (65.8%). One hundred twenty-eight (82.6%) patients received treatment while 27 (17.4%) patients refused treatment. The 5-year OS of all relapsed patients was 11.9%. The 5-year OS among the patients with early relapse was significantly lower than in the patients with late relapse (5.3% vs. 29.1%, respectively, p <0.0001). Site and immunophenotype were not associated with survival of relapsed ALL. The median survival times among the patients who received and refused relapse chemotherapy were 11.8 and 3.1 months, respectively (p <0.0001). Conclusion: The relapse rate accounted for one third of patients with ALL with the 5-year OS of 12%. Early relapse and those who refused treatment were associated with poor survival outcome.     

Surgical outcomes and prognostic factors of non-metastatic radiation-induced sarcoma of bone

BackgroundThe survival and prognostic factors in non-metastatic, radiation-induced bone sarcomas of bone have not been described. Moreover, the quantitative data about surgical outcomes and complications after limb-salvage surgery versus amputation are quite limited.MethodsTwenty-five patients with non-metastatic, radiation-induced sarcoma of bone who underwent definitive surgery were analysed. Histological diagnosis was osteosarcoma in 19 and undifferentiated pleomorphic sarcoma in six. The definitive surgery was limb-salvage surgery in 15 patients and an amputation in 10.ResultsThe 5-year overall survival rate (OS) and the 5-year event-free survival rate (EFS) were 53% (95% CI 31%–70%) and 40% (21%–59%), respectively. Patients with wide or radical surgical margins (n = 13) showed significantly better OS compared with those with marginal (n = 8) or intralesional (n = 2) margins (5-year OS, radical or wide = 74%, marginal = 17%, intralesional = 0%, p = 0.044). The risk of local recurrence was significantly higher in the limb-salvage group compared to the amputation group (49% vs 0%, p = 0.011). OS and EFS were not significantly different between limb-salvage group and an amputation group (p = 0.188 and 0.912, respectively).ConclusionsWe believe non-metastatic, radiation-induced sarcoma of bone should be resected with the aim of achieving wide or radical margins. Although limb-salvage surgery was related to higher rates of local recurrence compared with those of the amputation group, OS and EFS were not different among two groups. Surgeons need to discuss the higher risk of local recurrence in limb-salvage surgery.     

Predictors and Treatment Outcomes of Pediatric Osteosarcoma in Diverse Socioeconomic Backgrounds in Southeast Asia: A Retrospective Multicenter Study

Background: Pediatric osteosarcoma outcomes among developed and developing countries have not been previously compared. Countries in Southeast Asia (SEA) have a wide variety of socioeconomic statuses. A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. Methods: Pediatric patients with osteosarcoma treated between 1998 and 2017 in 4 SEA pediatric oncology centers were studied. Countries were classified using the World Bank Atlas method. Kaplan–Meier method and Cox’s Proportion Hazard Model were applied to estimate survival outcomes and identify prognostic factors. Results: In all, 149 patients with osteosarcoma with a mean age of 12.48±3.66 years were enrolled. The localized to metastatic disease ratio was 1.5:1. The 5-year overall survival (OS) and event-free survival (EFS) were 53.8% and 42%, respectively. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value <0.05). In patients with localized disease, EFS was superior with limb-salvage surgery (62%) than amputation or rotationplasty (40%) (p-value 0.009). MTX-containing chemotherapies provided higher OS (45.3%) and EFS (37.9%) than non-MTX regimens (12.3% and 10.7%, respectively) among metastatic patients (p-value 0.004 and 0.005, respectively). Metastatic disease was an independent prognostic factor for death but not relapse outcome.  Conclusion: The disease outcomes in SEA were acceptable compared to developed countries. The stage of disease was the only independent prognostic factor. MTX-containing regimens and limb-salvage surgery should be considered where possible.     

术前合并肾积水对膀胱癌根治术后患者生存预后的影响

  目的  探讨术前合并肾积水对病理TNM不同分期膀胱癌根治术后患者生存的影响。  方法  回顾性分析2013年1月至2017年12月231例于昆明医科大学第二附属医院行膀胱癌根治性切除术患者的病例资料,根据术前有无合并肾积水分为合并肾积水组（96例）和未合并肾积水组（135例）,比较两组的总生存（overall survival,OS ）率。采用Cox比例风险回归模型进行预后因素的单因素及多因素分析;根据不同TNM分期将患者进行分组,Kaplan-Meier法分别绘制生存曲线,采用Log-rank检验进行显著性分析。  结果  合并肾积水组与未合并肾积水组患者的3年和5年OS率分别为62.5%±4.9%和38.5%±5%与 74.8%±3.7%和66.8%±4.1%,未合并肾积水组均明显高于合并肾积水组（P<0.001）。多因素Cox比例风险回归模型分析显示,术前合并肾积水、病理T分期、淋巴结转移为术后OS的独立影响因素（P<0.05）。TNM分期的分层分析发现,合并肾积水的T2N0M0组与未合并肾积水的T3～4N0M0组（P=0.816）,以及合并肾积水的T3～4N0M0组与未合并肾积水的TxN+Mx组之间的生存差异均无统计学意义（P=0.591）。  结论  术前合并肾积水是膀胱癌根治术后患者OS的独立影响因素,同时术前合并肾积水可使T2N0M0及T3～4N0M0患者的术后生存曲线向更晚的病理TNM分期偏移。      

嗅神经母细胞瘤的预后因素和治疗结果分析

目的 探讨嗅神经母细胞瘤（ENB）的临床特点、预后因素及适宜治疗方案。方法 回顾性分析49例经病理确诊的FNB患者,改良Kadish分期为A期3例,B期15例,C期22例,D期9例。单纯手术治疗4例,单纯放射治疗11例．手术＋放射治疗19例,放射治疗＋化疗8例,手术＋放射治疗＋化疗7例。应用SPSS10．0软件进行统计分析,Kaplan-Meier法计算生存率（OS）和无病生存率（DFS）,Logrank检验生俘曲线之间的差异。结果 49例患者的5年OS为60．7％,5年DFS为41．9％。A、B期和C、D期患者的5年OS分别为78．4％和49．7％（X^2=2．10,P=0．15）,5年DFS分别为47．1％和38．4％（X^2=0．08,P=0．78）。有颈部淋巴结转移和无颈部淋巴结转移的5年OS分别为17．8％和70．8％（X^2=2．32,P=0．13）,5年DFS分别为O和53．4％（X^2=11．67,P〈0．01）。KPS≥80和KPS〈80患者的5年OS分别为69．0％和30．1％（X^2=7．01,P〈0．01）,5年DFS分别为46．7％和24．9％（X^2=6．37,P=0．01）。综合治疗组及单纯放疗和（或）单纯手术组的5年OS分别为69．7％和46．3％（X^2=3．49,P=0．06）,5年DF、S分别为52．2％和21．8％（X^2=7．03,P〈0．01）。无颈部淋巴结转移患者,接受手术治疗苦和未接受手术治疗者的5年OS分别为71．1％和44．6％（X^2=7．99,P〈0．01）,5年DFS分别为54．0％和24．1％（X^2=6．41,P=0．01）。11例单纯放疗患者5年OS为47．7％,5年DFS为30．7％。结论 FNB患者发病年龄较早,男性较多,就诊时多已是局部晚期,一般状况评分及颈部淋巴结转移是预后的影响因素,治疗以包括手术在内的综合治疗疗效较好,放射治疗在ENB的治疗中占有重要地位。     

术后放疗在T1-2N0M0期SCLC治疗中的意义

目的 探讨术后放疗对早期SCLC预后影响。方法 回顾分析我院1997—2010年临床分期为T_1-2N₀M₀期且行根治性切除术的71例SCLC患者临床资料,31例术后放疗,55例术前或术后化疗。Kaplan-Meier法计算LR率、远处转移率及生存率并Logrank法检验及单因素预后分析,Cox模型多因素预后分析。结果 5年样本数32例,5年OS率及LR率分别为52%和22%,术后是否放疗对生存无影响(P=0.524)。对于术后N (-)患者行放疗与未行放疗者中位OS分别为47.3个月与96.8个月(P=0.561),5年LR率分别为39%与23%(P=0.934)。对于术后N (+)患者行放疗者中位生存明显高于未行放疗者(66.7、34.6个月,P=0.016),行放疗者5年LR率亦明显低于未行放疗者(5%、75%,P=0.004)。全组患者远处转移率为30%,术后放疗与否对患者远处转移率无影响(P=0.576)。结论 术后放疗明显降低了术后N (+) SCLC患者LR率并提高了生存,而对N (-)患者反而有降低生存趋势,建议术后N (+)的SCLC患者行术后放疗。     

Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms:a multicenter study in South China

Background: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a heterogeneous group of rare tumors. Many issues in terms of epidemiologic features, pathogenesis, and treatment of GEP-NENs are still under discussion. Our study aimed to analyze the clinicopathologic characteristics and prognosis of Chinese patients with GEP-NENs. Methods: Complete clinicopathologic data and survival information of 1183 patients with GEP-NENs treated between 2005 and 2015 were collected from five medical centers in Guangdong Province, China. Patient survival was estimated using the Kaplan–Meier method and analyzed using the log-rank test; prognostic factors were analyzed using the Cox proportional hazards model. Results: The most common tumor location was the rectum (37.4%), followed by the pancreas (28.1%), stomach (20.7%), small intestine (7.2%), appendix (3.4%), and colon (3.3%). After initial definitive diagnosis, 1016 (85.9%) patients underwent surgery. The 1-, 3-, and 5-year overall survival (OS) rates for the entire cohort were 87.9%, 78.5%, and 72.8%, respectively. The 3-year OS rates of patients with G1, G2, and G3 tumors were 93.1%, 82.7%, and 43.1%, respectively (P < 0.001). The 3-year OS rates of patients with stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ tumors were 96.0%, 87.3%, 64.0%, and 46.8%, respectively (P < 0.001). Patients with distant metastasis who underwent palliative surgery had a longer survival than those who did not (P = 0.003). Similar survival benefits of palliative surgery were observed in patients with neuroendocrine tumor (P = 0.031) or neuroendocrine carcinoma (P = 0.046). In multivariate analysis, age, grade, N category, M category, and surgery were found to be independent prognostic factors. Conclusions: Patients with GEP-NENs who are women, younger than 50 years old, have smaller tumor size, have lower tumor grade, have lower T/N/M category, and who undergo surgery can have potentially longer survival time. Our data showed that surgery can improve the prognosis of GEP-NEN patients with distant metastasis. However, randomized controlled trials need to be conducted to establish the optimal criteria for selecting patients to undergo surgery.     

NLR、LMR和PLR与骨肉瘤预后的关系

目的 探讨术前中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)、血小板/淋巴细胞比值(PLR)对预测骨肉瘤患者预后的影响.方法 回顾性分析接受同样治疗方案的70例骨肉瘤患者的临床和生存资料,计算出初次确诊为骨肉瘤时的NLR、PLR和LMR,ROC曲线分析NLR、PLR和LMR的AUC值并确定最佳预测...     

Survival and outcomes of surgical treatment of the elderly NSCLC in China: a retrospective matched cohort study.

AIM: To compare survival and outcomes of pulmonary resection for elderly NSCLC patients with that of younger controls in China. METHODS: A database which included 4792 NSCLC patients who received complete surgery from 1985 to 2005 was used. The elderly patients (>or=70) were matched 1:1 to controls (<70) by 5 variables: gender; stage; histology; pulmonary resection types; adjuvant chemotherapy. The long-term survival rates, the operative mortality and short-term death after surgery were compared. RESULTS: There were 1304 patients: 652 cases were >or=70. The 5-year OS of elderly was 39%; that of the controls was 45% (p=0.06). Operative mortality rate between elderly and the controls was similar (9/652 vs 4/652 p=0.16) but the short-term death within 2 months after the surgeries were different (23/652 vs 7/652 p=0.003). The elderly with lobectomy had a worse 5-year OS than controls (42% vs 46% p=0.05), but the 5-year OS was similar for patients who received pneumonectomy (24% vs 36% p=0.40) and the limited resections (46% vs 39% p=0.27). The 5-year OS in patients who received adjuvant chemotherapy were similar (49% vs 44% p=0.10). CONCLUSION: Elderly have the similar long-term OS with the controls. They should not be denied the curative surgery and adjuvant chemotherapy based on their chronologic age. However, elderly patients had a higher risk of short-term death after the surgery, which suggests that elderly be given more intensive care after the surgery.