局部肌层浸润性膀胱癌预后影响因素分析

  目的  探讨影响局部肌层浸润性膀胱癌患者长期生存的预后因素。  方法  回顾性分析2002年1月至2011年6月新疆医科大学第一附属医院肿瘤中心收治的133例局部浸润性膀胱癌患者临床资料,选择年龄、合并症、肾积水、肿瘤大小、病灶数目、T分期、淋巴结转移、病理类型、肿瘤分级、治疗方式等10个对预后可能产生影响的因素,采用Kaplan-Meier法和Log-rank检验,对有意义的单因素进行Cox多因素分析。  结果  随访4~114个月,全组患者1、3、5年生存率分别为77%、64%、52%。单因素分析显示T分期、淋巴结及肾积水对预后的影响有统计学意义（P < 0.05）。Cox多因素分析显示影响局部肌层浸润性膀胱癌患者预后的因素分别为:T分期（RR=2.001,P=0.001）、淋巴结（RR=2.250,P=0.045）、肾积水（RR=1.954,P=0.047）。  结论  肿瘤T分期、淋巴结转移及肾积水是局部肌层浸润性膀胱癌患者的预后影响因素。      

肌层浸润性膀胱癌根治术患者的预后影响因素分析

目的 分析肌层浸润性膀胱癌根治术患者的预后影响因素.方法 选取肌层浸润性膀胱癌患者71例,统计1年生存率,收集患者年龄、性别、肿瘤直径等信息,分析预后影响因素.结果 本组71例患者,1年生存率为88.73％(63/71).肿瘤直径、肿瘤数量、有无淋巴结转移、有无术前新辅助化疗、有无术后辅助放化疗是肌层浸润性膀胱癌患者术...     

年龄对膀胱癌根治术的影响及预后分析

背景与目的：影响膀胱癌根治术预后的因素有许多,其中年龄是否是一项重要的预后指标,高龄患者是否应选择膀胱癌根治术,目前国内外尚存在争论。本文旨在研究年龄因素对于这行膀胱癌根治术患者的影响,进而探讨对高龄患者行根治术的意义。方法：回顾性分析行膀胱癌根治术后获得完整随访的121例患者的资料,对年龄与患者临床病理相关预后因素进行统计学分析。结果：行膀胱癌根治术高龄组患者（≥70岁）围手术期死亡的风险较其他年龄组（≤50岁或50～69岁）高,但术后早期并发症无明显差异。肌层浸润性尿路上皮癌患者随着年龄的升高,肿瘤特异性生存率（cancer specific survival,CSS）降低;非肌层浸润性尿路上皮癌患者,高龄组和其他年龄组的CSS无明显差异。多因素分析和相关性分析显示,年龄与肿瘤分期、病理分级、肿瘤大小、淋巴结转移和是否伴有淋巴血管侵犯均相关（P〈0.05）。结论：高龄患者行膀胱癌根治术是安全的,在提高生存率的同时,并没有增加术后早期并发症。年龄是膀胱癌根治术患者重要的预后因素,但并不对患者预后起决定作用。起决定作用的是与年龄相关的肿瘤病理分期、分级及其它预后不良因素。     

102例肌层浸润性膀胱移行细胞癌预后影响因素分析

目的 研究影响肌层浸润性膀胱移行细胞癌患者预后相关因素.方法 回顾性分析102例肌层浸润性膀胱移行细胞癌患者的临床病理以及完整随访资料,分析因素包括患者性别、年龄、合并慢性病、肾积水、肿瘤多灶性、瘤体大小、T分期、淋巴结是否转移、肿瘤组织分化程度和治疗方法 ,采用Kaplan-Meier法计算总生存率,采用Log-rank检验进行单因素分析,用Cox模型进行多因素分析.结果 随访期为4~119个月,全部患者1、3、5年总生存率分别为78.3%、65.2%、52.9%,中位生存期为62个月.单因素分析显示不同T分期、淋巴结是否转移、不同肿瘤组织分化程度及有无肾积水患者预后差异有统计学意义(P﹤0.05).Cox多因素分析显示,合并慢性病(RR=2.068,P=0.026)和肾积水(RR=3.218,P=0.002)是影响局部肌层浸润性移行细胞膀胱癌患者预后的独立因素.结论 T分期、淋巴结转移情况、肿瘤组织分化程度及肾积水是局部肌层浸润性膀胱移行细胞癌患者预后相关因素,而合并症及肾积水是预后的独立影响因素.     

肌层浸润性膀胱癌分子预后标记物研究进展

膀胱癌是泌尿系统常见肿瘤, 可分为非肌层浸润性膀胱癌、肌层浸润性膀胱癌和转移性膀胱癌。临床上患者多为非肌层浸润性膀胱癌, 易于复发, 复发后大多数细胞分化良好, 预后佳。但10%~30%患者肿瘤复发时转变为具有侵袭性的浸润性膀胱癌, 预后不良。目前临床上采用的分级分期方法很难准确预测具有复杂生物学行为的浸润性膀胱癌的预后。近年许多肿瘤标记物相继被发现并用于浸润性膀胱癌的诊断和预后判断。这些分子标记物不仅对浸润性膀胱癌患者预后的判断有提示作用, 同时决定着患者是否适合行保留膀胱的放化疗、新辅助化疗和以铂类为基础的辅助化疗等治疗方式。本文对影响浸润性膀胱癌预后的分子标记物进行综述。      

349例新辅助化疗后乳腺浸润性导管癌嗜神经侵袭与临床病理特征间的关系

摘 要：［目的］ 探讨新辅助化疗后乳腺浸润性导管癌嗜神经侵袭（perineural invasion,PNI）与患者临床病理特征之间的关系。［方法］ 收集甘肃省肿瘤医院349例乳腺浸润性导管癌患者的临床和病理资料,所有患者均接受术前新辅助化疗,分析PNI发生与临床病理特征之间的关系。［结果］ 新辅助化疗后349例患者中PNI阳性91例（35%）,PNI阴性258例（65%）。单因素结果显示,乳腺浸润性导管癌神经侵犯与腋下淋巴结转移、淋巴结转移数目、TNM分期、脉管侵犯、分子分型和组织学分级有关（均P<0.05）,而与年龄、肿瘤直径、Ki-67增殖指数、化疗后反应、ER、 PR及Her-2表达无关（均P>0.05）。多因素Logistic 回归分析显示,分子分型和组织学分级是PNI阳性的危险因素（P<0.05）。［结论］ 新辅助化疗后乳腺浸润性导管癌神经侵犯与腋下淋巴结转移、淋巴结转移数目、TNM分期、脉管侵犯、分子分型和组织学分级有关。     

胃癌根治术后早期复发的临床病理特点及预后分析

目的:探讨胃癌根治术后早期复发的相关因素及预后分析。方法:回顾性分析235例胃癌根治术后复发患者的临床病理资料,对相关参数进行单因素和多因素分析。Kaplan-Meier法进行预后的生存分析。结果:235例患者平均复发时间为术后24.3个月,其中早期复发145例（≤2年）,晚期复发90例（＞2年）。单因素分析显示手术方式、肿瘤大小、脉管侵犯、浸润深度、淋巴结转移、TNM分期、术后化疗与早期复发相关（P<0.05）。多因素分析显示肿瘤大小（P=0.001）、淋巴结转移（P=0.007）、术后化疗（P=0.011）是早期复发的独立影响因素。生存分析显示肿瘤大小（P=0.013）、TNM分期（P<0.01）是预后的独立影响因素。结论:肿瘤大小、淋巴结转移、术后化疗是胃癌早期复发的独立影响因素,且预后与肿瘤大小、TNM分期密切相关。     

81例男性乳腺癌临床特征及生存分析

目的探讨男性乳腺癌的临床特点、治疗和预后。方法回顾性分析81例男性乳腺癌患者的临床及病理特征、复发转移及生存情况。结果本组5年无病生存率和5年总生存率分别为63.6%和77.7%。单因素分析结果显示,影响患者无病生存时间的因素有肿物大小（P=0.002）、淋巴结状况（P=0.041）、临床分期（P=0.000）和辅助化疗（P=0.033）。影响本组患者总生存时间的因素有肿瘤大小（P=0.002）、淋巴结状况（P=0.012）、临床分期（P=0.000）和辅助化疗（P=0.040）。COX多因素分析示临床分期（P=0.000）和辅助化疗（P=0.018）为影响患者无病生存时间的独立因素;同时,临床分期（P=0.000）和辅助化疗（P=0.012）也是影响患者总生存时间的独立因素。结论男性乳腺癌发病率低,预后较差,病理类型以浸润性导管癌为主。以手术为主的综合治疗为其公认的治疗模式,其预后与临床分期和辅助化疗有关。应注意早期诊断和治疗,并重视术后辅助化疗等综合治疗。     

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。     

直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素分析

摘 要：［目的］ 探讨直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素。［方法］ 60例直肠NET患者进行手术治疗,其中行肠镜下电灼术3例,行经肛根治术15例,行经肛局部切除术41例,另1例肝转移患者行姑息性直肠病灶切除术。分析患者淋巴结转移情况及其预后的影响因素。［结果］ 直肠NET的淋巴结转移受肿瘤G分级、T分期以及肿瘤大小影响（P＜0.01）。多因素分析显示T分期为影响淋巴结转移的独立因素（OR=45.997,95%CI：4.032~526.128,P=0.001）。肿瘤G分级、T分期、N分期、M分期以及肿瘤大小均与直肠NET患者的预后相关（P＜0.05）,M分期是直肠NET患者预后的独立影响因素（OR=2.895,95%CI：1.482~3.528,P＜0.001）。［结论］ NET的淋巴结转移情况与T分期密切相关,预后受肿瘤的M分期影响。     

Neoadjuvant versus Adjuvant Chemotherapy in Patients with Resectable Muscle-Invasive Bladder Cancer

Introduction: In regards to resectable muscle-invasive bladder cancer (MIBC) patients, contemporary guidelines recommend treatment with radical cystectomy and perioperative chemotherapy (neoadjuvant or adjuvant). In addition, the 5-year survival rate ranges from 36% to 48% in connection to T3 or T4 staged tumors or lymph node metastatic tumors. Perioperative treatment can improve overall survival, and the most robust evidence are in favor of neoadjuvant chemotherapy. The purpose of this study was to assess the impact of perioperative chemotherapy on the survival of patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC). Methods: The medical records of ninety-four patients with muscle-invasive bladder cancer (MIBC) that were treated with radical cystectomy and perioperative chemotherapy from 2008 to 2018 were retrospectively analyzed at Songklanagarind hospital. Neoadjuvant and adjuvant chemotherapy groups were classified. Univariable and multivariable regression analyses were used to predict overall survival (OS) after treatment. The survival rates for each group were estimated and compared using long-rank testing. Results: Overall, we identified 94 eligible patients of whom 20 patients (21.2%) received neoadjuvant and 74 patients (78.8%) received adjuvant chemotherapy. The 5-year survival rate of the neoadjuvant group was 55.7%, and in regards to the adjuvant group it was 30.4%. A multivariable analysis yielded that, patients treated with neoadjuvant chemotherapy had longer survival than those treated with adjuvant chemotherapy (p =0.039).  The median survival here as log rank compares median survival. Conclusion: The overall survival of neoadjuvant chemotherapy (NAC) was better than adjuvant chemotherapy (AC) in regards to muscle-invasive bladder cancer. These data could support the use of neoadjuvant chemotherapy in MIBC prior to radical cystectomy.     

Radical cystectomy for invasive bladder cancer: results of multi-institutional pooled analysis

BACKGROUND: We report the outcome of radical cystectomy for patients with invasive bladder cancer, who did not have regional lymph node or distant metastases, at 21 hospitals. METHODS: Retrospective, non-randomized, multi-institutional pooled data were analyzed to evaluate outcomes of patients who received radical cystectomy. Between 1991 and 1995, 518 patients with invasive bladder cancer were treated with radical cystectomy at 21 hospitals. Of these, 250 patients (48.3%) received some type of neoadjuvant and/or adjuvant therapy depending on the treatment policy of each hospital. RESULTS: The median follow-up period was 4.4 years, ranging from 0.1 to 11.4 years. The 5-year overall survival rate was 58% for all 518 patients. The 5-year overall survival rates for patients with clinical T2N0M0, T3N0M0 and T4N0M0 were 67%, 52% and 38%, respectively. The patients with pT1 or lower stage, pT2, pT3 and pT4 disease without lymph node metastasis had 5-year overall survivals of 81%, 74%, 47% and 38%, respectively. The patients who were node positive had the worst prognosis, with a 30% overall survival rate at 5 years. Neoadjuvant or adjuvant chemotherapy did not provide a significant survival advantage, although adjuvant chemotherapy improved the 5-year overall survival in patients with pathologically proven lymph node metastasis. CONCLUSIONS: The current retrospective study showed that radical cystectomy provided an overall survival equivalent to studies reported previously, but surgery alone had no more potential to prolong survival of patients with invasive cancer. Therefore, a large-scale randomized study on adjuvant treatment as well as development of new strategies will be needed to improve the outcome for patients with invasive bladder cancer.     

Radical cystectomy for bladder cancer:oncologic outcome in 271 Chinese patients

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.     

术前脂蛋白水平与胃癌淋巴结转移的相关性及其对胃癌预后的预测价值

目的:探讨胃癌患者术前脂蛋白水平与淋巴结转移的相关性及其对胃癌预后的预测价值。方法:收集徐州医科大学附属医院于2015年8月至2018年8月期间收治的220例经病理学确诊的胃癌患者为胃癌组,另选取同期健康体检者或胃息肉患者100例作为对照组,对比两组血清脂蛋白（HDL-C、LDL-C、ApoA1等）水平差异,分析胃癌患者术前脂蛋白水平与胃癌淋巴结转移及临床病理参数的相关性,采用Kaplan-Meier法分析术前脂蛋白水平与生存的关系,利用Cox比例风险回归模型探讨其在胃癌预后中的预测价值。结果:与对照组相比,胃癌组LP(a)明显较高,HDL-C明显较低（P<0.05）;胃癌患者的血清HDL-C水平与肿瘤长径、淋巴结转移和肿瘤浸润深度显著相关（P<0.05）,而LDL-C则与性别和肿瘤分化程度显著相关（P<0.05）,ApoB与淋巴结转移有关（P<0.05）。生存分析结果显示,术前HDL-C水平≥1.40 mmol/L,ApoB水平≥0.90 g/L时,患者的生存期显著较长（P<0.05）。Cox比例风险回归模型结果显示,术前HDL-C和ApoB水平为胃癌患者预后不良的独立危险因素（P<0.05）。结论:胃癌患者血清ApoB和HDL-C水平异常,且与淋巴结转移有关。检测胃癌患者术前HDL-C和ApoB等指标有助于预测患者预后。     

Lymphatic invasion is a prognostic factor for bladder cancer treated with radical cystectomy

Background We aimed to elucidate the significance of pathological prognostic factors in patients with bladder cancer treated with radical cystectomy and pelvic lymphadenectomy focusing on the association between lymphatic invasion and disease recurrence. Methods Ninety-one patients with ladder cancer who had undergone radical cystectomy were examined retrospectively. Clinicopathological findings and clinical outcomes were analyzed. Patients who received palliative cystectomy or neoadjuvant chemotherapy and patients who did not receive lymphadenectomy owing to a poor general condition or far advanced local disease status were excluded. Results Lymphatic invasion and lymph node involvement were present in 45.1% and 23.1% of patients, respectively. Multivariate analyses, using the Cox proportional hazards model, indicated that lymphatic invasion (hazard ratio [HR], 5.30; P = 0.007) and lymph node involvement (HR = 3.05; P = 0.016) were independent prognostic factors for disease-specific survival. Of the 91 patients, 29 (31.9%) had recurrent disease during the follow-up period. The rate of recurrence in patients with lymphatic invasion and without lymph node involvement was 50% (11/22), which was not significantly different from that in patients with both lymphatic invasion and lymph node involvement (73.7%; 14/19; P = 0.121), indicating a high risk of disease recurrence in patients with bladder cancer with lymphatic invasion even in the absence of the lymph node involvement. Conclusion In patients with bladder cancer treated with radical cystectomy, lymphatic invasion is an independent prognostic factor for disease-specific and disease-free survival. Patients with lymphatic invasion have a high risk of disease recurrence after radical cystectomy even in the absence of lymph node involvement.     

动脉灌注新辅助化疗治疗膀胱尿路上皮癌的初步研究

背景与目的:根治性膀胱切除加盆腔区域淋巴结清扫是治疗浸润性膀胱癌的标准术式,但对于非器官局限性膀胱癌,局部复发与远处转移的风险较高。对这部分患者进行以顺铂为基础的新辅助化疗,可以降低复发率,改善手术疗效,提高生存率。本文旨在研究术前动脉灌注化疗对根治术的影响及其对肿瘤的治疗作用。方法:收集2004年至2005年间13例局部浸润性尿路上皮癌患者(T2～T4a),采用吉西他滨与顺铂(gemcitabine andcisplatin,GC)方案给予髂内动脉灌注化疗1～3次,随后8例行膀胱根治性切除术,2例由于肿瘤明显缩小放弃手术治疗,3例行经尿道膀胱肿瘤电切术。评价化疗前后白细胞、红细胞及血小板水平的变化,化疗前后肿瘤大小的变化,以及临床分期与病理分期的的比较。结果:化疗前后白细胞计数之间的差异无显著性(t=0.94,P=0.37),但红细胞及血小板计数之间的差异有显著性(t=3.41,2.38;P=0.00,0.04),但三项绝对计数值均在正常范围之内;化疗前后肿瘤大小的差异有显著性(t=2.52,P=0.04);8例根治性切除术患者中除两例临床分期与病理分期符合外,其余5例均有降期。结论:GC方案新辅助髂内动脉灌注化疗可以缩小肿瘤体积,导致肿瘤降期;化疗前后白细胞无显著降低,化疗导致红细胞及血小板降低,但未对手术造成不良影响。     

胸段食管鳞状细胞癌术后淋巴结转移患者预后影响因素及治疗策略分析

目的:探讨胸段食管鳞状细胞癌术后淋巴结（lymph node,LN)转移患者预后影响因素及治疗策略。方法:回顾性分析我院2008年1月-2014年3月收治的胸段食管鳞状细胞癌根治术后LN转移患者共411例临床资料,对预后影响因素进行单因素和多因素分析,进一步采用倾向性得分匹配法配对后确定最佳治疗策略。结果:入选患者随访1、3及5年累积总生存率分别为81.09%、40.66%、28.14%;随访1、3及5年累积无进展生存率分别为70.54%、41.20%、33.27%;中位总生存时间和无进展生存时间分别为27.0个月［（24.5~31.0）个月］、23.0个月［（21.0~27.0）个月］。单因素分析结果显示,性别、年龄、肿瘤长度、T分期、N分期及治疗策略与术后LN转移患者总生存时间有关（P<0.05）;性别、T分期、N分期及治疗策略与术后LN转移患者无进展生存时间有关（P<0.05）。多因素分析结果显示,性别、年龄、肿瘤位置、T分期、N分期及治疗策略均是术后LN转移患者总生存时间独立影响因素（P<0.05）;性别、肿瘤位置、T分期及N分期均是术后LN转移患者无进展生存时间独立影响因素（P<0.05）。将上述总生存和无进展生存可能影响因素纳入倾向性得分匹配法配对分析结果显示N分期和治疗策略是术后LN转移患者总生存时间和无进展生存时间独立影响因素（P＜0.05）。倾向性得分匹配法配对分析显示,术后辅助放疗和术后辅助化疗患者总生存率均显著高于单纯手术者（P＜0.05）;术后辅助放化疗患者总生存率和无进展生存率均显著高于单纯手术、术后辅助放疗及术后辅助化疗者（P＜0.05）;同时N1期患者总生存率和无进展生存率均显著高于N2、N3期（P＜0.05）。结论:淋巴结转移个数和治疗策略与胸段食管鳞状细胞癌根治术后LN转移患者远期预后密切相关;术后放化疗应作为首选辅助方案以期进一步改善患者生存获益。