Gigantic liposarcoma of the retroperitoneum

A case of giant liposarcoma of the retroperitoneum (7.5 kg, diam. 39 x 30 x 18 cm) is reported. The most frequent sites of onset are discussed and stress is laid on the most useful diagnostic investigations. Surgical treatment, the only possibility of treatment for such large tumors, is often not radical and the recurrence rate is high.     

The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma

OBJECTIVE: To determine if chemotherapy offers a survival benefit to patients with large, high-grade, primary extremity liposarcoma. SUMMARY BACKGROUND DATA: The impact of chemotherapy on the survival of patients with primary extremity soft tissue sarcoma is controversial and its effect on individual histologic subtypes is not defined. PATIENT AND METHODS: Two prospectively collected sarcoma databases were used to identify all patients with >5 cm, high-grade, primary extremity liposarcoma that underwent surgical treatment of cure from 1975 to 2003 (n = 245). Clinical, pathologic and treatment variables were analyzed for disease-specific survival (DSS), distant recurrence-free survival (DRFS) and local recurrence-free survival (LRFS). RESULTS: Sixty-three (26%) patients were treated with ifosfamide based chemotherapy (IF), 83 (34%) with doxorubicin based chemotherapy (DOX) and 99 (40%) received no chemotherapy (NoC). To assess the impact of DOX, a contemporary cohort analysis of patients treated from 1975 to 1990 was performed. The 5 year DSS of the DOX treated patients was 64% (53%-74%) compared with 56% (51%-79%) for the NoC patients (log-rank P value = 0.28). To assess the impact of IF, a contemporary cohort analysis of patients treated from 1990 to 2003 was performed. The 5 year DSS of the IF treated patients was 92% (84%-100%) compared with 65% (51%-79%) for the NoC patients (log-rank P value = 0.0003). Independent prognostic factors for improved DSS were smaller size (HR = 0.7, P = 0.01), myxoid/round cell histologic subtype (HR = 0.3, P = 0.03) and treatment with IF (HR = 0.3, P = 0.01). The five-year DRFS of the IF treated patients was 81% (70%-92%) compared with 63% (50%-76%) for the NoC patients (log-rank P value = 0.02). The 5 year LRFS of the IF treated patients was 86% (76%-96%) compared with 87% (77%-97%) for the NoC patients (log-rank P value = 0.99). CONCLUSIONS: In patients with large, high-grade, primary extremity liposarcoma; DOX is not associated with improved DSS and IF is associated with an improved DSS. Treatment with IF should be considered in patients with high-risk primary extremity liposarcoma.     

Huge liposarcoma of the left retroperitoneum

Liposarcoma is one of the most common soft-tissue sarcomas. Unless it grows to massive proportions, it rarely causes symptoms. A 64-year-old man presented with weight loss, asthenia, and increasing abdominal girth caused by a large liposarcoma in the left retroperitoneum. Despite resection with sarcoma-free margins and intensive follow-up evaluation, he died of a tumor recurrence 2 years later. Complete surgical resection of the liposarcoma is the only curative option, but establishing a prognosis remains a challenge.     

Multifactorial analysis of survival in primary extremity liposarcoma

The treatment of extremity soft tissue sarcoma is now directed at limb preservation with the addition of various adjuvant therapies to improve treatment results. To achieve this goal, a knowledge of prognostic factors for extremity soft tissue sarcoma becomes increasingly critical. The object of this study was to analyze prognostic factors for survival in patients with extremity liposarcoma.Eighty-three patients with primary localized extremity liposarcoma, admitted from 1968 to 1978, were retrospectively reviewed. Surgical resection was the primary mode of treatment. Eleven prognostic factors were analyzed. Tumor factors included: histologic subtype, tumor grade, size, depth, invasion of vital structures, and site; operative factors included: type of operation, and surgical margins; and patient factors included: symptoms, age at diagnosis, and sex. Kaplan-Meier survival curves, and univariate and stratified log-rank tests of association were performed. Independent factors for predicting survival were identified using the Cox model stepwise regression technique.In univariate analysis of the entire group of patients, 5 factors were significant for tumor mortality: tumor grade (p=0.00005), histologie subtype (p=0.00025), tumor size s5 cm (p=0.005), type of surgery/ margin (p=0.0001), and invasion of vital structures (p=0.008). When associations among all factors were analyzed, it was found that many factors were interdependent. The independent prognosticators were, therefore, determined according to the Cox model technique. For the multivariate analysis, well-differentiated and lipoblastic liposarcomas were excluded because of lack of survival variation within each group. The former group had no tumor-related deaths and the latter group showed 80% tumor mortality. The remaining patients with myxoid, high-grade fibroblastic and pleomorphic liposarcoma were subjected to multivariate analysis. Three factors emerged as independent prognostic predictors: high-grade tumor (p=0.013), inadequate resection/amputation (p=0.003), and tumorcm (p=0.04).

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Resumen El tratamiento del sarcoma de tejidos blandos de las extremidades actualmente está orientado hacía la preservación del miembro con la adición de diversas modalidades terapéuticas adyuvantes para mejorar los resultados. Para lograr este propósito, se hace recientemente importante disponer de conocimientos relativos a los factores de pronóstico en los sarcomas de tejidos blandos. El propósito del presente estudio fue analizar factores de pronóstico de supervivencia en pacientes con liposarcoma de las extremidades.Ochenta y tres pacientes con liposarcoma de localización primaria en la extremidad, hospitalizados entre 1968 y 1978, fueron revisados en forma retrospectiva. La resección quirúrgica fue la modalidad primaria de tratamiento. Once factores de pronóstico fueron analizados. Los factores tumorales incluyeron: subtipo histológico, grado tumoral, tamaño, profundidad, invasión de estructuras vitales, y ubicación; los factores operatorios fueron: tipo de operación, y márgenes quirúrgicos; y los factores relativos al paciente fueron: síntomas, edad en el momento del diagnóstico, y sexo. Se realizaron curvas de sobrevida de Kaplan-Meier, y pruebas univariables y de asociación estratificada. Los factores independientes para predecir sobrevida fueron identificados mediante la técnica regresiva del modelo de Cox.En el análisis univariable del grupo total de pacientes, 5 factores aparecieron de significación en cuanto a mortalidad tumoral: grado tumoral (p=0.00005), subtipo histológico (p= 0.00025), tamaño tumoral5 cm (p=0.005), tipo de cirugía/ márgen (p=0.0001), invasion de estructuras vitales (p= 0.008). Al analizar las asociaciones entre todos los factores se encontró que muchos factores son interdependientes. Los pronosticadores independientes fueron determinados entonces de acuerdo a la técnica del modelo de Cox. Para el análisis multivariable, bien diferenciado, y los liposarcomas lipoblásticos fueron excluídos debido a que no hubo variación en la sobrevida entre cada grupo. El primer grupo no exhibió muertes relacionadas con el tumor y el último mostró una mortalidad de causa tumoral de 80%. Los pacientes restantes con liposarcomas mixoides, y liposarcomas de alto grado fibroblásticos y pleomórficos fueron sometidos a análisis multivariable. Tres factores emergieron como predictores independientes de pronóstico: tumores de alto grado (p=0.013), resección/amputación inadecuada (p=0.003), y tumor5 cm (p=0.04).

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Résumé Grâce à l'apport des traitements adjuvants qui améliorent les résultats, l'attitude thérapeutique dans les sarcomes des parties molles s'oriente actuellement vers la conservation du membre. Il est donc indispensable de disposer de facteurs pronostiques des sarcomes des parties molles. Le but de cette étude était d'analyser les facteurs pronostiques de survie chez des patients ayant un liposarcome des extrémités.Les dossiers de 83 patients ayant un liposarcome primitif des extrémités et admis dans notre service entre 1968 et 1978, ont été revus rétrospectivement. La résection chirurgicale a été pratiquée en premier. Onze facteurs ont été pris en considération: facteurs tumoraux: type histologique, degré de malignité, taille de la tumeur, profondeur d'invasion, invasion des structures vitales, et site; facteurs opératoires: type d'opération, et largeur des marges de sécurité; facteurs propres au malade: symptômes, âge au moment du diagnostic, et sexe. Les méthodes statistiques employées comprenaient les courbes de Kaplan-Meier, le logrank et l'analyse monofactorielle. Les facteurs permettant de prévoir la survie ont été identifiés selon le modèle regressionnel pas-à-pas de Cox.De l'analyse monofactorielle de tous les patients, il ressort que 5 facteurs étaient significatifs: le degré de différenciation (p=0.00005), le type histologique (p=0.00025), la taille de la tumeur5 cm (p=0.005), le type de chirurgie et la marge de sécurité (p=0.0001), et l'invasion des structures vitales (p=0.008). Plusieurs facteurs d'entre eux étaient indépendants. Ils ont été analysés selon le modèle de Cox. A l'analyse multifactorielle, les liposarcomes bien différenciés et de type blastique ont été exclus en raison de l'absence de différence de survie entre les groupes. Dans le premier, il n'y avait pas de mort en rapport avec la tumeur et, dans le deuxième groupe, la mortalité était de 80%. Les autres patients avaient une tumeur myxoïde, fibroblastique de haut degré de malignité et pléomorphologique et ont eu une analyse multifactorielle. Les 3 facteurs pronostiques indépendants étaient: le degré de malignité (p=0.013), l'insuffisance de la résection (p=0.003), et la taille de la tumeur 5 cm (p=0.04).

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Presented at the Société Internationale de Chirurgie in Toronto, Ontario, Canada, September, 1989.     

Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: Importance of histological subtype with treatment recommendations

Background This study defines the behavior and classification of atypical lipomatous tumors (ALT) and well-differentiated liposarcomas (WDLS) of the extremity and trunk. Methods A total of 91 well-differentiated lipomatous tumors of the extremity and trunk were identified from a soft tissue tumor database between July 1982 and June 2001. A soft tissue pathologist, blinded to prior diagnosis and clinical outcome, reviewed histology. Those composed predominantly of mature adipose tissue with scattered atypical stromal cells and scant lipoblasts or fibrosis were ALTs. Tumors with lipoblast but <25% fibrosis were termed lipoma-like WDLS, and those with >-25% fibrosis were identified as sclerosing WDLS. Clinical factors were analyzed to assess effects on local recurrence-free survival (LRFS). Results Histological review identified 34 ALTs and 57 WDLSs. Of the WDLSs, 29 were lipoma-like and 28 were sclerosing. Five-year and 10-year LRFS were 100%±0% and 78%±9%, respectively. Factors evaluated were age, sex, tumor site, tumor size, histology, presentation status, margin status, and adjuvant radiotherapy. Positive resection margins and sclerosing histology were associated with reduced LRFS. Dedifferentiation was observed in three tumors (3%) Conclusions Lipoma-like WDLSs and ALTs share similar histological features and favorable behavior. Margin-positive sclerosing WDLSs have a 10-year LRFS of only 17% and should undergo function-preserving re-excision when possible, or adjuvant radiotherapy.     

Posttreatment prognostic nomogram for patients with metastatic urothelial cancer completing first-line cisplatin-based chemotherapy

BackgroundModels to predict the outcome of patients with metastatic urothelial cancer (UC), based on pretreatment variables, have previously been developed. However, patients often request “updated” prognostic estimates based upon their response to treatment.Patients and MethodsData were pooled from 317 patients enrolled in 8 trials evaluating first-line cisplatin-based chemotherapy in metastatic UC. Variables were combined in the Cox proportional hazards model to produce a nomogram to predict survival from the end of treatment. The nomogram was validated externally using data from a phase III trial.ResultsThe median survival from end of treatment was 10.65 months (95% confidence interval; 9.20–13.24); 69% of patients had died. Baseline and posttreatment variables were evaluated. Baseline performance status, baseline number of visceral metastatic sites, baseline white blood counts, and response to treatment were included in the final model. The nomogram achieved a bootstrap-corrected concordance index of 0.68. Upon external validation, the nomogram achieved a concordance index of 0.67.ConclusionsA model derived from pretreatment and posttreatment variables was constructed to predict survival from the completion of first-line chemotherapy in patients with metastatic UC. This model may be useful for patient counseling and for stratification of trials exploring “maintenance” therapy.     

Myxoid liposarcoma of the retroperitoneum. Presentation of a clinical case

Of all the soft tissue sarcomas, those localised in the retroperitoneum represent a particular challenge to the surgeon. Diagnosis is often late, when the tumour has already reached considerable proportions, creating particular problems for its removal. Liposarcomas are the most common histological form of retroperitoneal tumour. The authors report the case of a patient with retroperitoneal myxoid liposarcoma and use their analysis as the starting point for a review of the literature focused on the diagnosis and treatment of retroperitoneal tumours. They underline that modern imaging techniques (Eco, CT, NMR) are essential during the preoperative stage for a complete and detailed study of the neoplasm, as well as during follow-up. With regard to treatment, surgery is still the most effective approach in cases where this is feasible. The current trend towards aggressive surgery is backed by the improved results in terms of survival. An improved prognosis for patients with retroperitoneal tumours is linked to an early diagnosis and the development of more efficacious complementary therapies.     

初诊乳腺癌肝转移患者列线图预后模型的构建

背景与目的 乳腺癌肝转移（BCLM）患者预后较差,其预后因不同因素而有较大差别。关于BCLM预后的研究很少,且目前缺乏准确预测BCLM的预后的手段。因此,本研究构建列线图来预测初诊BCLM患者的3、5年总生存率（OS）和特异性生存率（CSS）,以期为临床提供参考。方法 在SEER数据库中提取2010—2016年的初诊为BCLM患者资料,根据纳入和排除标准,严格筛选后纳入研究病例共1 994例,按7∶3比例随机分配为建模组（1 398例）和验证组（596例）,将单因素分析差异有统计学意义的变量纳入多因素Cox回归模型进行分析,得到影响BCLM患者生存情况的独立危险因素。基于影响BCLM患者预后的独立危险因素构建预测OS和CSS的列线图模型,通过一致性指数和校正曲线评估列线图的可靠性。结果 年龄、种族、婚姻、组织学分级、激素受体状态、手术、化疗、骨转移、脑转移、肺转移是BCLM患者预后的独立影响因素（均P<0.05）,这些因素均用于构建列线图预后模型,建模组和验证组OS的一致性指数为0.709、0.731,建模组和验证组CSS的一致性指数为0.709、0.732。模型的校正曲线显示该列线图的生存率预测值与实际观测值之间具有良好的一致性。结论 所构建的列线图预后模型能够准确预测初诊BCLM患者预后状态,为临床医生制定个体化的治疗方案提供参考。     

Extent of lymph node dissection in melanoma of the trunk or lower extremity

The extent of lymph node dissection necessary to optimize survival and minimize local recurrence in patients with melanoma of the trunk or lower extremity is not well defined. We reviewed the records of 420 patients undergoing superficial or combined superficial and deep groin dissection for melanoma. Prognosis depended on the extent of lymph node involvement rather than the extent of surgery performed. Node-positive patients undergoing elective lymph node dissection had an improved survival over those undergoing therapeutic lymph node dissection. In no subgroup of patients was more extensive lymphadenectomy associated with significant improvement in survival or alteration in pattern of recurrence. Dissection of the deep pelvic nodes in patients with melanoma appears to be of more prognostic than therapeutic value.     

A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma

PURPOSE: Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution. MATERIALS AND METHODS: From January 1989 to August 2002, 833 nephrectomies (partial and radical) for renal cell carcinoma of conventional clear cell histology performed at Memorial Sloan-Kettering Cancer Center were reviewed from the center's kidney database. Patients with von Hippel-Lindau disease or familial syndromes, as well as patients presenting with synchronous bilateral renal masses, or distant metastases or metastatic regional lymph nodes before or at surgery were excluded from study. We modeled clinicopathological data and disease followup for 701 patients with conventional clear cell renal cell carcinoma. Prognostic variables for the nomogram included pathological stage, Fuhrman grade, tumor size, necrosis, vascular invasion and clinical presentation (ie incidental asymptomatic, locally symptomatic or systemically symptomatic). RESULTS: Disease recurrence was noted in 72 of 701 patients. Those patients without evidence of disease had a median and maximum followup of 32 and 120 months, respectively. The 5-year probability of freedom from recurrence for the patient cohort was 80.9% (95% confidence interval 75.7% to 85.1%). A nomogram was designed based on a Cox proportional hazards regression model. Following external validation predictions by the nomogram appeared accurate and discriminating, and the concordance index was 0.82. CONCLUSIONS: A nomogram has been developed that can be used to predict the 5-year probability of freedom from recurrence for patients with conventional clear cell renal cell carcinoma. This nomogram may be useful for patient counseling, clinical trial design and effective patient followup strategies.     

Preoperative prognostic nomogram for prophylactic steroid treatment of patients with subclinical Cushing’s syndrome

BackgroundSubclinical Cushing’s syndrome (SCS) is incidentally detected in a growing number of patients by advanced imaging technology. However, there is no consensus on the clinical management of SCS, especially in terms of whether prophylactic steroid treatment is necessary following adrenalectomy. In this study we developed a model based on preoperative indices for predicting postoperative adrenal insufficiency (AI) that can guide therapeutic decision-making.MethodsA total of 27 patients with SCS who underwent adrenalectomy between August 2016 and August 2019 were enrolled and divided into AI and non-AI groups. Cox proportional hazards regression and least absolute shrinkage and selection operator analyses were performed to select relevant clinical parameters. The predictive performance of our model was evaluated by time-dependent receiver operating characteristic (ROC) curve and calibration curve analyses.ResultsFive clinical parameters (apolipoprotein A1, neutrophil–lymphocyte ratio, total cholesterol, platelet count, and homocysteine) were identified as the best predictors of replacement therapy (RT). The areas under the ROC curve for our prognostic model were 0.833, 0.945, and 0.967 for 3-, 4-, and 5-day non-(N)RT, respectively. The calibration curve of the 5 independent RT-related markers showed a good fit between nomogram-predicted probability of NRT and actual NRT, suggesting that our model has good predictive value.ConclusionsOur prognostic nomogram can help clinicians identify patients with AI who would benefit from RT so that timely treatment can be initiated.KeywordsSubclinical Cushing’s syndrome (SCS); Replacement therapy (RT); Adrenal insufficiency (AI); Nomogram; Receiver operating characteristic (ROC)     

Extravisceral primary hydatid cyst of the retroperitoneum

BACKGROUND: Hydatid cyst (HC) continues to be endemic in the Mediterranean countries, such as Turkey. Living in a rural area is an important risk factor for the disease. HC is most commonly seen in the liver and lungs, but retroperitoneal hydatid cyst is very rare. The objective of this study was to evaluate the clinical and radiographic findings and surgical treatment of this unusual lesion. METHODS: Between 1979 and 2004, 14 cases with primary retroperitoneal hydatid cyst were treated surgically at our clinic. RESULTS: Symptoms included flank pain in eight (57.1%) and palpable mass in six patients (42.8%). The cyst was located in the right retroperitoneum in seven patients (50%), left retroperitoneum in five patients (35.7%), retrovesical region in one patient (7.1%) and paravesical region in one patient (7.1%). Surgical approaches were right paramedian extraperitoneal approach in four patients, left paramedian extraperitoneal approach in two patients and midline transperitoneal approach in eight patients. Total pericystectomy was chosen as the surgical procedure in all patients except in five (35.7%), who had partial cystectomy for cysts located near the vital structures. There were no complications and mortality postoperatively. CONCLUSION: A primary HC of the retroperitoneum is a distinct clinical entity that must be considered when caring for a patient with a retroperitoneal mass in endemic regions. It should be treated after the diagnosis is confirmed without any delay because of secondary spillages due to perforations and other possible complications.     

肝内胆管细胞癌预后影响因素分析及生存列线图建立

目的探讨肝内胆管细胞癌(ICC)切除术后预后相关影响因素及建立有效的列线图生存预测模型。方法回顾性分析2010年1月—2018年12月在西安交通大学第一附属医院行手术切除的160例ICC患者的临床病理资料,其中男性89例,女性71例;年龄(57.41±10.35)岁,年龄范围29~81岁。观察指标:(1)患者随访的结果,术后生存情况;(2)影响患者术后预后的单因素及多因素分析;(3)列线图模型的建立及验证。采用门诊和电话方式进行常规随访,术后1年内每3个月复查肝功能、CA19-9、上腹部B超、CT或MRI检查。随后每3~6个月随访1次。观察终点为术后总体生存时间,即为手术日期到随访截止日期,或因肿瘤复发及转移致死亡的日期。随访截至2019年8月1日。将患者临床病理资料纳入预后影响因素分析,单因素分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox比例风险回归模型。基于Cox比例风险回归模型筛选的独立危险因素建立列线图生存预测模型。将160例患者按7∶3的比例分为模型组(n=112)及验证组(n=48),模型组用于生存列线图的建立,验证组用于其预测能力的评估,通过一致性指数(C-index)评估列线图模型对ICC患者术后生存预测的准确性。正态分布的计量资料以均数±标准差(Mean±SD)表示,偏态分布的计量资料以M(范围)表示。计数资料用例数和百分比(%)表示。结果160例ICC术后患者,随访期间死亡100例,死亡原因均为肿瘤复发转移致多器官功能衰竭,存活60例,生存时间20个月(2~111个月),1、3、5年总体生存率分别为63.3%、30.0%、19.6%。单因素分析结果显示,CA19-9、肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型、肿瘤直径、脉管侵犯、TNM分期、淋巴结转移、卫星灶及切缘状态是ICC患者的预后影响因素(HR=1.78,1.97,2.91,1.89,3.06,2.86,2.07,1.94,2.24,1.95,2.68,2.00,95%CI:1.12~2.85,1.22~3.16,1.85~4.56,1.26~2.85,1.38~6.82,1.31~6.25,1.37~3.14,1.07~3.51,1.24~4.06,1.26~3.01,1.28~5.60,1.11~3.59,P<0.05)。多因素分析结果显示,肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度(低分化)及肿瘤细胞类型是影响ICC患者预后的独立危险因素(HR=2.47,2.37,2.06,5.52,5.72,95%CI:1.39~4.38,1.44~3.91,1.25~3.40,1.24~24.49,2.31~14.17,P<0.05)。列线图的建立基于5个独立危险因素,模型组的列线图预测术后生存的C-index值为0.71(95%CI:0.64~0.79),验证组C-index值为0.71(95%CI:0.61~0.81)。结论基于肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度和肿瘤细胞类型等影响ICC患者术后生存的独立危险因素构建的列线图生存预测模型具有较好的准确度。     

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma

IntroductionThe present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma.MethodsThe study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019.ResultsThe study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86).ConclusionCompartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.     

Giant primary liposarcoma of the chest

Liposarcomas are the most common soft tissue sarcomas in adults, although liposarcomas of the chest are uncommon. We report two cases of giant liposarcoma in the mediastinum and chest wall, respectively. An 82-year-old man presented with a mass in the right upper mediastinum, as seen by computed tomography (CT). He had a past history of subcutaneous lipoma resection on his back (19 years previously). The patient underwent tumor resection with a right thoracotomy. A 58-year-old woman presented with an enlarging mass of the right lateral chest, involving the diaphragm and ribs, as seen by CT. She had a past history of subcutaneous lipoma resection of the right chest (18 years previously). The patient underwent an en bloc resection that included the tumor and a part of the right diaphragm and ribs. Histological examination of both patients’ tumors revealed a well-differentiated liposarcoma, with no pathological relation to the previous lipoma resected in either case.     

胃癌患者预后相关影响因素的列线图模型构建及验证

背景与目的 中国胃癌疾病负担较重且预后影响因素较多,有关量化和综合评估预后风险的研究较少。因此,本研究基于列线图探究炎症指标中性粒细胞/淋巴细胞比率（NLR）和血小板/淋巴细胞比率（PLR）对胃癌患者预后生存的意义,并将其纳入列线图与传统TNM分期进行预后评估效能比较。方法 回顾性纳入2013年6月—2018年6月在中国科学技术大学第一附属医院胃肠外科接受胃癌根治切除术的胃癌患者作为训练组（n=300）,同时从胃肠外科另一病区纳入接受相同手术处理的胃癌患者作为验证组（n=100）。通过医院电子病历系统采集患者的年龄、性别、肿瘤类型、肿瘤部位、侵袭深度和淋巴结转移（LNM）等信息;术前3 d收集外周静脉血数据,并计算NLR和PLR,通过ROC曲线确定NLR（1.98）和PLR（134.87）的最佳临界点。术后2年内每3个月随访1次,2年后每6个月随访1次。采用Cox比例风险模型计算暴露与结局指标的关联,根据多因素分析结果识别影响胃癌预后的独立风险因素,纳入列线图后通过C-指数在训练组和验证组评估列线图的稳定性。最后,基于ROC曲线下面积（AUC）比较列线图和传统TNM分期的预测效能。结果 训练组男性患者220例（73.3%）,验证组男性患者69例（69.0%）,训练组平均年龄（62.52±10.61）岁,验证组平均年龄（63.67±10.21）岁。两组除肿瘤类型、分化程度和侵袭深度外,其他基线特征差异无统计学意义;训练组中位生存时间（OS）为28个月,1、3、5年OS率分别为63.5%、43.0%和35.1%;验证组中位OS为32个月,1、3、5年OS率分别为58.9%、41.6%和31.7%。单因素Cox回归分析显示,年龄、病理分型、肿瘤分化程度、侵袭深度、存在LNM、NLR、PLR和CEA水平均与OS有关（均P<0.05）。经过多因素调整后,存在LNM、术前NLR>1.98、PLR>134.87和癌胚抗原（CEA）≥5 μg/L的患者OS显著缩短（均P<0.01）。校准曲线结果显示列线图模型在训练组（C-指数=0.81）和验证组（C-指数=0.75）的拟合度良好。此外,列线图模型预测训练组1、3、5年OS率的AUC值（0.865,0.855,0.827）高于TNM分期（0.677,0.690,0.683）;验证组1、3、5年OS率的AUC值（0.856,0.788,0.725）高于TNM分期（0.781,0.691,0.605）。结论 NLR和PLR是预测胃癌患者术后生存的独立风险因素,基于两者构建的列线图可以较为准确地预测行胃切除术胃癌患者的1、3、5年OS率,为临床医师提供更精确的治疗、护理决策证据。     

非转移性膀胱小细胞癌预后多因素分析及列线图的构建

目的探讨非转移性膀胱小细胞癌(BSCC)的独立预后因素,并建立可以个体化预测患者癌症特异性生存率(CSS)的列线图。方法回顾性分析SEER数据库中2004年至2016年确诊并登记的BSCC患者的临床病理资料,簇选后共纳入360例患者,应用Kaplan-Meier法计算患者的生存率并绘制生存曲线,Log-rank检验评价不同亚组生存差异的显著性,并根据Cox多因素分析结果,运用R软件绘制列线图。列线图的预测性能由校准图和ROC曲线下面积(AUC)进行内部验证。结果年龄>80岁、肿瘤最大径>5.0 cm及T4期是CSS的独立危险因素;术中盆腔淋巴结清扫、(术前或术后)辅助化疗或联合放化疗是独立保护因素。所建列线图预测确诊后1、3、5年CSS的预测精准度分别为0.79、0.72和0.71。结论基于SEER数据库,本研究确定了非转移性BSCC的独立预后因素,并建立了可以个体化预测非转移性BSCC患者预后的列线图,这将有助于设计临床试验和促进医患沟通。