A scoring system for prediction of early recurrence after liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

Background The management of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is controversial due to the early recurrence after curative hepatectomy, and many variables were related to the prognosis. The purpose of this study was to predict the tumor recurrence in early postoperative period of the patients with BCLC stage B HCC.

Methods From January 2004 to January 2012, 104 patients with BCLC stage B HCC underwent hepatectomy. Clinicopathological factors and follow-up data were statistically analyzed to establish a predicting scoring system.

Results The overall survival rates for one, three, and five years were 69.2%, 52.7%, and 42.3%, and the disease-free survival rates for one, three, and five years were 52.9%, 47.3%, and 37.5%, respectively. The multiple factors analysis showed that the micro-vessel invasion, lymph nodes metastasis, multiple lesions, and the high expression of HMGB1 were independent factors (P <0.05). A scoring system was established to predict the early recurrence within one year after the surgery for BCLC stage B HCC, according to the analysis results with a specificity of 85.1% and a sensitivity of 80.3%.

Conclusion Variant clinicopathological factors were associated with early postoperative recurrence for BCLC stage B HCC and recurrence early after hepatectomy was more likely in patients with a higher score of the scoring system.

     

A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy （LATG） with extended lymphadenectomy in patients with advanced gastric cancer （AGC）.This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy （OTG） for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion （pT2 and pT3） were matched by propensity scoring,and 116 patients （58 LATG and 58 OTG） were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups （30.8±10.2 vs.29.0±8.3）.Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group （P ＜0.05,respectively）.Rates of post-operative complications （12.1％ vs.15.5％） and postoperative mortality （0％ vs.1.7％）,as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population.     

小肝癌患者微血管侵犯与肝移植后肿瘤复发及预后相关性研究

目的：分析影像学上符合Milan标准的肝癌肝移植患者术后复发相关的危险因素,评估Milan标准和微血管侵犯对肝移植术后肿瘤复发的预测价值。方法：回顾性分析浙江大学医学院附属第一医院2007—2013年期间115例影像学符合Milan标准并行肝移植治疗的肝癌患者,通过单因素及多因素Cox回归分析和生存分析探究影响肝移植术后肿瘤复发的危险因素,并分析其预测价值。结果：入组的98（98/115）例患者中,术后1、3、5年总体生存率及无瘤生存率分别为91.8%、80.6%、79.6%和87.8%、74.5%、73.5%。微血管侵犯、大血管侵犯、超出Milan标准和移植前降期治疗与小肝癌肝移植术后复发显著相关（P<0.05）;多因素分析提示微血管侵犯和超出Milan标准是预测肝癌肝移植术后复发的独立危险因素。肝癌不伴和伴有微血管侵犯的术后1、3、5年无瘤生存率分别为 92.8%、85.5%、85.5% 和75.9%、55.2%、48.3% （P<0.01）;而术后病理检查证实符合及超出Milan标准肝癌患者术后1、3、5年无瘤生存率分别为 91.7%、83.3%、79.8% 和 64.3%、42.9%、42.9% （P<0.01）。结论：微血管侵犯多提示肝癌肝移植受者术后肿瘤的高复发转移倾向,对指导术后早期积极的辅助治疗、密切随访及补救性治疗等都具有一定的临床意义。     

Hyper-CVAD chemotherapy or autologous stem cell transplantation in patients with peripheral T cell lymphomas: a single centre report

Background  Peripheral T-cell lymphoma (PTCL) is generally characterized by poor prognosis after conventional chemotherapy. The place for high-dose chemotherapy and autologous stem cell transplantation (ASCT) in these patients is still not clear. In this study, we presented the outcomes of PTCL patients followed these treatments in our centre.

Methods  We retrospectively analyzed the outcomes of 39 patients with PTCL received the two treatments between 1999 and 2010.

Results  The 3-year overall survival (OS) of 61.9% and 3-year progression free survival (PFS) of 35.7% were observed in the 39 patient. Twenty-one patients received Hyper-CVAD chemotherapy with 3-year OS of 46.2% and 3-year PFS of 27.9%. Eighteen patients received ASCT with 3-year OS of 70.3% and 3-year PFS of 44.2%. Further analysis revealed that patients with elevated lactate dehydrogenase, at least 2 international prognostic index (IPI) points, and extranodal involvement had a poorer outcome compared with the control group.

Conclusion  These findings might suggest that Hyper-CVAD chemotherapy and ASCT could offer a durable survival benefit for patients with aggressive PTCL.

     

Evaluation of whether serum tumor markers in patients with epithelial ovarian carcinoma change following chemotherapy

Background  Phenotypic and genotypic heterogeneity is a known feature of many cancers. Whether serum tumor marker kinds vary and change following chemotherapy is still unclear. The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy, and the potential clinical significance in patients with epithelial ovarian carcinoma (EOC) or primary serous peritoneal carcinoma (PSPC).

Methods  Samples were collected before surgery, during chemotherapy and during follow-up for enzyme-linked immunosorbent assay (ELISA)-based evaluation of serum CA-125, CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy. In total, 72 patients were examined, including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.

Results  In 35 de novo patients, 20% (7/35) demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma (57.1%, 4/7) showed resistance to chemotherapy. In the 37 recurrent patients, 51.4% (19/37) had changed serum tumor markers, of whom 57.9% (11/19) presented with serous carcinoma. There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers. However, for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group. In the 17 patients with secondary recurrence, 37.5% (6/17) had changed tumor marker levels. The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.

Conclusions  Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence, indicating that in addition to the markers that are abnormal before surgery, those markers that are normal should also be monitored during chemotherapy and follow-up.

     

改良FOLFFOX7方案对进展期胃癌新辅助化疗的安全性和有效性

Background  Gastric cancer is one of the most common types of malignant tumors in China and East Asia and has the highest mortality rate of the malignant gastrointestinal tumors. Neoadjuvant chemotherapy is a systemic or local chemotherapy that is given prior to the local treatment of malignant tumors. Neoadjuvant therapy is currently showing some positive prospects; however, its clinical effects remain controversial. In this study, we used the modified FOLFOX7 (mFOLFOX7) regimen as a neoadjuvant chemotherapy regimen. Perioperative clinical and pathological efficacy, toxicity, effects of surgery, postoperative observation, and prognosis were studied to investigate its clinical efficacy and safety.

Methods  Eighty patients with advanced gastric cancer were treated in our surgery department from 2005 to 2009; 38 of these patients received mFOLFOX7 neoadjuvant chemotherapy, the other 42 patients assigned to the control group. The perioperative effects of mFOLFOX7 chemotherapy, including clinical effects and toxicity, were observed in each patient.

Results  After mFOLFOX7 chemotherapy, clinical and pathologic stages decreased in 21.1% and 36.8% of the patients, respectively, but the results were not statistically significant (P=0.129). The clinical response rate was 50% (19/38). Toxicity was mild; most adverse events were grade I or II and involved no severe infections or deaths. Compared with the control group, the radical resection rate increased (92.1% vs. 85.7%; P=0.437); surgical effects were completed without an increased incidence of perioperative complications. The 1-, 2-, and 3-year survival rates were 78.70%, 57.40%, and 51.66%, respectively, in the neoadjuvant chemotherapy group and 78.57%, 56.87%, and 43.16%, respectively, in the control group.

Conclusions  The mFOLFOX7 regimen was very effective and well-tolerated as a neoadjuvant chemotherapy for advanced gastric cancer. However, the 1-, 2-, and 3-year survival rates in the mFOLFOX7 group were not significantly different from the control group.     

Outcomes of peripheral blood stem cell transplantation in patients from human leukocyte antigen matched or mismatched unrelated donors

Background AIIogeneic peripheral blood stem cell transplantation from unrelated donors （UR-PBSCT） is an alternative treatment for many hematologic diseases due to lack of human leukocyte antigen （HLA）-identical sibling donors. This study aimed to evaluate the impact of the degree of the HLA match on the clinical efficacy of UR-PBSCT. Methods Patients who underwent UR-PBSCT from September 2003 to September 2012 were retrospectively investigated. They were divided into three groups according to high-resolution molecular typing. SPSS version 17.0 was used to analysis and compare the statistics of engraftment, incidence of GVHD, other complications and survival among the groups. Results One hundred and eleven patients received UR-PBSCT, 60 of them with an HLA matched donor （10/10）, 36 of them with a one locus mismatched donor （9/10）, and 15 of them with a two loci mismatched donor （8/10）. Similar basic characteristics were found in the three groups. No differences were found in engraftment of myeloid cells or platelets in the three groups （P〉0.05）. Two-year cumulative incidence of relapse, overall survival （OS） and disease-free survival （DFS） among those three groups were similar （P〉0.05）. The cumulative incidence of 100-day Ill-IV aGVHD in the HLA matched group and the one HLA locus mismatched group were significantly lower than that in the two HLA loci mismatched group （3.3%, 8.6%, and 26.7%, P=0.009）. The occurrence rate of new pulmonary infections in the HLA matched group was lower than in the two HLA mismatched groups （26.67%, 52.78%, and 41.18%, P=0.035）. The cumulative incidence of 100-day and 2-year transplantation related mortality （TRM） in two HLA loci mismatched group was higher than in the HLA matched group and in the one HLA locus mismatched group, （8.4%, 11.8% and 33.3%, P=0.016） and （12.3%, 18.7% and 47.5%, P=0.002）. Conclusions HLA mismatch will not significantly impact the engraftment or 2-year survival after UR-PBSCT, but two mismatched HLA     

An Asian population-based survival analysis of patients with distal esophageal and gastric cardia adenocarcinomas

Background  Gastroesophageal junction adenocarcinomas include adenocarcinomas of the distal esophagus (DE) and gastric cardia (GC). It is controversial whether these tumors are the same entity and whether they have the same survival rates. Patients with DE and GC adenocarcinomas have a similar survival rate in the US; however, data are lacking in Asian countries. Therefore, we conducted a retrospective study to understand the implications of the tumor location in the survival of Asian patients.

Methods  A total of 209 patients with pathologically confirmed DE and GC adenocarcinomas, from 2005 to 2007, were included in the study. We identified patients with adenocarcinomas of the DE (DE group, n=91) and GC (GC group) (n=118). We performed an unadjusted survival analysis using the Kaplan-Meier method, and used a Cox proportional hazards regression model to adjust for potential confounding covariates.

Results  We found no significant difference between the overall survival of the DE and GC groups. The 3-year survival rates were 44.8% and 53.0%, respectively, and the 5-year survival rates were 27.9% and 30.2%, respectively (P=0.162). We found no significant difference in early staging, advanced staging, different T staging, and different N staging, between the groups. Both advanced post-operative N staging and advanced AJCC staging had a significant adverse effect on survival.

Conclusions  Patients with DE and GC adenocarcinomas have similar survival rates in the Asian population. Both post-operative N staging and AJCC staging are prognostic factors.

     

Monitoring the source of mesenchymal stem cells in patients after transplantation of mismatched-sex hematopoietic stem cells plus third-party cells

Background In bone marrow transplant patients, the microenvironment in bone marrow is damaged after chemotherapy or radiotherapy. Subsequent to allogenic hematopoietic stem cell transplantation in patients with clinically successful engraftments, the source of mesenchymal stem cells （MSCs） remains controversial. To further verify the stimulatory effect of the simultaneous transplantation of cells from second donors on engraftment success for hematopoietic stem cell transplantation in support of donor MSCs engraftments, the aim of this study is to monitor the dynamics of the engraftment of bone marrow-derived MSCs in patients after transplantation with mismatched-sex hematopoietic stem and third-party cells. Methods In this study, the hematopoietic stem cells from 32 clinical donors of different sexes that resulted in successful engraftments were selected for transplantation and were classified into three groups for research purposes： group A consisted of 14 cases of transplantation with bone marrow and recruited peripheral hematopoietic stem cell transplantation, group B contained 8 cases of simultaneous re-transfusion of MSCs from the second donor, and group C contained 10 cases of simultaneous re-transfusion of umbilical blood from the second donor. The bone marrow from 32 patients with successful engraftments of hematopoietic transplantation were selected and sub-cultured with MSCs. Flow cytometry （FCM） was used to measure the expression of surface antigens on MSCs. Denaturing high-performance liquid chromatography （DHPLC） in combination with polymerase chain reaction amplification of short tandem repeats （STR- PCR） was used to measure the engraftment status of fifth-generation MSCs in patients. Fluorescence in situ hybridization （FISH） revealed the sex origin of the fifth-generation MSCs in 32 patients. Dynamic examinations were performed on patients receiving donor transplantations. Results The progenies of fifth-generation MSCs were successfully cultured in 32 cases. The results of FCM demonstrated that the expression levels of CD14＋ and CD45＋ cells were lower than 0.04% in the fifth-generation MSCs. The analysis using DHPLC and FISH showed similar results. One patient from group B also received a temporary transplantation of MSCs from the donor. The MSCs in the remaining 31 patients all originated from the patients themselves. Conclusions After transplantation, the MSCs present in patients originated from the host. In patients transplanted with MSCs from a second donor, the phenomenon of temporary chimerization of MSCs was observed.     

Retrospective study of mycophenolate mofetil treatment in IgA nephropathy with proliferative pathological phenotype

Background Mycophenolate mofetil （MMF） and cyclophosphamide （CTX） are widely used in treating various kidney diseases.However,whether they are effective and which one is better for treating IgA nephropathy patients with proliferative pathological phenotype in renal diseases,such as endocapillary proliferation,cellular crescents,and/or capillary loops fibrinoid necrosis is still unknown.We,therefore,initiated a study to compare the effects of MMF and CTX in treating IgA nephropathy with the above pathological lesions.Methods One hundred and nineteen patients with IgA nephropathy who had at least one of the three aforementioned lesions were enrolled.All patients were treated with prednisone; 48 patients received prednisone only （Pred group）,40 received MMF and prednisone （MMF ＋ Pred group）,and 31 were treated with CTX and prednisone （CTX ＋ Pred group）.The median time of follow-up was 30 months （maximum：96 months）.The primary endpoint was defined as renal survival.The incidence of remission of proteinuria was the secondary endpoint.Results Serum creatinine in all groups declined significantly at different follow-up times （P=0.002）,and the differences among the three groups were significant （P＜0.001）.At 24 months of follow-up,the decline rates were 12.35％,32.95％,and 24.14％ in the Pred,MMF ＋ Pred,and CTX ＋ Pred groups respectively.For urine protein excretion,the decline rates were 49.12％ （Pred）,73.67％ （MMF ＋ Pred）,and 63.53％ （CTX ＋ Pred） respectively at 24 months of follow-up.The differences among the three groups were not significant （P=0.714）.Renal survival （the primary endpoint） was significantly different （P=0.027）; however,the sencondary endpoint was similar for all the three groups （P=0.100）.Conclusions For IgA nephropathy patients with endocapillary proliferation,cellular crescents,and/or fibrinoid necrosis of capillary loops,prednisone combined with MMF was more effective in lowering the serum creatinine than with CTX.Combined MMF and orednisone treatment led to a better renal survival compared to that of prednisone with CTX.     

肝细胞肝癌肝移植的预后因素分析

目的评价肝细胞肝癌（ hepatocellular carcinoma, HCC）原位肝移植后的预后相关因素。方法回顾性分析1993年11月到2006年5月期间汉诺威医科大学对117例HCC进行肝移植的经验。结果经多因素分析,肿瘤大小和肿瘤数量（米兰标准或加州标准）、微血管侵犯、移植前治疗和肿瘤复发是影响患者生存预后的重要因素。结论原位肝移植是治疗HCC的理性术式;合适的选择标准,积极的移植前治疗,复发的有效控制,是患者获得良好预后的关键。     

Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach

Background As a common form of gastric cancer migration,lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer.Surgery is the fundamental curative option for gastric cancer that varies depending on different stages.The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.Methods In our retrospective study,the data of 328 patients of proximal gastric cancer with different T stages were analyzed.By comparing the differences of lymph node metastatic rate and ratio,we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes.Also,we were especially interested in the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage.Results The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4％ and 23.3％,respectively.The tumors of different T stages were statistically significant in size and differentiation degree （P ＜0.05）,multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer （RR,12.025; 95％ CI,2.326 to 62.157; P=0.003）.The overall survival rate of patients with No.5,6 group lymph node metastasis and those without was significantly different,but the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage were not statistically significant.Conclusions Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis.D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare.Therefore the range of the lymph node dissection in radical gastrectomy     

Routine use of a transanastomotic stent is unnecessary for hepatojejunostomy in liver transplantation

Background  The use of transanastomotic stents for Roux-en-Y hepatojejunostomy (RYHJ) in liver transplantation (LT) remains controversial. The aim of this retrospective study was to assess the role of transanastomotic stent for RYHJ in LT.

Methods  RYHJ for biliary reconstruction in LT was performed in 52 patients. Twenty-five patients had bile duct reconstruction by RYHJ with transanastomotic stents (S group), while 27 patients underwent the same procedure without transanastomotic stents (non-S group). The two groups were compared in terms of post-LT biliary complications and survival.

Results  The incidences of bile leakage, anastomotic stricture, non-anastomotic stricture, biliary sludge/lithiasis and biliary infection were 12% (3/25), 9.5% (2/21), 23.5% (4/17), 11.8% (2/17), and 24% (6/25), respectively in the S group, and 0, 0, 20.0% (5/25), 10.0% (2/20), and 16.7% (4/24), respectively in the non-S group. One and three year survival rates were 48.0% (12/25) and 34.0% (8/23), respectively, in the S group and 57.7% (15/26) and 38.9% (7/18), respectively, in the non-S group. There was no significant difference between the two groups in terms of the incidence of various biliary complications and survival (P >0.05).

Conclusion  The routine use of transanastomotic stents is not necessary for RYHJ for biliary reconstruction in LT

     

Prognostic significance of metastatic lymph nodes ratio in patients with gastric adenocarcinoma after curative gastrectomy

Background We evaluated the impact of the number of metastatic lymph nodes and the metastatic lymph nodes ratio （the ratio between metastatic lymph nodes and total dissected lymph nodes,MLNR） in patients with gastric adenocaminoma following curative gastrectomy and also analyzed the relationship between the number of removed lymph nodes and prognosis in node-negative gastric cancer.Methods From January 2005 to December 2010,1 390 patients who were diagnosed with gastric adenocarcinoma and underwent curative gastrectomy were included.In particular,lymph node metastasis was not present in 515 patients.The number of metastatic lymph nodes and the metastatic lymph nodes ratio were selected for univariate and multivariate analyses to evaluate their influences on the disease outcome.The survival curve was presented according to the number of removed lymph nodes in node-negative gastric cancer using Kaplan-Meier plots.Results The overall 5-year survival rate was 54％ in this group.Univariate analysis revealed that age category,macroscopic appearance,histological grade,tumor size,depth of primary tumor invasion,number of metastatic lymph nodes,metastatic lymph nodes ratio,tumor,nodes,metastasis-classification （TNM） stage and status of lymphovascular,and vessel invasion have significant impact on survival.The number of metastatic lymph nodes and the metastatic lymph nodes ratio both have significant impact on survival （P ＜0.001）.However,in multivariate analyses,only the metastatic lymph nodes ratio was identified to be an independent prognostic factor （P ＜0.001）.The number of removed lymph nodes in node-negative was a strong prognostic factor of survival,the more lymph nodes dissected,the better the survival.Conclusions The metastatic lymph nodes ratio has more significant prognostic value for survival in patients with gastric cancer following curative gastrectomy than the number of metastatic lymph nodes.The number of removed lymph nodes miaht be an important proanostic factor for gastric cancer without lymph node metastasis.     

Clinical features and outcomes of 210 patients with idiopathic pulmonary fibrosis

Background Idiopathic pulmonary fibrosis （IPF） is a lethal chronic interstitial lung disease （ILD） of unknown cause and having a variable and unpredictable course.This study aimed to summarize the clinical features and follow-up outcomes and to identify potential factors useful for the assessment of prognosis in IPF.Methods Two hundred and ten patients hospitalized and diagnosed as IPF in our unit from January 1999 to June 2007 were enrolled into this study.The baseline demographic,clinical,radiologic and physiologic characteristics were summarized.Clinical follow-up data until February 2010 were collected,and the median survival time and 1-,2-,and 5-year survival rates,as well as the influences of the summarized baseline variables on the prognosis were analyzed.Results The age at diagnosis as IPF was （64±10） years,the duration before diagnosis of 106 patients （50％） was shorter than 2 years,and 73％ were males.One hundred and forty-five patients （69％） had a history of smoking with a median pack-year of 18.Eighty-nine patients （42％） had emphysema and 62 patients （29％） pulmonary arterial hypertension （PAH）.One hundred and twenty-four patients were followed up,of which 99 patients died from various causes including respiratory failure related to IPF （93％）.The follow-up period was （21±23） months.The median survival time was 38months.The 1-,2-,and 5-year survival rates were 61％,52％,and 39％,respectively.Multivariate analysis showed clubbing,PAH,duration from initial onset to diagnosis,and forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） were independent prognostic indicators of IPF.Conclusion IPF patients who have clubbing,PAH,a higher FEVJFVC,and a short duration from initial onset to diagnosis have a poorer outcome.     

围手术期抑瘤治疗对于进展期肝癌肝移植的临床价值

目的 探讨围手术期抑瘤治疗对降低进展期肝癌(pTNM分期:Ⅲ、Ⅳa)肝移植术后肝癌复发率、提高患者生存率的临床价值.方法 回顾分析了2002年4月至2005年12月于我院接受肝移植的36例Ⅲ、Ⅳa期肝癌患者的临床资料.抑瘤组患者(20例)术前均接受经皮肝动脉栓塞化疗(TACE)、或TACE联合射频消融(RFA)、无水酒精瘤内注射(PEI),术中、术后均采用阿霉素 5-氟尿嘧啶 顺铂方案行全身静脉化疗;以未接受任何抑瘤治疗的16例患者为对照(非抑瘤组),比较两组的肿瘤复发率、累计生存率和无瘤生存率.结果 抑瘤组肿瘤复发率(12/20,60.0%)明显低于非抑瘤组(14/16,87.5%)(P＜0.05).抑瘤组和非抑瘤组1年、2年生存率比较差异有显著意义(P＜0.05);抑瘤组1年、2年无瘤生存率亦显著高于非抑瘤组(P＜0.05).术前接受TACE联合RFA/PEI治疗的患者肿瘤坏死范围明显优于单用TACE者.结论 对于进展期肝癌患者等待肝移植期间采取TACE RFA/PEI治疗以抑制肿瘤进展,术后配合全身辅助化疗可以显著提高患者生存率、降低肿瘤复发率.阿霉素 5-氟尿嘧啶 顺铂化疗方案安全可行,具有临床应用价值.     

微血管侵犯对肝细胞癌肝移植术后预后的影响

目的:探讨微血管侵犯（microvascular invasion,MVI）对肝细胞癌（HCC）肝移植术后预后的影响。方法:回顾性分析HCC行原位肝移植手术病人183例的临床和随访资料,其中符合米兰标准76例,USCF标准84例,上海标准102例,杭州标准126例。用Kaplan-Meier法计算4组1年、3年、5年累积生存率,并用Log-Rank检验比较各组生存曲线的差异。将每组分为MVI和无MVI亚组,比较肿瘤复发率、5年无瘤生存率及1年、3年、5年生存率。结果:4组病人的生存时间差异均无统计学意义（P>0.05）;随着HCC肝移植标准扩大,MVI率逐渐升高（P<0.05）,3年、5年生存率和5年无瘤生存率均逐渐降低（P<0.05）。符合上海标准病人中,无MVI亚组肿瘤复发率低于MVI亚组（P<0.05）,5年生存率和5年无瘤生存率均高于MVI亚组（P<0.05）;符合杭州标准病人中,无MVI亚组肿瘤复发率低于MVI亚组（P<0.05）,3年、5年生存率和5年无瘤生存率均高于MVI亚组（P<0.05~P<0.01）。结论:MVI可预测符合上海标准和杭州标准的HCC肝移植术后复发情况,对肝移植综合治疗具有指导意义。     

Effect of neoadjuvant chemotherapy on expressions of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 in breast cancer

Background This study was designed in an attempt to determine the influence of neoadjuvant chemotherapy on estrogen receptor （ER）, progesterone receptor （PR）, human epidermal growth factor receptor 2 （Her-2）, and Ki-67 expressions in patients with breast cancer. Methods Pre- and post-neoadjuvant chemotherapy, paired-tumor specimens from 103 patients with breast cancer administrated with anthracycline or anthracycline combined taxane regimen were collected. Immunohistochemical staining for ER, PR, Her-2, and Ki-67 was performed by the DAKO EnVision method. Results Among the 103 cases, five patients （4.9%） had a complete response （CR）, 82 （79.6%） partial response （PR）, 15 （14.6%） stable disease （SD）, and one （0.9%） progressive disease （PD）, yielding an overall response rate （CR ＋ PR） of 84.5%. Nine patients achieved pathological CR. There was a significant decrease in the average index of Ki-67 post- neoadjuvant chemotherapy, compared with that before chemotherapy （24.1% vs. 39.7%, P 〈0.001）. After neoadjuvant chemotherapy, the changes of Ki-67 in different subtypes of breast cancer were different （P 〈0.001）, and these changes correlated with response to neoadjuvant chemotherapy （P 〈0.001）. No significant changes in immunohistochemical expression were observed for ER, PR and Her-2. Conclusions Neoadjuvant chemotherapy apparently reduced Ki-67 index in primary breast carcinomas, but profiles for ER, PR and Her-2 were not significantly different before and after neoadjuvant chemotherapy. The change of Ki- 67 correlated with molecular subtypes and response to neoadjuvant chemotherapy, suggesting that Ki-67 index was a surrogate marker to predict the treatment response of neoadjuvant chemotherapy.     

肝移植治疗原发性肝癌的价值

随着肝移植手术技术和术后管理水平的不断提高,肝移植治疗原发性肝癌的作用越来越受到关注。肝癌虽然可以作为肝移植的适应证之一,但是各个中心对选择肝癌肝移植的标准并不统一。国外在肝癌肝移植的适应证掌握方面比较严格,目前参照比较多的有米兰标准、加利福尼亚大学旧金山分校(UCSF)标准和匹兹堡标准。米兰标准和UCSF标准都严格限制肿瘤大小和数目,却未兼顾血管侵犯、组织学分化程度等影响预后的重要因素。浙江大学医学院附属第一医院肝移植中心提出了适合中国国情的肝癌肝移植标准(杭州标准),杭州标准超越了米兰标准,并在考虑了影响预后的多个危险因素的基础上安全地拓展了米兰标准,使更多的肝癌患者能接受肝移植治疗,且取得了和符合米兰标准患者相似的长期生存率。另外,本文还总结了肝癌肝移植的围手术期综合治疗,为减少肝移植术后肝癌复发、提高肝移植患者长期存活率,使肝移植真正成为治疗肝癌的重要方法。     

Epidemiology of acute kidney injury in intensive care septic patients based on the KDIGO guidelines

Background Acute kidney injury （AKI） is a common complication of sepsis,which is associated with higher risks of adverse outcomes.Recently,kidney disease：improving global outcomes （KDIGO） recommended a new guideline forAKI,including a little modification on the AKI staging criteria.Methods This retrospective study included 211 septic patients admitted to the intensive care unit （ICU） at Xiangya Hospital,Central South University from January 2008 to January 2011.AKI was diagnosed and classified according to the KDIGO or acute kidney injury network （AKIN） criteria.Differences between the AKI and non-AKI groups for baseline characteristics,laboratory examinations,etiology,outcomes,as well as the risk factors for AKI and 28-day mortality were analyzed.The reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN criteria.Results The overall incidence of AKI in septic patients was 47.9％,and the 28-day mortality was 32.7％.The incidence of AKI was significantly higher in patients with more severe sepsis.Indicators of hepatic and respiratory function were significantly worse in the AKI group.Furthermore,a higher proportion of patients were infected with Enterobacter cloacae in the AKI group.The independent risk factors for AKI were shock,the number of organ failures,blood urea nitrogen （BUN）levels,and the use of vasopressors.The independent risk factors for mortality were BUN and creatine kinase-MB （CK-MB）levels.Both the KDIGO criteria and the AKIN criteria were significantly associated with 28-day mortality.Conclusions The incidence and 28-day mortality of AKI were very high in ICU septic patients.Greater attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical practice.Patients with an intra-abdominal source of infection were more likely to develop AKI.KDIGO criteria are reliable in AKI staging.