Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy

ObjectivesTo assess the impact of short and long term outcomes of diaphragm resection and repair in cyto-reductive surgery (CRS) and intra-peritoneal chemotherapy (IPC).Methods1230 consecutive CRS/IPC procedures were performed between 1996 and 2018 in Sydney, Australia. Among these, 652 underwent diaphragmatic intervention. The analysis was preformed according to histological subtype. First diaphragm interventions were compared to non-diaphragmatic CRS. Secondly, diaphragm resection was compared to diaphragm stripping. Overall survival and recurrence free survival was assessed based on histological diagnosis.ResultsThere were no differences between the resection and stripping groups for the colorectal cohort. For mesothelioma, increased incidences of pleural effusions in the resection group were noted (63% vs.28%, p = 0.017). In HAMNs, the resection group was associated with increased reoperations (42% vs. 15%, p = 0.03) and in hospital death (16.7% vs. 0.6%, p = 0.012). Resection in LAMNs were linked with increased transfusion requirements (9 vs. 6, p = 0.01), reoperation (39% vs. 23%, p = 0.05) and prolonged length of stay (34 days vs. 25 days, p = 0.02).There were no differences in overall survival and recurrence free survival in colorectal cancer. Median overall survival was decreased in mesothelioma by 20 months. In LAMNs the median survival was significantly decreased for the resection group. Similarly, the resection group had a 4-month earlier recurrence.ConclusionWe conclude that diaphragm interventions are an essential part of CRS. They are associated with increased perioperative morbidity. This morbidity is not attributable to whether the patient underwent diaphragm stripping or resection. However in mesothelioma and LAMNs, requiring diaphragm resection is likely to be an indicator for tumor aggression.     

多西他赛联合内分泌疗法治疗转移性激素敏感性前列腺癌的疗效研究

目的探讨多西他赛联合内分泌疗法治疗转移性激素敏感性前列腺癌的临床疗效。方法回顾性分析长海医院2004年1月至2018年7月收治的497例转移性激素敏感性前列腺癌患者的病例资料。患者确诊年龄为(72.1±8.7)岁。治疗前中位PSA为100.0(42.3~999.0)ng/ml。TNM临床分期分别为:T2期213例(42.9%)、T3期160例(32.2%)、T4期124例(24.9%);N0期319例(64.2%)、N1期144例(29.0%)、Nx期34例(6.8%);M0期100例(20.1%)、M1a期51例(10.3%)、M1b期332例(66.8%),M1c期9例(1.8%)、Mx期5例(1.0%)。穿刺Gleason评分≤7分146例(29.4%)、8分103例(20.7%)、≥9分248例(49.9%)。根据治疗方式分为2组,采用单独内分泌治疗(单独治疗组)459例,多西他赛联合内分泌治疗(联合治疗组)38例。采用倾向评分匹配方法,卡钳值设置为0.02,对两组数据实行1∶1匹配。共37对匹配成功,匹配后两组的年龄(P=0.102)、PSA(P=0.713)、T分期(P=0.113)、N分期(P=0.226)、M分期(P=0.514)、Gleason评分(P=0.612)、肿瘤负荷(P=0.812)比较差异均无统计学意义。采用log-rank和Breslow-wilcoxon检验比较两组的无进展生存期和肿瘤特异性生存期。绘制两组患者年龄、临床TNM分期、Gleason评分、肿瘤负荷及是否接受过姑息性电切手术等各亚组生存情况的森林图,并针对高肿瘤负荷亚组比较两组间的无进展生存期差异。结果匹配后单独治疗组和联合治疗组的中位随访时间分别为22.6个月和13.7个月;发生去势抵抗的患者例数分别为23例和17例;死亡患者例数分别为3例和6例。单独治疗组和联合治疗组患者进展为去势抵抗的中位时间差异无统计学意义(10.3个月与16.5个月,P>0.05);平均前列腺癌特异性生存期分别为21.9个月和14.8个月,但均未达到中位生存期,且差异无统计学意义(P>0.05)。高肿瘤负荷亚组中,联合治疗组的中位无进展生存期明显优于单独治疗组(10.6个月与7.2个月,P=0.044),但低肿瘤负荷亚组中两组平均无进展生存期分别为10.5个月和12.6个月,均未达到中位生存期,且差异无统计学意义(P>0.05)。结论多西他赛联合内分泌治疗可以延长高肿瘤负荷激素敏感性前列腺癌患者的无进展生存期,但低肿瘤负荷患者无明显获益。     

原发性锁骨滑膜肉瘤1例

患者,男,46岁,因发现右锁骨肿物伴疼痛1年余,加重3个月入院。患者2015年4月无明显诱因下发现右锁骨内侧肿物,约拇指大小,伴持续性钝痛。自2016年2月,肿物迅速增大至约鸡蛋大小,疼痛明显加剧,并出现右侧肩胛骨冈上区放射痛,遂于2016年5月25日至我院就诊。入院后查体:右锁骨胸骨端肿物稍突出于体表,肿物大小约5.5 cm×4.5 cm,质中。X线片显示:右锁骨边缘骨皮质模糊,骨质密度减低,右侧胸锁关节显示不清。右锁骨穿刺活检显示:浸润横纹肌及骨组织,伴有坏死。免疫组化:IHC:Vimentin(+),Ki-67:25%,CD68(+),Bc1-2(+),CD99(+),CR(+),CK(+),EMA(+),S-100少数(+),CK19(-),CD56(-),Actin(-),CD117(-),CD34(-),Calponin(-),Desmin(-),Myogenin(-),MyoD1(-),SMA(-)。病理诊断结论:形态学及免疫组化符合滑膜肉瘤,中度分化。