Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients w...Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients with brain metastasis （BM）.Methods：From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors （TKIs） in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox＇s regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models （RPA and GPA） were validated respectively.Results：All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval （95% CI） was 14 （12.3-15.8） months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different （P0.001）.In the multivariate analysis as RPA and GPA entered Cox＇s regression model,Karnofsky performance status （KPS） ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion：KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.展开更多
A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary l...A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary lesions,who underwent modified hemilaminectomy,were studied retrospectively.The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm),in which the inner parts of the medial and lateral laminae were mostly undercut for wider view.Spinal lesions were cervical in 21 cases,thoracic in 12 cases,lumbar in 10 cases,and multiple in 2 cases.Forty-three cases were completely excised via hemilaminectomy alone.Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy.With respect to neurological status,the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up.At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI),none of the subjects showed spinal deformity or instability.By preserving musculoligamentous attachments and posterior bony elements as much as possible,the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors,especially in patients with meningiomas and neurinomas.展开更多
文摘Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients with brain metastasis （BM）.Methods：From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors （TKIs） in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox＇s regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models （RPA and GPA） were validated respectively.Results：All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval （95% CI） was 14 （12.3-15.8） months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different （P0.001）.In the multivariate analysis as RPA and GPA entered Cox＇s regression model,Karnofsky performance status （KPS） ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion：KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.
文摘A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary lesions,who underwent modified hemilaminectomy,were studied retrospectively.The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm),in which the inner parts of the medial and lateral laminae were mostly undercut for wider view.Spinal lesions were cervical in 21 cases,thoracic in 12 cases,lumbar in 10 cases,and multiple in 2 cases.Forty-three cases were completely excised via hemilaminectomy alone.Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy.With respect to neurological status,the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up.At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI),none of the subjects showed spinal deformity or instability.By preserving musculoligamentous attachments and posterior bony elements as much as possible,the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors,especially in patients with meningiomas and neurinomas.
