Long-Term Outcomes and Prognosis of Transrectal High-Intensity Focused Ultrasound Therapy for Patients with Localized Prostate Cancer—Therapy after Recurrence and Predictive Factors

Objectives: To evaluate the outcomes and prognosis of high-intensity focused ultrasound (HIFU) therapy for patients with localized prostate cancer, and identify suitable candidates for this therapy by investigating the predictive factors. Methods: The 224 patients (low 54, intermediate 111 and high-risk patients 59) with T1-2 stage were treated using the Sonablate device and followed for over 12 months after treatment. Recurrence was determined based on histological findings, prostate-specific antigen (PSA) failure and local or distant metastasis. The factors which are predicting variables with potential effects were investigated by Kaplan-Meier and multivariate analysis. Results: A total of 255 treatment sessions (193 with one, 31 with two) were performed. No patients died of prostate cancer, but 15 died of other causes and 14 patients were lost during follow-up. The 7-year recurrence-free survival (RFS) rates in all patients were 75%, and 5-year RFS rates were 98%, 84% and 59% in the low, intermediate and high-risk patients respectively. In the 216 patients who underwent histological examination at 6 months or later after HIFU, 25 (12%) were positive. In 77 patients with recurrence after first-HIFU, the second treatments were hormonal therapy and HIFU. Of the 31 patients who underwent a second HIFU, the 5-year RFS rates were 64%, and 5-year RFS rates were 100%, 74% and 33% in the low, intermediate and high-risk patients. The significant predictor for recurrence was risk-group, T-stage (T1 vs T2), Gleason score (≤3 + 4 and ≥4 + 3), pretreatment PSA (Conclusions: Prognosis of HIFU for Patients with localized prostate cancer was good, and the low and intermediate-risk patients with T1-staging are suitable indications for HIFU. Effective predictors for outcomes were risk-group, T-stage, Gleason score, pretreatment PSA and nadir PSA.

Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

AIM:To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team(MDT) modality.METHODS:Ninety patients with local recurrence were studied,out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007.For each patient,the recurrence pattern was assessed by specialist radiologists from the MDT using imaging,and the treatment strategy was decided after discussion by the MDT.The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.RESULTS:The recurrence pattern was classified as follows:Twenty-seven(30%) recurrent tumors were evaluated as axial type,21(23.3%) were anterior type,8(8.9%) were posterior type,and 13(25.6%) were lateral type.Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery,and R0 resection was achieved in 36(87.8%) of these patients.The recurrence pattern was closely associated with resectability and R0 resection rate(P < 0.001).The recurrence pattern,interval to recurrence,and R0 resection were significantly associated with 5-year survival rate in univariate analysis.Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.CONCLUSION:The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern;R0 resection is the most significant factor affecting long-term survival.

Retrospective analysis of prognostic factors for sixty osteosarcoma patients with local recurrence

Objective:The aim of this study was to identify prognostic factors and imply the appropriate management for local recurrent osteosarcoma.Methods:The clinical records of 60 patients with local recurrence osteosarcoma were reviewed between January 2002 and December 2010.The mean followed-up time for these patients was 49.1 months(range 13 to 143 months).The factors of age,gender,tumor site,tumor size,surgical procedure,neoadjuvant chemotherapy,frequency of primary postoperative adjuvant chemotherapy,lung metastasis,metastasis of other sites(except for lung) and treatment after local recurrence were selected as the measurements for this analysis.Kaplan-Meier method was used to measure the overall survival and post-recurrence survival.The univariate analysis was used to determine the prognostic factors related with survival by Log-rank test.The COX proportional-hazard regression model was used to analyze the correlation between the prognostic factor and the survival.Results:The median post-recurrence survival and overall survival of 60 patients were 32 months(95% confidence interval:16.2-47.8) and 55 months(95% confidence interval:39.3-70.7) respectively.The 2and 3-year cumulative survival rates were 81.7% and 55.4%,respectively.The Log-rank univariate analysis showed that age,gender,tumor size,metastasis of other sites(except for lung) and treatment after local recurrence were associated with the prognosis of osteosarcoma with local recurrence(P < 0.05).The Cox regression analysis revealed that gender(P = 0.016),metastasis of other sites(except for lung,P = 0.017) and treatment after local recurrence(P = 0.028) were the independent prognostic factors of osteosarcoma with local recurrence.On the other hand,the prognosis of local recurrent osteosarcoma was not associated with tumor site,surgical procedure,frequency of primary postoperative adjuvant chemotherapy,neoadjuvant chemotherapy and lung metastasis(P > 0.05).Conclusion:The independent prognostic factors for local recurrent osteosarcoma were the metastasis of other site(except for lung) and the treatment after local recurrence.The aggressive surgical treatment for local recurrence and distant metastasis could effectively improve the survival of local recurrent osteosarcoma.

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP). CLIP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not published. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma replaced by tumor), TNM stage, CLIP score, and resection margin were the risk factors for early recurrence, whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. In univariate survival analysis, Child-Pugh stages, resection margin, tumor size, microsatellite, venous invasion, tumor type, tumor extension, TNM stages, and CLIP score were associated with prognosis. The multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.

Alcohol,postprandial plasma glucose,and prognosis of hepatocellular carcinoma

AIM:To identify factors associated with prognosis of hepatocellular carcinoma(HCC) after initial therapy.METHODS:A total of 377 HCC patients who were newly treated at Katsushika Medical Center,Japan from January 2000 to December 2009 and followed up for > 2 years,or died during follow-up,were enrolled.The factors related to survival were first analyzed in 377 patients with HCC tumor stage T1-T4 using multivariate Cox proportional hazards regression analysis.A similar analysis was performed in 282 patients with tumor stage T1-T3.Additionally,factors associated with the period between initial and subsequent therapy were examined in 144 patients who did not show local recurrence.Finally,214 HCC stage T1-T3 patients who died during the observation period were classified into four groups according to their alcohol consumption and postprandial glucose levels,and differences in their causes of death were examined.RESULTS:On multivariate Cox proportional hazards regression analysis,the following were significantly associated with survival:underlying liver disease stage [non-cirrhosis/Child-Pugh A vs B/C,hazard ratio(HR):0.603,95% CI:0.417-0.874,P = 0.0079],HCC stage(T1/T2 vs T3/T4,HR:0.447,95% CI:0.347-0.576,P < 0.0001),and mean postprandial plasma glucose after initial therapy(< 200 vs ≥ 200 mg/dL,HR:0.181,95% CI:0.067-0.488,P = 0.0008).In T1-T3 patients,uninterrupted alcohol consumption after initial therapy(no vs yes,HR:0.641,95% CI:0.469-0.877,P = 0.0055) was significant in addition to underlying liver disease stage(non-cirrhosis/Child-Pugh A vs B/C,HR:0649,95% CI:0.476-0.885,P = 0.0068),HCC stage(T1 vs T2/T3,HR:0.788,95% CI:0.653-0.945,P = 0.0108),and mean postprandial plasma glucose after initial therapy(< 200 mg/dL vs ≥ 200 mg/dL,HR:0.502,95% CI:0.337-0.747,P = 0.0005).In patients without local recurrence,time from initial to subsequent therapy for newly emerging HCC was significantly longer in the "postprandial glucose within 200 mg/dL group" than the "postprandial glucose > 200 mg/dL group"(log-rank test,P < 0.05),whereas there was no difference in the period between the "non-alcohol group"(patients who did not drink regularly or those who could reduce their daily consumption to < 20 g) and the "continuation group"(drinkers who continued to drink > 20 g daily).Of 214 T1-T3 patients who died during the observation period,death caused by other than HCC progression was significantly more frequent in "group AL"(patients in the continuation and postprandial glucose within 200 mg/dL groups) than "group N"(patients in the non-alcohol and postprandial glucose within 200 mg/dL groups)(P = 0.0016).CONCLUSION:This study found that abstinence from habitual alcohol consumption and intensive care for diabetes mellitus were related to improved prognosis in HCC patients.

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox tropic examination were used, a retrospective clinicopathologic analysis was made in 156 cases of hepatocellular carcinoma after hepatectomy. RESULTS Of the 156 cases, 68 4%, 57 3%, 46 7%, 31 5% and 28 6% had 1, 2, 3, 4 and 5 postoperative tumor free years respectively with a total recurrence rate of 53 2% (83/156). In the 83 recurrent cases, 65 were of intrahepatic sabclinical type, with a re resection rate of 78 3% (65/83). The relevant factors involved in recurrence were: males, tumor number and size, capsule infiltration, portal veins involvement, etc. Those factors obviously influenced the prognosis of the patients with postoperative hepatocellular carcinoma ( P <0 05). 63 1% tumor nodes (41/65) of recurrent liver cancinomas were located at the ipsilateral segment of the primary ones. CONCLUSION Males, tumor number and size, capsule infiltration and portal veins involvement are the factors for postoperative hepatocellular carcinoma recurrence after surgery. The recurrence is mainly unicentral. Right front lobe is the liver segment with a high recurrence rate.

结直肠癌经自然腔道取标本手术的早期炎性反应、肿瘤学治疗结局与远期预后

目的:比较结直肠癌传统腹腔镜手术(laparoscopic surgery,LAP)与无腹部辅助切口是经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)术后的炎性反应程度、肿瘤学治疗结局与远期生存预后。方法:共1 020例患者纳入研究,其中NOSES组416例,LAP组604例。倾向得分匹配平衡两组患者基线资料,最后,两组各有344例患者纳入研究。收集两组患者临床病理特征、围手术期参数、早期炎性反应指标与预后信息。研究终点为5年总生存期(overall survival,OS)、无瘤生存率(disease-free survival,DFS)与无局部复发率生存率(local-recurrence free survival,LRFS)。结果:NOSES具有术后疼痛轻(P<0.05)、额外麻醉药物使用比例少(11.0%vs 29.9%,P<0.001)、切口并发症发生率低(1.5%vs 4.4%,P=0.023)、术后胃肠道功能恢复快(2.7 vs 3.3天,P=0.022)等短期优势。NOSES组患者术后第2天平均体温显著高于LAP组(37.3 vs 37.1℃,P=0.031)。此外,NOSES组患者术后第1、3天的平均中性粒细胞百分比与术后第3天的C反应蛋白水平显著高于LAP组(P<0.05)。然而,两组患者术后盆腔感染并发症发生率无显著差异(0.9%vs 1.2%,P=1.000)。此外,两组患者标本长度、近端切缘距肿瘤距离、远端切缘距肿瘤距离和淋巴结清扫数量等病理结果方面无统计学差异(P>0.05)。预后方面,两组患者有着相似的5年OS(91.6%vs 89.3%,P=0.434)、DFS(84.1%vs 83.6%,P=0.898)与LRFS(95.9%vs 94.0%,P=0.369)。结论:结直肠癌NOSES是安全可行的,有着疼痛轻、恢复快、切口并发症发生率低等明显的短期优势。虽然NOSES手术会在早期引起较强的急性全身炎性反应,然而并不会转化为相关并发症。此外,NOSES手术与LAP有着相似的肿瘤学治疗结局与远期预后,可以在临床工作中广泛开展与推广。

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

核糖蛋白1对非肌层浸润膀胱癌术后复发的预测作用

目的探讨核糖蛋白1(RPN1)对非肌层浸润膀胱癌(NMIBC)术后复发的预测作用。方法运用GEPIA2数据库分析RPN1 mRNA在膀胱癌中的表达差异及其与预后的关系;2018年5月~2021年5月在我院行经尿道肿瘤电切术治疗NMIBC病人的石蜡标本76例为癌症组,32例膀胱镜检的正常组织为正常组。采用免疫组化技术检测76例NMIBC病人RPN1蛋白的表达情况,Cox多因素分析其表达与NMIBC临床病理参数以及术后复发的关系。结果数据库分析发现,RPN1 mRNA在膀胱癌组织中表达水平高于正常膀胱组织;免疫组化结果显示,RPN1蛋白主要表达于细胞质中,RPN1蛋白在NMIBC病人中阳性表达率为64.47%,32例正常组织中阳性表达率为9.37%,RPN1蛋白在癌组织中的表达水平明显高于正常膀胱组织,差异有统计学意义(P<0.05),且RPN1表达与肿瘤直径、组织学分级、病理分期、复发密切相关(P<0.05)。生存分析结果表明,RPN1高表达病人的无复发生存率较低表达病人显著降低,差异有统计学意义(P<0.05)。Cox回归分析显示,RPN1高表达是NMIBC术后复发的独立危险因素。结论RPN1在NMIBC中呈高表达,其表达水平与复发及预后相关。

结直肠癌根治术后复发转移患者的预后因素分析

目的探讨影响结直肠癌根治术后复发转移患者生存时间的临床病理因素,为治疗方案的选择提供更多理论依据。方法收集2002年1月1日-2007年12月31日收治的住院与随访资料完整的132例结直肠癌根治术后复发转移患者的临床资料,回顾性分析其临床病理因素与生存时间的关系。结果单因素分析结果显示,单发转移者生存率高于多发转移者,直肠癌复发转移者生存率高于结肠癌复发转移者,再次手术治疗者生存率高于采用非手术治疗者。Cox回归模型多因素分析表明,复发转移后的治疗方式、复发转移部位的数目、原发肿瘤的侵袭深度、淋巴结转移等与患者的生存时间相关,其中复发转移后的治疗方式是最重要的影响因素。结论结直肠癌根治术后复发转移者以直肠癌居多,但其预后优于结肠癌复发转移者;复发转移后再次手术治疗有助于改善预后。

乳腺癌局部复发与远处转移关系的回顾性分析

目的:探讨乳腺癌局部复发和远处转移的关系及其相关因素。方法:收集我院诊治的乳腺癌根治术后经病理确诊首次局部复发且资料相对完整的97例女性患者,回顾性分析其临床特点和治疗结果。结果:97例患者中发生远处转移者75例,中位转移时间为15.2个月。单因素分析表明淋巴结转移数目、肿瘤大小和激素受体状况是影响复发后转移中位时间的相关因素。胸壁、腋窝、锁骨上区复发后转移中位时间分别为17.0、16.3和16.0个月,≥2个部位复发者发生转移中位时间为10个月,P=0.033。化疗组和未化疗组复发后发生远处转移间隔分别为16.0和11.9个月,P=0.084。内分泌治疗组和未接受内分泌治疗组复发后发生远处转移间隔分别为24.3和12.7个月,P=0.021。结论:乳腺癌局部复发是远处转移的标志。评价化疗在复发患者治疗中的作用尚需设计更严谨的随机对照临床试验。

ⅡB～Ⅲ期食管癌根治术后预防性放疗疗效分析

目的探讨术后预防性放疗对ⅡB、Ⅲ期胸段食管癌根治术患者生存的影响。方法收集2007—2010年本院行食管胸段鳞癌根治术患者336例,其中ⅡB期65例、Ⅲ期271例;术后未行放疗组(S)220例,术后放疗组(S+R)116例;放疗中位剂量50 Gy。采用Kaplan-Meier法计算生存率及局控率;Log rank法检验行单因素预后分析。结果随访率为98.2%,全组患者5年生存率及5年无进展生存率分别为29.3%和25.6%;中位生存时间及中位无进展生存时间分别为26.7月和17.4月。ⅡB期患者S组与S+R组5年生存率分别为30.1%与48.6%,差异无统计学意义(χ~2=2.279,P=0.131);Ⅲ期患者S组与S+R组5年生存率分别为24.9%与32.8%,差异有统计学意义(χ~2=5.865,P=0.015);术后病理淋巴结阳性患者S组与S+R组5年生存率分别为25.9%与35.8%,差异有统计学意义(χ~2=7.663,P=0.006);全组患者S组与S+R组的中位局控时间分别为10.6和16.3月,差异有统计学意义(χ~2=6.043,P=0.014)。结论食管癌根治术后预防性放疗可明显降低局部复发并使Ⅲ期及术后病理淋巴结阳性的患者生存获益。

88例中青年胸腺瘤伴重症肌无力患者的临床分析

目的探讨中青年胸腺瘤伴重症肌无力患者的临床病理特点及预后。方法回顾性分析解放军第309医院收治的88例经病理证实的50岁以下中青年胸腺瘤伴MG患者的临床病理资料。结果 88例患者中,肿瘤大小多在5cm以下者,占70.5%,WHO分型以B2型为主,占46.7%,Masaoka分期以Ⅰ、Ⅱ期为主,占77.3%,MG分型以Ⅱb型最多,占63.7%。3年和5年总体生存率分别为97.2%和87.5%。WHO分型中A、AB、B1、B2型与B3型患者的3年生存率分别为98.2%和94.1%(P=0.419),5年生存率分别为88.0%和83.3%(P=1.000)。Masaoka分期中Ⅰ、Ⅱ期患者与Ⅲ、Ⅳ期患者的3年生存率分别为98.1%和94.7%(P=0.461),5年生存率分别为96.2%和60.0%(P=0.015)。结论中青年胸腺瘤伴MG患者与其他年龄患者相比,其临床病理特点无特殊,生存率较高,Masaoka分期与预后有关。

喉癌组织p21、SLC7A11表达与患者临床病理特征及预后、复发的关系

目的观察喉癌组织p21、SLC7A11表达变化,并探讨其在喉癌发生、发展中的作用。方法采用免疫组化SP法检测327例份喉癌组织(喉癌组)和62例份声带息肉组织(对照组) p21、SLC7A11表达。分析喉癌组织p21、SLC7A11表达与患者临床病理特征的关系。采用Kaplan-Meier法分析喉癌组织p21、SLC7 A11表达与患者预后和复发的关系。结果喉癌组p21、SLC7 A11阳性表达率均高于对照组(χ~2分别为8. 53、8. 56,P均<0. 05)。喉癌组织SLC7 A11阳性表达与肿瘤临床分期有关(P <0. 05)。喉癌组织p21阳性表达与肿瘤临床分期及淋巴结转移有关(P均<0. 05)。喉癌组织SLC7A11阳性表达/p21阴性表达与患者术后复发有关(P <0. 01),与患者生存期无明显相关性(P> 0. 05)。SLC7A11阳性表达/p21阴性表达者术后复发时间明显短于SLC7A11阴性表达/p21阴性表达者、SLC7A11阴性表达/p21阳性表达者、SLC7A11阳性表达/p21阳性表达者(χ~2分别为9. 344、8. 304、5. 924,P均<0. 05),但生存时间与SLC7A11阴性表达/p21阴性表达者、SLC7 A11阴性表达/p21阳性表达者、SLC7 A11阳性表达/p21阳性表达者比较差异无统计学意义(χ~2=4. 592,P> 0. 05)。结论喉癌组织SLC7 A11高表达、p21低表达,二者表达变化与患者术后复发有关,而与术后生存时间关系不大。

手术治疗肾癌根治术后孤立局部复发病灶的长期预后分析

目的:分析手术切除肾癌根治术后局部复发病灶的长期疗效以及肾癌局部复发病灶的长期预后因素。方法:回顾性研究北京大学第一医院泌尿外科局限性肾癌接受根治术后出现局部孤立复发病灶患者资料。根据现有文献资料,局部复发定义为肾窝、同侧肾上腺以及同侧腹膜后淋巴结出现的复发病灶。本研究中位随访时间为62个月,肿瘤特异性生存时间与肿瘤复发模式的评估使用Kaplan-Meier方法进行。结果:从1994年1月至2011年12月共有1 045名患者因肾癌于北京大学第一医院接受了肾癌根治术,其中有15名患者在随访时间(62.7±36.2)个月中出现了局部复发,有9名患者接受了手术治疗,余6名患者未接受手术治疗。接受手术治疗的患者1年肿瘤特异性生存率为87%,未接受手术治疗患者为60%;4年肿瘤特异性生存率在接受手术治疗的患者中为72%,在未接受手术治疗的患者中仅为30%。手术治疗组和未接受手术患者的生存时间分别为(51.8±7.4)个月和(28.4±9.2)个月,复发间隔时间分别为(39.4±29.5)个月和(29.3±23.9)个月。结论:有选择地对肾癌局部复发病灶进行手术切除是一种可行的治疗手段,并可能延长患者生存时间。

鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响

目的探讨鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响。方法对67例鼻咽癌放疗后颈部淋巴结残留或复发而原发灶未复发的患者的临床病理资料进行回顾分析。选择性别、年龄、原发癌病理类型、残留或复发淋巴结大小、累及的侧数、淋巴结累及区域、累及区域数量、复发淋巴结的手术方式、颈动脉是否受侵、术后是否有严重并发症、是否补充放疗、是否复发、有无远处转移等临床病理因素,用χ2检验和Cox回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果单因素分析显示有无远处转移与预后明显相关,多因素分析结果表明,残留或复发淋巴结大小、是否累及Ⅴ区、残留或复发淋巴结累及区域数量、手术方式和有无远处转移与预后明显相关。Kaplan-Meier法进行生存分析显示颈部淋巴结残留或复发患者再次治疗的总1、3、5年生存率分别为88.6%、52.2%、38.6%,而采用根治性手术较采用局部手术生存率高。结论远处转移是影响鼻咽癌放疗后颈部淋巴结残留或复发患者预后的决定性因素。而残留或复发淋巴结大小、是否累及Ⅴ区、累及区域数量和手术方式也是重要因素,根治性手术可提高生存率。

乳腺癌术后胸壁复发患者肿瘤组织CXCR4、Survivin表达变化及其意义

目的观察乳腺癌术后胸壁复发患者原发和复发肿瘤组织趋化因子受体4(CXCR4)、生存素(Survivin)表达变化,并分析其表达变化与患者临床病理特征和预后的关系。方法选择乳腺癌术后胸壁复发患者120例,取复发肿瘤组织、原发肿瘤组织及其癌旁正常组织标本,采用免疫组化法检测CXCR4、Survivin表达。分析复发肿瘤组织CXCR4、Survivin表达与患者临床病理特征和预后的关系。结果乳腺癌复发肿瘤组织和原发肿瘤组织CXCR4、Survivin阳性表达率均明显高于癌旁正常组织(P均<0.05);复发肿瘤组织CXCR4、Survivin阳性表达率虽然高于原发肿瘤组织,但差异无统计学意义(P均>0.05)。复发肿瘤组织CXCR4阳性表达与患者复发前肿瘤直径、TNM分期、转移淋巴结个数有关(P均<0.05),与患者年龄、月经状态、复发前手术方式和复发前是否放疗无关(P均>0.05)。复发肿瘤组织Survivin阳性表达与患者复发前肿瘤直径、TNM分期、转移淋巴结个数、是否放疗有关(P均<0.05),与患者年龄、月经状态、复发前手术方式无关(P均>0.05)。复发肿瘤组织CXCR4、Survivin阳性表达者中位生存时间和1、2、5年生存率均明显低于其阴性表达者(P均<0.05)。结论乳腺癌术后胸壁复发患者原发和复发肿瘤组织CXCR4、Survivin表达均明显升高,其表达变化与肿瘤复发和转移有关。二者有可能成为预测乳腺癌术后复发患者预后的指标。

局部复发鼻咽癌再程调强放疗的临床疗效和预后研究

【目的】研究鼻咽癌治疗后局部复发患者再次行调强放疗的疗效及影响预后的相关因素。【方法】回顾性研究分析本院收治的132例鼻咽癌综合治疗后局部复发患者的临床资料。其中，男性93侧，女性39例，中位年龄49．8（25～72）岁，初治后复发时间间隔平均为55（11～201）个月。确诊复发后，所有患者均采用三维调强适形放疗进行治疗。【结果】132例患者中12例失访，中位随访时间为34．6个月，中位生存时间36．3个月，1、3、5年生存率分别为79％（95／120）、55％（66／120）、25％（30／120）。至随访截止日期，死亡55例，其中29例因放疗副作用死亡，14例因放疗后再复发，11例因远处转移，1例放疗后再复发并转移。单因素分析结果显示，性别、年龄、既往吸烟史、初治肿瘤原发灶（Tumor，T）分期、初治淋巴结（Node，N）分期、初治临床分期、复发T分期、复发N分期、复发临床分期、原发肿瘤体积（Gross Tumor Volume，GTV）剂量、临床靶区体积（Clinieal Target Volume，cTV）剂量、GTV体积、CTV体积、合并化疗与否、治疗后疗效评价、使用放疗增敏剂等因素均与生存期无明显相关（P〉0．05）；多因素分析提示，初治临床分期及复发T分期是预测无远处转移的复发鼻咽癌的独立预后因素（P〈0．05）。近期毒副反应主要包括骨髓抑制、胃肠道反应、放射性口腔黏膜炎，无一例发生4级毒副反应。【结论】鼻咽癌治疗后局部复发再程调强放疗有效、可靠，毒副反应可耐受；初治临床分期及复发T分期是预测无远处转移的复发鼻咽癌的独立预后因素。

根治性经括约肌间切除术治疗低位直肠癌的远期疗效观察

目的评估经括约肌问切除术（ISR）对低位直肠癌实施根治性切除的远期疗效（包括肿瘤学效果及肛门功能）。方法对2006年2月至2013年5月采用ISR进行RO切除术并成功保肛的91例低位直肠癌患者的临床资料进行回顾性分析。结果术后病理分期pTNMⅠ期35例、Ⅱ期30例、Ⅲ期26例。无围术期死亡。发生吻合口瘘2例，新直肠黏膜坏死2例，吻合口狭窄15例。术后随访6～94个月。平均随访（403±239）个月。中途失访10例。远处转移9例，局部复发3例，1例术后36个月发现左侧盆壁淋巴结转移，1例术后35个月骶前复发，1例术后52个月发现骶骨转移。无吻合口复发。随访截止时，8例死于肿瘤远处转移。5年累积生存率90．9％，5年累积无病生存率81．3％。至术后1年。行部分、次全、完全ISR患者肛管最大静息压分别为（85±1．4）、（7．9±2．2）、（4．4±1．2）kPa，大便失禁严重程度Vaizey评分为4．2±3．0、5．7±3．0、13．7±3．2。结论在进行RO切除的前提下，低位直肠癌患者使用ISR技术进行保肛治疗具有较低局部复发率以及可以接受的肛门节制功能。

三阴性乳腺癌临床病理特征及其与预后的关系

目的对三阴性乳腺癌(triple-negative breast cancer,TNBC)临床病理特征及其预后分析。方法收集2001年2月—2010年2月在我院术后经病理学确诊的493例乳腺癌患者资料,回顾性分析其临床病例特征及预后。结果 TNBC多见于<35岁未绝经的女性,且组织学分级较高(P<0.05)。TNBC 5年无病生存率(DFS)低于非三阴性乳腺癌(non-TNBC)(58.5%,76.5%)(P<0.05);5年总生存率(OS)低于non-TNBC(70.5%,86.5%)(P<0.05)。结论 TNBC临床病理特征特殊且复发转移率高,预后差,针对其辅助治疗方案需进一步探究。