介入治疗老年人原发性肝癌疗效及影响生存因素分析(附56例报告)

目的：探讨肝动脉化疗栓塞治疗老年人原发性肝癌的疗效及其影响生存的因素。材料和方法：５６例有完整资料的老年人原发性肝癌分别经肝动脉化疗和栓塞术（ＨＡＩ和ＨＡＥ）后，观察肿瘤缩小程度和生化指标，并随访其生存时间和生存率。结果：５６例平均生存期为１４７月，其中ＨＡＩ为９７月，ＨＡＥ为１６３月，一年生存率ＨＡＥ组明显高于ＨＡＩ组，分别为６２８％和２３１％（Ｐ＜００５）；巨块型、结节型和弥漫型三组一年生存率分别为５９５％、６６７％、０％；临床分期、门脉癌栓和功能状态对生存率影响差异无显著意义：一次和多次ＨＡＥ比较对肿瘤缩小程度差异无显著性；所有病例术后均无严重并发症。结论：ＨＡＥ是老年人原发性肝癌安全有效的治疗方式和影响生存率的主要因素。

大骨瓣减压术治疗大面积脑梗死体会

目的分析在大面积脑梗死患者治疗中,大骨瓣减压术的应用疗效。方法选取我院2010年1月—2015年1月收治的30例大面积脑梗死患者为研究对象,随机均分为对照组与干预组,对照组患者接受常规治疗,干预组患者接受大骨瓣减压术治疗,对比2组患者术后存活率。结果干预组患者的存活率明显高于对照组,存在统计学差异(P<0.05)。结论在大面积脑梗死患者治疗中,大骨瓣减压术具有较好的疗效,值得应用。

Dose surgical sub-specialization influence survival in patients with colorectal cancer?

AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival.These variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree groups.Patients in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ cancers.Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P<0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective: The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.Methods: A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed.Between January 1998 and May 2004,133 patients were enrolled.Several factors such as age,sex,skip metastasis,number of N2 lymph node stations,type of resection,histology,adjuvant therapy etc.,were recorded and analyzed.SPSS 16.0 software was used.Results: Overall 5-year survival for 133 patients was 32.33%,5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively,and 5-year survival for cN0–1 and cN2 sub-groups were 37.78% and 20.93% respectively.COX regression analysis revealed that number of N2 station (P = 0.013,OR: 0.490,95% CI: 0.427–0.781) and cN status (P = 0.009,OR: 0.607,95% CI: 0.372–0.992) were two favorable prognostic factors of survival.Conclusion: Number of N2 station and cN status were two favorable prognostic factors of survival.In restrict enrolled circumstances,after combined therapy made up of surgery and postoperative adjuvant therapy have been performed,satisfied survival could be achieved.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

Impact of adjuvant chemotherapy delay on survival in cancer breast patients

Objective： The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. It is usually prescribed within 2-3 months after definitive surgery. The aim of this retrospective study was to assess the impact of adjuvant chemotherapy （CT） delay beyond 3 weeks （ 21 days） in premenopausal patients with ER-absent tumors being treated for early stages breast cancer on overall survival （OS） and disease-free survival （DFS）. Methods： This retrospective study was conducted through revision of medical records of premenopausal patients diagnosed with early stage ｜-｜IIA breast cancer and ER-absent tumors who received adjuvant CT after definitive surgery at the Department of Clinical Oncology, Ain-Shams University Hospitals. Results： Between 2005 and 2008, 105 patients were retrospectively analyzed and included. Patients were divided into 2 groups： Group A including 48 patients who started adjuvant CT 〈 21 days of surgery and group B which included 57 patients who had CT delay 〉 21 days. Both groups were matched demographically. Comparisons of overall survival, and disease-free survival between group A and group B patients all favored group A. At 5-year the OS rates were 87% and 73% for groups A and B respectively （P = 0.001）, while DFS rates were 85% and 64% in groups A and B respectively （P = 0.001）. Analysis of other prognostic factors （age, T, N, grade, HER2 status, surgery type, CT type, local radiotherapy received） were analyzed. Only nodal status predicted for worse DFS （P = 0.05） and OS （P = 0.006）. Conclusion： Delay in initiating adjuvant chemotherapy for early stage breast cancer patients with ER-absent tumors was associated with a decrease in both OS and DFS rates.

Investigation of the Effect of Neoadjuvant Chemotherapy on Stage Ⅱ Breast Cancer

OBJECTIVE To investigate the effect of neoadjuvant chemotherapy in treatment of Stage Ⅱ breast cancer. METHODS The data from 113 patients with breast cancer of the same pathologic type in Stage Ⅱ,during the period of 1995 to 2001,were analyzed retrospectively.Among the patients,47 were treated with neoadjuvant chemotherapy,and 66 received no adjuvant therapy before surgery（control group）.After the patients of the neoadjuvant chemotherapy group had received 2 courses of chemotherapy with the CMF regimen,the surgical procedure was conducted. RESULTS Complete remission（CR）was attained in 9 of the 47 cases receiving neoadjuvant chemotherapy and partial remission（PR）was reached for 22 cases.The rate of breast-conserving surgery was enhanced from 22.73%to 46.81%（P〈0.05）in the neoadjuvant treatment group. There was no difference in the 5-year overall survival（OS）and disease-free survival（DFS）rate between the two groups（P〉0.05）,but the 5-year OS and DFS of the cases with clinical tumor remission was higher compared to the control group（P〈0.05）. CONCLUSION Neoadjuvant chemotherapy can enhance the rate of breast conservation for Stage Ⅱ breast cancer and may improve the prognosis of the cases with clinical remission.

Clinical analysis of long-term survivors for unresectable hepatocellular carcinoma

Objective:The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellular carcinoma(HCC).Methods:Between 1999 and 2003, a total of 166 patients underwent multimodality therapy for unresectable HCC.All patients underwent multimodality therapy, such as transarterial chemoembolization(TACE), chemotherapy, local ablative therapy, and/ or Chinese traditional medicine.Thirty-nine(23.5%) patients survival ≥ 1 years, and 10(6.0%) patients survived ≥ 3 years.These 39 patients surviving over 1 year were investigated in this study.Eighteen clinical and biologic variables were assessed using univariate and multivariate analyses.Results:TNM staging and tumor extension were isolated by univariate analysis.Only tumor extension was independent risk factors by multiple regression analysis.Of these, 25.6%(10 of 39) survived over 3 years.These 10 patients surviving over 3 years were investigated further.By the end of June 2004, follow-up varied from 3 years and 2 months to 5 years and 1 month.Six patients were still alive with free of disease.Conclusion:Tumor extension was demonstrated to be prognostic of long-term survivors.Multimodality therapy may make a major contribution to achieving long-term survival in patients with unresectable HCC.

Dexamethasone plus lenalidomide in treatment of multiple myeloma

Combination of lenalidomide with dexamethasone （LD） is of high effectiveness for treatment of multiple myeloma （MM）, resulting in an improved overall survival, response rate, and time to progression in relapsed or refractory MM. Adverse events, especially venous thromboembolism, were generally well tolerated. In addition, lenalidomide plus dexamethasone is a potential therapy in maintenance of myeloma.