155例癫痫患者规范化诊疗及预后多因素分析

目的分析我院癫痫患者规范化诊疗及预后多因素。方法选取我院2014年8月—2017年8月到我院接受治疗的300例癫痫患者作为研究对象。所有患者均给予实验检查、脑电图检查及影像学等诊断。根据患者是否实施规范化诊治,将其分为两组,A组接受规范化诊治,B组为没有接受规范化诊治,观察两组患者的治疗疗效并研究影响预后的因素。结果 A组患者的临床有效率为90.3%,优于B组的临床有效率32.4%,差异具有统计学意义(P<0.05)。结论对癫痫患者实施规范化诊疗效果显著,而非规范化诊疗的患者依从性差,因此需要根据癫痫病的发作原因及类型等为患者提供规范化诊疗。

1667例肺癌外科治疗的多因素预后分析

目的 分析总结肺癌外科治疗多种相关预后因素,以提高肺癌的规范治疗和远期疗效。方法 对1991年至2000年手术治疗的1667例肺癌回顾性临床分析。结果 1422例NSCLC中,497例Ⅰ期的5年生存率为55.03％,298例Ⅱ期为41.24％,582例Ⅲ期为19.23％,45例Ⅳ期肺癌为4.36％。789例N_0肺癌的5年生存率49.97％,302例N_1的23.18％,549例N_2的18.44％,27例N_3无5年生存,1年生存率仅21.82％。916例鳞癌的5年生存率为42.97％。403例腺癌的26.32％,差异显著(P<0.01)。结论 分期因素、N因素和病理类型是肺癌预后的最重要相关因素,综合治疗尤其是新辅助化疗有新的前景。

影响晚期原发性肝癌生存期的多因素预后分析

目的观察晚期原发性肝癌的疗效,分析影响晚期原发性肝癌的相关预后因素。方法将符合标准的306例病例分为中医组、中药介入组和化疗介入组。其中,中医组辨证口服中服汤剂,中药介入组经肝动脉灌注羟基喜树碱或亚砷酸注射液,并常规碘化油栓塞,化疗介入组予常规肝癌TACE化疗用药。以生存天数为终点观察指标,用K-M法进行生存分析,计算生存率,用COX回归比例风险模型进行预后因素分析。结果共纳入合格病例306例Ⅲb/Ⅳ原发性肝癌患者,其中中医组254例,中药介入组38例,化疗介入组14例。失访49例。经K-M法分析,中医组中位生存期255d,半年累积生存率为65.6%,1年累积生存率为46.1%,18个月累积生存率为20.47%。中药介入组中位生存期286d,半年累积生存率为69.1%,1年累积生存率为33.7%,18个月累积生存率为5.61%。化疗介入组中位生存期271d,半年累积生存率为84.42%,1年累积生存率为25.32%,18个月累积生存率为0。3组差异无统计学意义(P>0.05)。COX回归分析显示,肝功能分级、既往治疗及中医证型、病程、静脉侵犯为对预后有重要影响的因素。结论肝功能分级、既往治疗为有利的预后因素,病程、静脉侵犯、中医证型(肝肾阴虚)为不利的预后因素。晚期肝癌积极、恰当的治疗仍可使患者生存受益,中医药对于晚期肝癌具有一定的疗效,介入治疗不能明显延长晚期肝癌的生存期,但对于严格选择适应证的患者可有生存受益。

非小细胞肺癌脑转移手术治疗预后相关因素分析

目的非小细胞肺癌（non-small cell lungcancer，NSCLC）一旦发生脑转移往往提示预后不良，对于一些脑转移瘤患者，手术仍然是其可选择的治疗方法，但是就如何选择手术获益人群，仍然是神经外科医生面临的难题。本研究就NSCLC脑转移瘤手术切除后组织亚型对患者术后生存期预后影响进行分析。方法选取2005—01—01～2013-12—31天津医科大学肿瘤医院脑系科收治的78例手术治疗NSCLC脑转移瘤患者的临床病例资料。其中男40例，女38例。年龄38~81岁，中住年龄55岁。以发现脑转移病灶首发44例，发现肺原发病灶首发34例。病灶位于幕上43例，幕下9例，幕上下均累及26例。颅内病灶单发28例，颅内病灶≥2个50例，有颅外其他部位转移26例，仅有颅内部位转移52例，患者术前功能状态评分（karnofsky，KPS）均≥70。结果患者研究终点是术后生存期，从患者手术之日计算。中位生存期为8．40个月，本研究中只有2例（2．56％）患者其生存期分别为39和52个月，1、2、3年生存率分别为34．5％、11．9％和5．2％。单因素分析显示，性别（x^2=5．918。P=0．015）、NSCLC组织亚型（x^2=5．361，P=0．021）、脑转移瘤是否首发（x^2=3．932，P=0．047）、脑转移瘤术前化疗与否（x^2=4．810，P=0．028）、原发灶控制与否（x^2=21．452，P〈0．001）、脑转移术后全脑放疗与否（x^2=32．454，P〈0．001）和脑转移术后化疗与否（x^2=7．690，P=0．006）对术后生存期有影响。多因素分析显示，NSCLC组织亚型（P=0．001）、原发灶控制与否（P=0．015）、脑转移瘤是否首发（P=0．026）和术后是否行全脑放疗（P〈0．001）是其独立的预后因素。NSCLC中鳞癌脑转移瘤患者中位生存期7．98个月，并且无一例鳞癌脑转移瘤患者生存期〉2年，明显低于NSCLC中腺癌脑转移瘤患者。因此，术后全脑放疗是脑转移瘤患者良好预后因素。结论在选取手术治疗NSCLC脑转移瘤患者时，考虑由预后等级评估所确定的脑转移个数、KPS评分、年龄以及颅外转移有无等4个参数时，也应该把NSCLC组织亚型对术后预后影响考虑在内。

辅助化疗治疗胃癌的疗效评价和影响胃癌预后的多因素分析

分析辅助化疗治疗胃癌的临床疗效与影响预后多因素。方法:回顾性研究把2015年1月~2020年4月本院收治的胃癌患者40例分成两组,对照组行胃癌根治术,观察组行胃癌根治术+辅助化疗,对比临床疗效,分析胃癌预后因素。结果:观察组临床有效率高于对照组(P<0.05);多因素分析,胃癌预后独立因素有辅助化疗、病理类型、术前标志物、侵犯层次、肿瘤大小。结论:胃癌预后的危险因素较多,在胃癌根治术治疗的基础上加入奥沙利铂+替吉奥/卡培他滨辅助化疗,效果显著。

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.

Prognostic factors of T4 gastric cancer patients undergoing potentially curative resection

AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.

Weekend and nighttime effect on the prognosis of peptic ulcer bleeding

AIM:To evaluate whether weekend or nighttime admission affects prognosis of peptic ulcer bleeding despite early endoscopy.METHODS:Retrospective data collection from four referral centers,all of which had a formal out-of-hours emergency endoscopy service,even at weekends.A total of 388 patients with bleeding peptic ulcers who were admitted via the emergency room between January 2007 and December 2009 were enrolled.Analyzed parameters included time from patients' arrival until endoscopy,mortality,rebleeding,need for surgery and length of hospital stay.RESULTS:The weekday and weekend admission groups comprised 326 and 62 patients,respectively.There were no significant differences in baseline characteristics between the two groups,except for younger age in the weekend group.Most patients (97%) had undergone early endoscopy,which resulted in a low mortality rate regardless of point of presentation (1.8% overall vs 1.6% on the weekend).The only outcome that was worse in the weekend group was a higher rate of rebleeding (12% vs 21%,P = 0.030).However,multivariate analysis revealed nighttime admission and a high Rockall score (≥ 6) as significant independent risk factors for rebleeding,rather than weekend admission.CONCLUSION:Early endoscopy for peptic ulcer bleeding can prevent the weekend effect,and nighttime admission was identified as a novel risk factor for rebleeding,namely the nighttime effect.

Overexpression of polo-like kinase1 predicts a poor prognosis in hepatocellular carcinoma patients

AIM： To elucidate the role of overexpressed polo-like kinasel （PLK1）in hepatocellular carcinoma （HCC）. METHODS： We prospectively collected clinicopathological, immunohistochemical and semi-quantitative reverse transcription-polymerase chain reaction （RT-PCR） data from 135 HCC patients undergoing successful hepatectomy. The correlations between PLK1 mRNA expression and clinicopathologic variables were analyzed by Mann-Whitney U test. Prognostic factors were identified by univariate and multivariate analyses. RESULTS： Immunohistochemical results showed overexpression of PLK1 was mainly found in tumor tissues compared with tumor-free tissue. A similar mRNA result was obtained by semi-quantitative RT-PCR. A total of 111 samples were positive for PLK1 mRNA expression. The positive expression was correlated with venous invasion, tumor nodules and Edmondson grade. Furthermore, 1, 3, 5-year survival rates in the positive expression group were significantly lower than the negative control group. Multivariate analysis showed that positive PLK1 expression was an independent risk factor for HCC. CONCLUSION： PLK1 could be a potential biomarker for diagnosis and therapy for HCC.

Advanced duodenal carcinoma:Chemotherapy efficacy and analysis of prognostic factors

Objective This study aimed to determine the ef icacy of chemotherapy and to identify potential chemo-therapy agents to treat advanced primary duodenal carcinoma （PDC）. Methods Seventy-three patients with advanced PDC were included in the study. Response rate （RR）, disease control rate （DCR）, progression-free survival （PFS）, overal survival （OS） and prognosis were com-pared among patients using the Cox proportional hazards model. Results The overal RR and DCR of 52 patients were 21.15% and 69.23%, respectively. The median PFS and OS times were 4.51 and 11.47 months, respectively. Pal iative chemotherapy improved the OS of patients with advanced PDC compared with patients who did not receive chemotherapy （14.28 months vs. 5.20 months, HR = 0.205, 95% CI： 0.077 to 0.547, P = 0.0016）. Multivariate analysis indicated mucinous histology and liver metastasis as factors predictive of poor prognosis in patients with advanced PDC. Conclusion Pal iative chemotherapy may improve the OS of patients with advanced PDC. Mucinous histology and liver metastasis were the main prognostic factors in patients with advanced PDC.

Both the 5th and 6th Editions of TNM Staging System Fail to Independently Predict Long-term Prognosis after Radical Hepatectomy in Hepatocellular Carcinoma Sized > or = 5cm

Objective To validate the predictive power of the 5th and 6th editions of TNM staging system(TNM-5,TNM-6) in a Chinese patient cohort with hepatocellular carcinoma(HCC) sized > or = 5 cm after radical hepatectomy.Methods Consecutive 121 patients with HCC sized > or = 5 cm undergoing radical hepatectomy between January 1995 and December 2002 were included.The impact of clinicopathological variables on prognosis was determined by univariate and multivariate analyses,after excluding 2 perioperative deaths.Results In univariate analysis,TNM-5 stage did not show prognostic significance for overall or disease-free survival,as opposed to TNM-6 stage,Edmondson-Steiner grade,portal vein tumor thrombosis(PVTT),vascular invasion,satellite nodule,Child-Pugh grade,and hepatitis B surface antigen(HBsAg) positivity.When these significant variables were entered in multivariate analysis,Edmondson-Steiner grade was the sole independent prognosticator for both overall and disease-free survival,whereas Child-Pugh grade independently influenced disease-free survival.However,TNM-6 stage lost its predictive potential in multivariate analysis.Conclusions Neither TNM-5 nor TNM-6 staging system is revealed to be independently prognostic in patients with HCC sized > or = 5 cm after radical hepatectomy.Therefore,TNM-6 calls for more support in many subsets of HCC patients.

Novel prognostic score for patients with gastric carcinoma

Objective:The lack of a simple criterion for gastric carcinoma creates a persistent challenge for clinicians trying to provide patients with useful prognostic information.The aim of this study was to identify baseline prognostic factors,and use this information to establish a simple criterion to predict outcome in gastric carcinoma.Methods:Between 2005 and 2010, 155 patients with gastric carcinoma,were enrolled.Clinicopathologic prognostic factors were evaluated by univariate and multivariate analysis.Results:Of the 155 patients,48(30.9%)died.Three independent poor prognostic factors were identified by multivariate analysis:gross type>or=3(hazard ratio[HR],1.564;95%CI,1.067 to 2.294),peritoneal dissemination (HR,3.750;95%CI,1.760 to 7.989)and lymphatic duct invasion(HR,3.578;95%CI,1.422 to 9.004).One point was added for each category among three independent prognostic factors.Prognostic score(PS)was determined by an aggregate of these points for each category.There existed a significant difference between survival of patients with PS 0 or 1 and 2(P< 0.0001).Conclusion:Three poor prognostic factors were identified and a simple criteria was devised.Information from this analysis can be used to predict prognosis of gastric carcinoma with a strict stratification.

A clinical analysis and prognostic study of 62 cases with T1G3 urothelial carcinoma of the bladder

Objective:The aim of our study was to clarify the clinicopathological factors affecting the outcome of T1G3 urothelial carcinoma of the bladder.Methods:We retrospectively reviewed 62 cases of T1G3 bladder cancer treated with transuretheral resection of bladder toumor (TURBT) followed by intravesical instillation between 1997 and 2009.Cumulative survival was analyzed by Kaplan-Meier method.Cox regression was used for univariate and multivariate analysis.Log-rank method was used for the significance test.The statistical difference was accepted when the P value was lower than 0.05.Results:Median follow-up period was 40 months (6-140 months).Forty-one cases of intravesical recurrence (66%) were observed during follow-up.Two-and 5-year recurrence-free survival rates were 43.4% and 35.1%.Fourteen cases of progression (23%) were observed during the follow-up period.Two-and 5-year progression-free survival rates were 86.4% and 83.5%,respectively.Significant factors for tumor recurrence and progression were analyzed by Cox regression.Tumor multiplicity (RR=2.250),size (RR=1.039) and history of recurrence (RR=2.162) were significantly correlated with recurrence and tumor multiplicity (RR=3.695) was significantly correlated with progression on multivariate analysis.Conclusion:Tumor multiplicity,size,history of recurrence were correlated with recurrence and tumor multiplicity was significantly correlated with progression.Tumor multiplicity,size and history of recurrence should be taken into account when we make therapy strategies for T1G3 urothelial carcinoma of the bladder.

Prognostic factors for the survival of 66 cases with extensive stage-small cell lung cancer

Objective The objective of this retrospective study was to investigate the prognostic factors associated with survival among patients with extensive stage-smal cel lung cancer （ES-SCLC）. Methods Clinical data from 66 patients with ES-SCLC diagnosed via histopathology or cytology between July 2005 and July 2009 at Anyang Tumor Hospital （China） were analyzed. Univariate and multivariate Kaplan-Meier, log-rank, and Cox proportional hazard regression analyses were conducted. Results The 12-, 24-, and 36-month survival rates among patients with ES-SCLC were 40.9%, 13.6%, and 6.1%, respectively. The median survival time （MST） was 10 months. Univariate analyses indicated that weight loss, eficacy of first-line chemotherapy, total number of chemotherapy cycles, treatment meth-od, and serum sodium levels significantly influenced survival among patients with ES-SCLC. Multivariate analyses suggested that the eficacy of first-line chemotherapy, total number of chemotherapy cycles, and serum sodium levels were independent prognostic factors associated with survival. Conclusion The eficacy of first-line chemotherapy, total number of chemotherapy cycles, and serum sodium levels are important prognostic factors for patients with ES-SCLC.

肺癌脑转移瘤放疗方案比较临床疗效及预后分析

目的：比较同期推量放射治疗（simultaneousintegratedboostintensity-modulatedradiotherapy，SIB）和全脑照射＋三维适形放射治疗（wholebrainirradiation＋three-dimensionalconformalradiotherapy，WBRT＋3D-CRT）序贯治疗2种方法治疗肺癌脑转移瘤患者的临床资料，并分析影响预后的因素。方法：收集2008—02—01—2010—02—01在我院行SIB（研究组）56例和wBRT＋3D-CRT序贯治疗（对照组）55例的肺癌脑转移瘤患者临床资料。总结与患者预后的相关因素。结果：研究组完全缓解（CR）为71．4％（40／56），对照组为45．5％（25／55），差异有统计学意义，P=0．005。研究组平均住院时间为24d，对照组为44d，差异有统计学意义，P〈O．001。研究组0～3级急性放疗反应分别为43、8、4和1例，对照组分别为44、6、3和2例，差异无统计学意义，P=0．730。2组均无4级急性放疗反应发生。研究组1、2和3年生存率分别为64．3％、32．1％和10．7％，对照组分别为34．5％、20．0％和5．5％，差异有统计学意义，P=0．008。单因素和多因素分析结果均显示，大体肿瘤体积（grosstumorvolume，GTV）、原发灶控制或脑外其他部位转移情况和放疗方法等是影响肺癌脑转移瘤患者预后的因素。结论：SIB能提高肺癌脑转移瘤完全缓解率、缩短住院时间，是影响肺癌脑转移瘤患者预后的独立因素，为肺癌脑转移瘤患者提供了一个简单、精确、周期短和疗效好的放疗方法。

多发脑转移瘤手术治疗临床病理回顾性分析

目的探讨手术治疗多发脑转移瘤的临床疗效并分析影响其预后的因素。方法收集天津医科大学肿瘤医院2002-01-01-2012-12-01于我院行开颅手术治疗的62例多发脑转移瘤患者的临床资料。原发病灶明确者61例,其中肺癌32例,乳腺癌12例,消化道肿瘤6例,恶性黑色素瘤4例,生殖系统肿瘤3例,肾癌2例,甲状腺癌2例,原发灶不明1例。总结手术治疗效果及与患者预后的相关因素。结果术前有神经症状及体征的54例患者术后症状和体征消失或改善50例(92.6%),无明显改善4例(7.4%),无加重及死亡病例,术前无神经症状及体征的8例患者术后未出现手术相关神经症状和体征。生存期与生存率从脑转移诊断日起计算,中位生存期为12.0个月,1、2和3年生存率分别为54.8%、17.7%和4.8%。单因素分析显示,脑转移瘤数目(χ2=14.936,P<0.001)、颅外其他部位转移情况(χ2=6.382,P=0.012)、脑转移术前放疗与否(χ2=4.192,P=0.041)、术后化疗与否(χ2=3.397,P=0.006)、脑转移治疗分组(χ2=9.178,P=0.027)等对生存期有影响;多因素分析显示,脑转移瘤数目(P=0.001)、颅外其他部位转移情况(P=0.047)、脑转移术前放疗与否(P<0.001)、脑转移瘤的治疗分组(P=0.001)是影响多发脑转移瘤患者手术治疗的独立预后因素。手术+放化疗组中位生存期为15.0个月分别与单纯手术组的9.0个月(χ2=6.569,P=0.010)和手术+放疗组的12.0个月(χ2=7.158,P=0.007)相比差异有统计学意义。结论手术能明显缓解多发脑转移瘤患者的临床症状,提高患者的生存质量;对于原发肿瘤控制、无颅外其他部位转移、颅内转移灶数目≤3个和已行头颅放疗的多发脑转移瘤患者更能从手术中获益,手术联合放化疗等综合治疗可进一步延长患者的生存期。