常规加IMRT推量放疗联合化疗治疗高分级胶质瘤的疗效和 预后因素(英文)

Objective:The aim of the study was to retrospectively evaluate the outcomes and important prognostic factors for patients with high-grade gliomas (HGG) treated with conventional radiotherapy (RT) followed by IMRT as a boost in com- bination with chemotherapy. Methods: From November 2004 to November 2006,112 consecutive patients with high-grade gliomas were treated with radiotherapy,which included initial conventional radiotherapy and an IMRT boost to a total dose of 57.5–62.5 Gy,with 27-29 fractions delivered over 37–45 days. All cases received 3-6 cycles of chemotherapy,63 cases received temozolomide,and another 49 cases received methyl-CCNU and teniposide. The acute and late treatment toxicities and the patterns of treatment failure were recorded. The overall survival (OS) rate and progression-free survival (PFS) rate were calculated,and the prognostic factors were analyzed. Results: Most of the acute radiation reactions were grade 1 or 2. No grade 4 acute reactions were noted. Three cases developed radiation necrosis. Grades I,II,and III myelosuppressions were observed in 5,32,and 12 cases of 49 patients treated with teniposide and methyl-CCNU,respectively. Grades I and Ⅱ myelosuppressions were observed in 15 and 3 of the 6 3 patients who were treated with temozolomide,respectively. The 57 cases (50.9%) had recurred locally,and 13 cases (11.6%) had intracranial dissemination. The OS rates at 1,2,and 3 years were 78.9%,54.7%,and 30.8%,respectively. The PFS rates at 1,2,and 3 years were 63.8%,38.9%,and 10.5%,respectively. A multivariate analysis showed that only tumor location and KPS were prognostic factors of OS. These same two variables and histopathology were statistically significant predictive factors in a multivariate analysis for PFS. Conclusion:Radiation toxicities were not found to be increased in this retrospective study with 112 consecutive patients of combined modality therapy including an IMRT boost treatment for HGG. Higher rate of local regional dissemination within the brain was observed than before. Tumor location,histopathology and KPS were important prognostic factors.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

BackgroundThe 左 atrial 尺寸被看作了不利心血管的结果的一个有用标记。然而，左 atrial 区域索引(LAAI ) 是否与不稳定的心绞痛(UAP ) 在病人为预后有预兆的价值，不是众所周知的。这研究被瞄准估计在 LAAI 之间的协会，在 UAP patients.MethodsWe 的结果注册了作为 UAP 诊断的 391 个在里面医院病人的一个总数。临床并且在基线的 echocardiographic 数据被收集。病人是跟随的 for&#x000a0； adverse&#x000a0 的发展； cardiovascular&#x000a0；(CV ) 事件，为心绞痛的包括的医院重新接纳，尖锐心肌的梗塞(AMI ) ，充血的心失败(CHF ) ，击和所有原因 mortality.ResultsDuring 26.3 &#x000b1 的一吝啬的后续时间；8.6 个月， 98 个不利 CV 事件发生了(为心绞痛，四 AMI，四 CHF，一中风和五所有原因死亡的 84 医院重新接纳) 。在一个 multivariate 考克斯模型， LAAI [或：1.140， 95% CI：1.016-1.279， P = 0.026 ] ，心脏舒张的血压(或：0.976， 95% CI：0.956-0.996， P = 0.020 ) 并且脉搏压力(或：1.020， 95% CI：1.007-1.034， P = 0.004 ) 为在 UAP patients.ConclusionsLAAI 的不利 CV 事件的独立预言者是独立于的不利 CV 事件的一个预言者临床并且在 UAP 病人的另外的 echocardiographic 参数。

Recurrence in node-negative advanced gastric cancer:Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series

AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.

Doublecortin and CaM kinase-like-1 as an independent prognostic factor in patients with resected pancreatic carcinoma

AIM To elucidate the effect of expression of doublecortin and Ca M kinase-like-1(DCLK1) in patients with pancreatic ductal adenocarcinoma(PDAC). METHODS Tumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition(EMT) marker expression, and cancer stem cell(CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker.RESULTS In total, 48.5%(66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors(median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade(P = 0.0290), preoperative CA19-9 level(P = 0.0060), epithelial cell adhesion molecule(Ep CAM) expression(P = 0.0235), and the triple-positive expression of CD44/CD24/Ep CAM(P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4(P = 0.0091), high preoperative serum SPan-1 level(P = 0.0034), R1/2(P < 0.0001), positive expression of DCLK1(P < 0.0001) or CD44(P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio(OR) = 2.019, 95% confidence interval(CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression(OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors. CONCLUSION DCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.

Where does chemotherapy stands in the treatment of ampullary carcinoma? A review of literature

Ampullary carcinoma(AC) is a rare gastrointestinal tumor without clear treatment recommendations.The management of this tumor is usually extrapolated from the treatment of pancreatic,biliary duct and intestinal cancers.Few papers have studied the AC as an independent entity and yet succombs to several limitations.These studies were retrospective single institutional experiences with limited sample sizes recruited over a long period of time.Unlike metastatic ACs where chemotherapy is the only recommended option,localized AC once excised may be approached by either chemotherapy alone or concomitant chemoradiation therapy.In this review,we report the overall survival and recurrence factors of more than 1000 patients from all the studies treating exclusively ACs.We also review the medical treatment of this tumor and conclude to the necessity of multi-institutional randomized controlled studies for AC exclusively.

Imbalanced expression of mitogen-activated protein kinase phosphatase-1 and phosphorylated extracellular signal-regulated kinases in lung squamous cell carcinoma

Objective:Mitogen-activated protein kinases (MAPKs) are correlated with a more malignant phenotype in many cancers.This study was designed to evaluate the predictive value of the expression of MAPK phosphatase-1 (MKP-1) and phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK 1/2),as the key regulatory mechanism of the MAPKs,in lung squamous cell carcinoma (SCC).Methods:We assessed the expressions of MKP-1 and p-ERK 1/2 in twenty subjects at different differentiation degree of SCC and five normal lungs by immunohistochemistry and real-time reverse transcriptase polymerase chain reaction (RT-PCR) analysis.Results:Immunohistochemistry and real-time RT-PCR assay showed that the expression of MKP-1 was gradually decreased as tissue type went from normal lung tissues to increasingly undifferentiated carcinoma,and it was negatively correlated with tumor differentiation (P<0.01).However,the expression of p-ERK 1/2 or ERK 1/2 was gradually increased as tissue type went from normal lung tissues to increasingly undifferentiated carcinoma,and it was positively correlated with tumor differentiation (P<0.01).Conclusions:Our data indicates the relevance of MKP-1 and p-ERK 1/2 in SCC as a potential positive and negative prognostic factor.The imbalanced expression of MKP-1 and p-ERK 1/2 may play a role in the development of SCC and these two molecules may be new targets for the therapy and prognosis of SCC.