Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

DLGAP5在肝细胞癌中的表达及临床意义

目的:探讨Discs大同源物相关蛋白5(Discs large homolog associated protein 5,DLGAP5)在肝细胞癌(hepatocellular carcinoma,HCC)中的表达及其临床意义。方法:采用免疫组化法检测144对肝细胞癌组织和对应的癌旁组织样本中DLGAP5蛋白的表达,分析其表达与患者临床病理特征的关系,绘制Kaplan-Meier生存曲线分析DLGAP5表达对患者预后的影响。结果:肝细胞癌组织中DLGAP5表达阳性率77.8%,高于癌旁组织的阳性率38.9%,差异有统计学意义(P<0.01)。DLGAP5表达与肿瘤直径、TNM分级、脉管癌栓及肿瘤包膜完整性有关(均P<0.05),而与患者性别、年龄、乙型肝炎表面抗原、肝硬化及远处转移无关(均P>0.05)。Kaplan-Meier生存曲线分析显示,DLGAP5高表达组患者总生存率显著低于DLGAP5低表达组患者,差异具有统计学意义(P<0.05)。结论:DLGAP5蛋白在肝细胞癌中表达增高,其高表达与患者的预后不良有关。

单中心卵巢癌患者5年生存率随访报告

目的:分析单一妇科肿瘤中心卵巢癌患者的生存情况,为卵巢癌诊治工作提供有用经验。方法:汇总2011年至2016年于山东大学齐鲁医院接受治疗的920例卵巢癌患者的临床数据及随访信息,所有患者随访周期超过5年或5年内出现不良结局事件,分析患者预后情况。结果:2011年至2016年本中心卵巢癌患者总体5年生存率为50.8%。结论:山东大学齐鲁医院卵巢癌患者总体5年生存率显著改善。

Thirty-one patients with primary hepatocellular carcinoma survived for more than 5 years after hepatectomy

Objective: To investigate the factors affecting progno- sis of patients with primary hepatocellular carcinoma (PHC) after resection. Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had sur- vived for more than 5 years were compared with 56 patients who had survived for less than 5 years. Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, pre- sence of cirrhosis and tumor size were important fac- tors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group. Conclusions: Early detection of tumor and radical re- section are of value in raising the 5-year survival rate. Much remains to be investigated about the rela- tionship between safe margin distance and prognosis of patients with PHC.

浙江省台州市胆囊癌5年相对生存率(2014-2018年):基于周期法分析

目的本研究旨在提供浙江省台州市胆囊癌最新5年相对生存率总体及分层数据。方法选择浙江省台州市4个具有高质量数据的肿瘤登记处2004—2018年期间诊断为胆囊癌并随访至2018年12月31日的病例及其随访信息。采用周期法分析2014—2018年胆囊癌总体及按诊断年龄、性别、地区分层的5年相对生存率,并评估15年期间(2004—2018年)的5年相对生存率的变化趋势。结果2004—2018年期间台州市4个肿瘤登记处胆囊癌患者共计914例。2014—2018年5年相对生存率为29.1%,分层分析显示,男性患者5年相对生存率明显低于女性患者(24.3%vs 30.2%),并呈现明显的年龄梯度:5年相对生存率从35.7%(≤54岁组)逐步下降到25.8%(>74岁组);城镇患者5年相对生存率高于农村患者(30.4%vs 28.3%)。15年期间(2004—2018年)胆囊癌患者5年相对生存率的总体及分层(性别、诊断年龄和城乡)数据均呈明显上升趋势。结论本研究发现浙江省台州市胆囊癌患者5年相对生存率(2004—2018年)已达29.1%,并且最近15年期间的5年相对生存率呈现明显上升趋势,为制订胆囊癌预防和控制政策及干预措施提供了重要依据。

手术切除联合植入5-氟尿嘧啶治疗局部区域复发乳腺癌患者的效果

目的:观察手术切除联合植入5-氟尿嘧啶(5-FU)治疗局部区域复发乳腺癌患者的效果。方法:选取2015年3月至2019年3月该院收治的96例局部区域复发乳腺癌患者进行前瞻性研究,按照摸球法将其分为观察组与对照组各48例。对照组行切除手术治疗,观察组在对照组基础上联合植入5-FU治疗,比较两组手术前后T细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+))水平和自然杀伤细胞(NK)水平,术后1年、3年复发率、生存率和并发症发生率。结果:手术前后,两组CD3^(+)、CD4^(+)、CD8^(+)和NK细胞水平比较,差异无统计学意义(P>0.05);术后1年,观察组复发率为10.42%,明显低于对照组的27.08%,差异有统计学意义(P<0.05);术后3年,观察组复发率为25.00%,明显低于对照组的45.83%,差异有统计学意义(P<0.05);术后1年,两组生存率比较,差异无统计学意义(P>0.05);术后3年,观察组生存率为91.67%,明显高于对照组的75.00%,差异有统计学意义(P<0.05);住院期间,两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:手术切除联合植入5-FU治疗局部区域复发乳腺癌患者可提高3年生存率和降低复发率,效果优于单纯手术切除。

Chronic disease and its therapeutic drugs may effect on the postoperative 5-year survival rate of lung cancer patients

In this study, we aimed to investigate the influencing factors of postoperative 5-year survival rate in non small-cell lung cancer（NSCLC） patients with stage I–III. We enrolled 220 patients who underwent surgical operation and survived longer than 3 months, with histologically confirmed adenocarcinoma or squamous cell carcinoma from Jan. 2009 to Dec. 2009. Multiple variables, like age, gender, smoking, alcohol, obesity, family history of cancer, diabetes, hypertension, antidiabetic drugs, tumor staging, pathology, treatments, surgical side as well as lipid levels, were selected. We found that tumor staging was associated with 5-year survival rate of stage I–III NSCLC patients by univariate analysis. Furthermore, diabetes mellitus, hypertension and surgical side were associated with the overall survival of NSCLC patients with stage I, stageⅡand stage III, respectively. In conclusion, the status of chronic disease had potential effect on the postoperative 5-year survival rate of lung cancer patients.

新辅助化疗对胃癌5年生存率影响的Meta分析

目的应用Meta分析的方法探讨术前新辅助化疗对胃癌5年生存率的影响。方法通过Pubmed、Cochrane图书馆、EMBASE、Ovid检索系统、Google搜索引擎及手工检索有关胃癌新辅助化疗的临床对照研究。按纳入排除标准进行筛选,并对入选研究的文献进行质量评价,提取资料进行Meta分析。结果 2000～2007年共8项随机对照试验1 510例胃癌患者纳入分析,其中新辅助化疗后手术治疗组718例,直接手术组792例。Meta分析结果显示新辅助化疗后手术与直接手术相比,死亡风险优势比(OR)值为0.67,95%可信区间为0.53～0.83,P=0.000 3,差异有统计学意义。结论与直接手术相比,手术前行新辅助化疗与提高患者5年生存率有一定相关性。

诊断技术进步对肿瘤特异性死亡率、发病率及5年生存率的影响

目的探讨诊断技术进步对肿瘤发病率、死亡率和5年生存率带来的影响。方法检索美国SEER数据库和美国肿瘤报告年签,汇编前列腺癌和肾癌的发病率、死亡率及5年生存率统计指标。结果诊断技术进步带来发病率升高和5年生存率增高。结论诊断技术进步对肿瘤流行病学指标带来影响。5年生存率的延长可能夸大肿瘤治疗效果。

新辅助化疗对80例Ⅲ期乳腺癌患者5年生存率的回顾性分析

目的 进一步探讨新辅助化疗对Ⅲ期乳腺癌的临床疗效及 5年生存率的影响。方法 将手术后的 80例Ⅲ期乳腺癌分为A组、B组。A组为CMF方案化疗 3周期后 ,1周内手术 ,B组为术前未施化疗组。手术均为改良根治术 ,术后常规综合治疗。结果 A组 5年生存率 (73% ) ,明显高于B组 (2 9% ) ,差异具有显著性P <0 .0 5。化疗有效组 5年生存率高于化疗无效组。

52例老年上皮性卵巢癌病人的临床特点及预后相关因素分析

目的探讨老年上皮性卵巢癌病人的预后相关因素及5年生存率。方法回顾性分析2010~2012年于我院初治的52例上皮性卵巢癌老年病人的临床资料,采用卡方检验进行单因素分析,采用Cox比例风险模型进行多因素分析。结果 52例老年病人的总体5年生存率为42.31%,Ⅰ~Ⅱ期病人的5年生存率明显高于Ⅲ~Ⅳ期病人(P<0.05),分别为84.21%、18.18%;手术残留灶<1 cm的病人5年生存率显著高于残留灶≥1 cm的病人(P<0.05),分别为56.76%、6.67%;化疗疗程≥6个周期的病人5年生存率明显高于化疗疗程<6个周期的病人(P<0.05),分别为50.00%、46.30%。多因素分析结果显示手术分期是老年卵巢癌病人预后的独立影响因素。结论手术分期、残留灶大小、化疗疗程等可影响病人预后,其中手术病理分期是老年上皮性卵巢癌预后的独立影响因素。

CD15及Ki-67表达水平与乳腺癌患者病理参数及5年存活率的关系分析

目的探讨CD15抗原及Ki-67表达水平与乳腺癌患者病理及5年存活率的关系。方法选取2014年5月-2015年5月我院收治的乳腺癌患者手术切除的癌组织和癌旁组织(距病变部位>5 cm处,且证实为无癌浸润)石蜡标本各90例为研究对象。检测乳腺癌组织中CD15、Ki-67的表达并分析二者与乳腺癌临床病理、5年存活率的关系。结果乳腺癌组织中CD15、Ki-67的阳性表达率高于癌旁组织(P<0.05)。TNM分期Ⅱ~Ⅲ期、合并淋巴结转移的乳腺癌组织CD15、Ki-67的阳性表达率均较高(P<0.05),出现神经侵犯、直径≥2 cm的乳腺癌组织Ki-67的阳性表达率较高(P<0.05)。不同类型的乳腺癌组织Ki-67的阳性表达率比较差异有统计学意义(P<0.05)。乳腺癌组织中CD15、Ki-67表达呈正相关(r=0.406,P=0.008)。本组90例乳腺癌患者的5年总存活率为64.44%(58/90),CD15、Ki-67阳性表达组5年生存率均低于CD15、Ki-67阴性表达组(P<0.05)。结论CD15、Ki-67表达阳性与乳腺癌TNM分期、淋巴结转移有关,Ki-67的阳性表达与乳腺癌的肿瘤类型、大小、神经侵犯相关,二者与乳腺癌患者的5年存活率密切相关。

组蛋白去乙酰化酶5在脑胶质瘤中的表达及临床分析

目的探讨组蛋白去乙酰化酶5在脑胶质瘤中的表达及临床分析。方法收集2012年1月~2015年12月确诊为脑胶质瘤并进行手术治疗留有蜡块标本的患者100例,按照WHO分型Ⅰ~Ⅳ级分为两组,Ⅰ~Ⅱ级属于低级别组,Ⅲ~Ⅳ属于高级别组,每组各50例。采用免疫组织化学法检测HDAC5在脑胶质瘤中的表达和分布。结果低级别组2例死亡,生存率96.0%,高级别组死亡18例,生存率64.0%,明显低于低级别组,差异有统计学意义(χ2=16.324,P<0.05)。高级别组HDAC5表达阳性率显著高于低级别组,差异有统计学意义(P<0.05)。结论 HDAC5蛋白在脑胶质瘤细胞中的表达与胶质瘤的病理级别、肿瘤分化及患者生存周期可能具有相关性。

铕—5—氟尿嘧啶抗肿瘤作用实验观察

本文报道铕-5-氟尿嘧啶对体外培养的人红白血病K_(562)细胞及小鼠白血病L_(1210)细胞,用小孔板法,100.0、50.0、10.0、5.0μg/ml终浓度剂量,24小时后,残留率分别为35.7%、53.6%、68.9%、84.1%及29.6%、48.2%、74.0%、82.4%;对小鼠移值性肿瘤S_(180),用70.0mg/kg剂量,瘤重抑制率为36.2%;用35.0mg/kg剂量,瘤重抑制率为31.5%;铕-5-氟尿嘧啶小鼠单次腹腔注射LD_(50)为343.3～405.9mg/kg。

46例乳腺癌组织Ki-67表达与ER、PR、CerbB-2表达水平、临床病理特征及5年生存率关系的回顾性分析

目的探讨乳腺癌组织Ki-67表达与雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、CerbB-2表达水平、临床病理特征及5年生存率关系。方法比较2010年1月至2011年6月于本院就诊的46例乳腺癌患者的乳腺癌组织和癌旁组织中Ki-67、ER、PR、CerbB-2蛋白表达水平,并分析乳腺癌组织Ki-67表达与ER、PR、CerbB-2表达、临床病理特征及5年生存率的关系。结果乳腺癌组织中Ki-67、ER、PR、CerbB-2蛋白表达阳性率均较癌旁组织升高(P<0.05)。乳腺癌组织Ki-67表达与ER、PR、CerbB-2表达水平,肿瘤直径、淋巴结转移等临床病理特征以及5年生存率均密切相关(P<0.05)。结论乳腺癌组织Ki-67蛋白阳性表达与乳腺癌亚型、临床病理特征及5年生存率均密切相关。

中西医结合治疗对恶性实体瘤患儿5年生存情况的影响

目的探讨中西医结合治疗对恶性实体瘤患儿5年生存情况的影响。方法研究对象为2005年1月~2009年12月首都医科大学附属北京儿童医院收治的恶性实体瘤患儿167例,持续回访5年,回访时间截至2015年1月。将符合纳入标准的患儿采用随机数字表法分为治疗组83例,对照组84例,其中治疗组脱落16例为67例,对照组脱落20例为64例。治疗组常规进行化疗、手术治疗及中药治疗;对照组常规进行化疗及手术治疗。比较两组患儿生存时间、生存情况、复发情况。结果治疗组5年生存率为69.0%,对照组5年生存率为46.7%。两组患儿平均生存时间比较差异有高度统计学意义(P <0.01)。两组患儿复发率比较差异无统计学意义(P> 0.05)。两组患儿无病生存情况比较差异有统计学意义(P <0.05)。结论扶正健脾中药结合西医治疗实体瘤患儿能通过减轻化疗不良反应,顺利完成化疗,延长生存时间,提高其存活率,改善其生存质量。

P53表达与乳腺癌患者复发转移及预后的关系

目的探讨乳腺癌患者活检组织石蜡标本中P53表达的变化及其在监测乳腺癌患者复发转移及预后中的意义。方法采用免疫组化SP染色法和原位杂交法同时检测88例乳腺癌患者的活检组织石蜡标本中P53的表达情况,结合患者的转移复发情况分析P53表达水平与乳腺癌患者预后的关系。结果免疫组化SP染色法结果显示P53高表达者27例,低表达者43例;原位杂交法结果显示P53高表达者28例,低表达者42例。2种检测方法P53高表达符合率为100%。P53高表达者对化疗的敏感性及5年生存率均明显低于P53低表达者(P<0.05),而P53高表达者的复发率、转移率明显高于P53低表达者(P<0.05)。结论P53或可作为评估乳腺癌复发、转移和患者5年生存率的独立指标之一。

Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for longterm survival. In contrast, five-year survival in nonresected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2%(11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11%(11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve longterm survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.