Smaller tumor size is associated with poor survival in T4b colon cancer

AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis(T4b N0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival(CSS).METHODS: We analyzed T4 b N0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results(SEER) database. A preliminary analysis of T4 b N0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.RESULTS: A total of 1734 T4 b N0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size(P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4 b N0 patients(P = 0.024), and a trend of association in T4 b N1(P = 0.182) and T4 b N2 patients(P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4 b N0-2M0 patients(P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.CONCLUSION: Smaller tumor size is associated with poorer CSS in the T4 b N0-2M0 subset of colon cancer, particularly in the T4 b N0M0 subgroup.

Influence of tumor response on the survival of patients with extensive-stage small-cell lung cancer treated with the etoposide plus cisplatin chemotherapy regimen

Objective In this study, we evaluated the difference of progression-free survival （PFS） and overall survival （OS） between extensive-stage small-cell lung cancer （ES-SCLC） patients who acquired partial response （PR） or complete remission （CR） after two cycles of first-line chemotherapy with the etoposide plus cisplatin （EP） regimen and those who acquired PR or CR after four or six cycles. Methods A total of 106 eligible patients treated with the EP chemotherapy regimen for two to six cycles, at The General Hospital of Shenyang Military Region （China） between November 2004 and Way 2011, were enrolled in this study. RECIST version 1.1 was used for the evaluation of chemotherapy efficiency. We followed up all eligible patients every 4 weeks. All statistical data were analyzed by using SPSS 21.0 statistical package for Windows. Results After a median follow-up of 293 days （range, 62-1531 days）, all patients had died by the cutoff date. Fifty-one patients acquired PR or CR after two cycles of chemotherapy; the median PFS reached 6.0 months （95% CI, 5.1-6.9）, and the median OS was 10.5 months （95% CI, 8.6-12.4）. Twenty-eight patients acquired PR or CR after four or six cycles; the median PFS was 4.8 months （95% CI, 4.4-5.2）, and the median OS was 7.5 months （95% CI, 6.8-8.2）. Both PFS and OS showed a statistical difference between the two groups. Conclusion ES-SCLC patients who acquired PR or CR after two cycles of the EP regimen as first-line therapy had longer PFS and OS than those who acquired PR or CR after four or six cycles.

Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center

The local recurrence rate of phyllodes tumors of the breast varies widely among different subtypes, and distant metastasis is associated with poor survival. This study aimed to identify factors that are predictive of local recurrence-free survival(LRFS), distant metastasis-free survival(DMFS), and overall survival(OS) in patients with phyllodes tumors of the breast. Clinical data of all patients with a phyllodes tumor of the breast(n = 192) treated at Sun Yat-sen University Cancer Center between March 1997 and December 2012 were reviewed. The Pearson χ2 test was used to investigate the relationship between clinical features of patients and histotypes of tumors. Univariate and multivariate Cox regression analyses were performed to identify factors that are predictive of LRFS, DMFS, and OS. In total, 31(16.1%) patients developed local recurrence, and 12(6.3%) developed distant metastasis. For the patients who developed local recurrence, the median age at the diagnosis of primary tumor was 33 years(range, 17-56 years), and the median size of primary tumor was 6.0 cm(range, 0.8-18 cm). For patients who developed distant metastasis, the median age at the diagnosis of primary tumor was 46 years(range, 24-68 years), and the median size of primary tumor was 5.0 cm(range, 0.8-18 cm). In univariate analysis, age, size, hemorrhage, and margin status were found to be predictive factors for LRFS(P = 0.009, 0.024, 0.004, and 0.001, respectively), whereas histotype, epithelial hyperplasia, margin status, and local recurrence were predictors of DMFS(P = 0.001, 0.007, 0.007, and < 0.001, respectively). In multivariate analysis, independent prognostic factors for LRFS included age [hazard ratio(HR) = 3.045, P = 0.005], tumor size(HR = 2.668, P = 0.013), histotype(HR = 1.715, P = 0.017), and margin status(HR = 4.530, P< 0.001). Histotype(DMFS: HR = 4.409, P = 0.002; OS: HR = 4.194, P = 0.003) and margin status(DMFS: HR = 2.581, P = 0.013; OS: HR = 2.507, P = 0.020) were independent predictors of both DMFS and OS. In this cohort, younger age, a larger tumor size, a higher tumor grade, and positive margins were associated with lower rates of LRFS. Histotype and margin status were found to be independent predictors of DMFS and OS.

Prognostic significance of primary tumor localization in stage Ⅱ and Ⅲ colon cancer

AIM To investigate the effects of tumor localization on disease free survival(DFS) and overall survival(OS) in patients with stage Ⅱ-Ⅲ colon cancer.METHODS This retrospective study included 942 patients with stage Ⅱ and Ⅲ colon cancer, which were followed up in our clinics between 1995 and 2017. The tumors from the caecum to splenic flexure were defined as right colon cancer(RCC) and those from splenic flexure to the sigmoid colon as left colon cancer(LCC).RESULTS The median age of the patients was 58 years(range: 19-94 years). Male patients constituted 54.2%. The rates of RCC and LCC were 48.4%(n = 456) and 51.6%(n = 486), respectively. During the median follow-up of 90 mo(range: 6-252 mo), 14.6% of patients developed recurrence and 9.1% of patients died. In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, DFS was similar in terms of primary tumor localization(stage Ⅱ; P = 0.547 and P = 0.481, respectively; stage Ⅲ; P = 0.976 and P = 0.978, respectively). In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, OS was not statistically significant with respect to primary tumor localization(stage Ⅱ; P = 0.381 and P = 0.947, respectively; stage Ⅲ; P = 0.378 and P = 0.904, respectively). The difference between median OS of recurrent RCC(26 ± 6.2 mo) and LCC(34 ± 4.9 mo) cases was eight months(P = 0.092).CONCLUSION Our study showed no association of tumor localization with either DFS or OS in patients with stage Ⅱ or Ⅲ colon cancer managed with or without adjuvant therapy. However, post-recurrence OS appeared to be worse in RCC patients.

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity.However,false positive lesions might incorrectly influence treatment decisions.Therefore,preoperative biopsies must be performed to avoid unnecessary surgery.Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors.However,the rate of local recurrences is usually low after breast conservative treatment(BCT) of MC/MF tumors.It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years,with small tumors and absence of extensive ductal carcinoma in situ.A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial.Surgery should achieve both acceptable cosmetic results and negative margins,which requires thorough preoperative radiological workup and localization of lesions.Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity,namely fibrosis.In conclusion,BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists,surgeons and radiotherapists.

Systematic literature review of the antitumor effect of octreotide in neuroendocrine tumors

AIM To provide a comprehensive examination of the existing evidence of the antitumor effect of long-acting octreotide in neuroendocrine tumors(NETs).METHODS A systematic literature review of clinical trials and observational studies was conducted in PubM ed, EMBASE, and Cochrane through January 18, 2017. Conference abstracts for 2015 and 2016 from 5 scientific meetings were also searched.RESULTS Of 41 articles/abstracts identified, 13 unique studies compared octreotide with active or no treatment. Two of the 13 studies were clinical trials; the remaining were observational studies. The phase 3 Placebo-Controlled, Double-Blind, Prospective, Randomized Study of the Effect of Octreotide long-acting repeatable(LAR) in the Control of Tumor Growth in Patients with MetastaticNeuroendocrine Midgut Tumors clinical trial showed that long-acting octreotide significantly prolonged time to tumor progression compared with placebo in patients with functionally active and inactive metastatic midgut NETs; no statistically significant difference in overall survival(OS) was observed, possibly due to the crossover of placebo patients to octreotide. Retrospective observational studies found that long-acting octreotide use was associated with significantly longer OS than no octreotide use for patients with distant metastases although not for those with local/regional disease. CONCLUSION The clinical trial and observational studies with informative evidence support long-acting octreotide's antitumor effect on time to tumor progression and OS. This review showed the rarity of existing studies assessing octreotide's antitumor effect and recommends that future research is warranted.

新辅助化疗对局部晚期食管癌循环肿瘤细胞及生存率的影响

目的探讨新辅助化疗(neoadjuvant chemotherapy,NAC)联合手术对局部晚期食管癌循环肿瘤细胞及生存率的影响。方法选取2010-08至2015-08在医院接受治疗的局部晚期食管癌110例,随机分为观察组和对照组,每组55例。观察组于术前给予NAC后行手术治疗,对照组单纯行手术治疗。采用免疫富集法和免疫荧光染色技术鉴别分离外周血中循环肿瘤细胞(circulating tumor cells,CTC),分别于治疗前和治疗后3、6、12、24、36个月检测CTC值。随访3年并记录两组的近期生存率。结果治疗前两组患者外周血中的CTC值差异无统计学意义。治疗后1、2、3年内,观察组外周血中的CTC值分别为6. 88、6. 56、7. 20;对照组为12. 8、13. 0、13. 2,观察组显著低于对照组,差异有统计学意义(P <0. 05)。观察组术后1、2、3年生存率分别为96. 36%、89. 09%、65. 45%;明显高于对照组的78. 18%,56. 36%,34. 55%,差异有统计学意义(P <0. 05)。结论 NAC联合手术可提高局部晚期食管癌患者的近期疗效、降低肿瘤恶性程度,提高患者近期生存率。

Oncological outcomes and predictors of radiofrequency ablation of colorectal cancer liver metastases

BACKGROUND Surgical resection is considered the standard treatment option for long-term survival in colorectal cancer liver metastasis(CRLM)patients,but only a small number of patients are suitable for resection following diagnosis.Radiofrequency ablation(RFA)is an accepted alternative therapy for CRLM patients who are not suitable for resection.However,the relatively high rate of local tumor progression(LTP)is an obstacle to the more widespread use of RFA.AIM To determine the oncological outcomes and predictors of RFA in CRLM patients.METHODS A retrospective analyze was performed on the clinical data of 85 consecutive CRLM patients with a combined total of 138 liver metastases,who had received percutaneous RFA treatment at our institution from January 2013 to December 2018.Contrast-enhanced computed tomography was performed the first month after RFA to assess the technique effectiveness of the RFA and to serve as a baseline for subsequent evaluations.The Kaplan-Meier method was used to calculate overall survival(OS)and LTP-free survival(LTPFS).The log-rank test and Cox regression model were used for univariate and multivariate analyses to determine the predictors of the oncological outcomes.RESULTS There were no RFA procedure-related deaths,and the technique effectiveness of the treatment was 89.1%(123/138).The median follow-up time was 30 mo.The LTP rate was 32.6%(45/138),and the median OS was 36 mo.The 1-,3-,and 5-year OS rates were 90.6%,45.6%,and 22.9%,respectively.Univariate analysis revealed that tumor size and ablative margin were the factors influencing LTPFS,while extrahepatic disease(EHD),tumor number,and tumor size were the factors influencing OS.Multivariate analysis showed that tumor size larger than 3 cm and ablative margin of 5 mm or smaller were the independent predictors of shorter LTPFS,while tumor number greater than 1,size larger than 3 cm,and presence of EHD were the independent predictors of shorter OS.CONCLUSION RFA is a safe and effective treatment method for CRLM.Tumor size and ablative margin are the important factors affecting LTPFS.Tumor number,tumor size,and EHD are also critical factors for OS.

局部皮瓣在面部软组织缺损修复中的应用

目的:探讨局部皮瓣美容修复面部皮肤软组织缺损的临床效果。方法:选取2016年2月-2019年10月收治的头面部肿物、瘢痕、外伤患者60例,根据面部软组织缺损部位、面积设计局部皮瓣美容修复,观察患者皮瓣修复效果、心理变化及患者满意度及复发情况。结果:皮瓣成活良好切口愈合,术后患者SDS评分、SAS评分均低于术前,差异有统计学意义(P<0.05)。随访12个月,58例患者的皮瓣与周边皮肤组织厚度、色泽无明显差异,无牵拉及不对称,外观与功能修复效果满意,满意度为96.67%;仅2例患者复发,复发率为3.33%。结论:局部皮瓣美容修复面部皮肤软组织缺损,操作简单,修复皮瓣的性状与缺损处相似,瘢痕小,安全性高,患者满意度高,值得临床应用。

缩短疗程化疗治疗儿童青少年局限期尤文氏肉瘤家族肿瘤的研究

目的局限型尤文氏肉瘤家族肿瘤(ESFT)合适的化疗疗程数尚未确定。本研究探讨8个疗程化疗联合局部治疗对儿童青少年局限期ESFT的疗效,并分析局部治疗方式对预后的影响。方法 2002年3月至2010年3月在中山大学肿瘤防治中心收治的46例儿童、青少年局限期ESFT入组。所有患者均接受CDV/IE交替方案8个疗程的化疗,每3周重复。CDV化疗包括环磷酰胺(1000 mg/m^2,d1)、长春新碱(1.5 mg/m^2,d1)、阿霉素(50 mg/m^2,d1);IE化疗包括异环磷酰胺(1.5 g/m^2,d1-5)、足叶乙甙(100 mg/m^2,d1-5)。局部治疗采用手术和(或)放疗。结果 46例患者中位年龄11岁(8个月~19岁)。男34例,女12例。肿瘤位于躯干17例,头颈15例,四肢12例,腹膜后2例。骨尤文氏肉瘤24例,骨外尤文氏肉瘤22例。35例局部晚期患者接受术前化疗,化疗客观有效率为88.6%。11例先行手术完整切除后化疗。局部治疗方式为手术加放疗19例,单纯手术13例和单纯放疗14例。中位随访64个月,全组5年无事件生存率(EFS)和总生存率(OS)分别为67.0%±7.0%和73.6%±6.5%。局部治疗采用手术加放疗、单纯手术和单纯放疗的患者的5年EFS分别为73.7%±10.1%、61.5%±13.5%和62.5%±13.5%(P>0.05)。局部早期和局部晚期患者5年EFS分别为79.5%±13.1%和62.9%±8.2%(P>0.05)。随访结束时,无心脏毒性或第二肿瘤发生。结论 8个疗程化疗联合有效的局部治疗对于局限期儿童青少年ESFT患者可获得较好的生存率。

手术联合新辅助化疗对局部晚期食管癌患者的疗效及生存时间研究

目的评估手术联合新辅助化疗治疗局部晚期食管癌的疗效及生存时间。方法收集2010年4月~2012年2月间本院收治的局部晚期食管癌患者88例,按照随机数表法将入组患者分为对照组(n=44)、观察组(n=44)。对照组患者接受常规手术治疗,观察组患者接受新辅助化疗联合手术治疗,对比两组术前、术后3月血清肿瘤标志物及血管新生指标的含量差异,进行随访并记录两组患者的中位生存时间及1年、5年生存率。结果术前,两组患者血清肿瘤标志物、血管新生指标含量的差异无统计学意义(P>0.05)。术后3月,观察组患者血清肿瘤标志物YY1、TSGF、Cyfra21-1以及血管新生指标TGF-β1、VEGF、MMP-9的含量均显著低于对照组患者(P<0.05)。随访期间,观察组患者的中位生存时间长于对照组患者,术后1年、5年生存率高于对照组患者(P<0.05)。结论新辅助化疗联合手术治疗局部晚期食管癌,可降低肿瘤恶性程度,延长患者生存时间。

进展期肝细胞癌采取放疗辅以体外局部高热热疗对疗效、生存期的影响

目的探析为进展期肝细胞癌患者采取放疗辅以体外局部高热热疗对患者病情疗效及生存期的影响。方法纳入2019年1月至2020年1月在本院接受治疗被确诊为进展期肝细胞癌患者60例,以随机数字表法将患者分为对照组、观察组,各30例。对照组单纯用放疗治疗,观察组配合体外局部高热热疗干预措施。在为期12个月随访后对两组患者疗效、肝功能指标、血清肿瘤标志物、相关不良反应以及生存期情况进行比较,归纳二者联合治疗对患者的临床价值。结果观察组患者病情有效缓解率高于对照组,差异有统计学意义(P<0.05)。治疗前,观察组患者血浆丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清总胆红素(TBIL)指标,差异无统计学意义(P>0.05);观察组患者治疗后各项肝功能指标低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血清甲胎蛋白(AFP)、甲胎蛋白异质体L3(AFP-L3)、高尔基糖蛋白-73(GP73)、血管内皮生长因子(VEGF)指标比较,差异无统计学意义(P>0.05);观察组患者治疗后各项指标低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组患者不良反应事件中放射性肝损伤比例低于对照组,差异有统计学意义(P<0.05)。在末次随访时,观察组患者的生存率高于对照组,差异有统计学意义(P<0.05)。结论对进展期肝细胞癌患者在放疗干预基础上联合体外局部高热热疗对于提升病情控制效果,改善肝功能及肿瘤标志物指标有积极的价值,能有效延长患者的生存期。

Endoscopic full-thickness resection vs surgical resection for gastric stromal tumors: Efficacy and safety using propensity score matching

BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.

射频消融治疗包膜下与非包膜下早期肝细胞癌患者的远期预后

目的基于倾向评分匹配(PSM)比较射频消融(RFA)对包膜下和非包膜下早期肝细胞癌(HCC)患者的长期疗效。方法选取2018年1月至2021年12月河南科技大学第二附属医院收治的接受超声引导下经皮RFA作为一线治疗的143名早期HCC患者为研究对象。将患者分为包膜下组和非包膜下组,使用PSM方法均衡两组间基线信息,评估包膜下位置与RFA治疗结果的相关性,计算并比较两组间局部肿瘤进展(LTP)、无病生存率(DFS)及总生存率(OS)。结果PSM后有47对基线均衡的患者入组。包膜下组1、2和3 a的DFS率分别为76%、67%和60%,非包膜下组分别为76%、72%和67%;包膜下组1、2和3 a的OS率分别为95%、92%和89%,非包膜下组分别为98%、95%和91%。邻近包膜下并不是影响DFS(HR=1.154,P=0.672)和OS(HR=0.815,P=0.718)的独立危险因素。此外,两组的LTP发生率、严重并发症率、技术成功率、术后住院时间比较差异无统计学意义(P>0.05)。结论RFA治疗包膜下组和非包膜下组HCC的LTP、DFS、OS和严重并发症发生率无显著差异。

基于分子分型的髓母细胞瘤复发相关影响因素分析

目的分析基于分子分型的髓母细胞瘤复发率并筛查其相关危险因素。方法纳入2011年3月至2013年11月首都医科大学附属北京天坛医院收治并经术后病理证实的67例髓母细胞瘤患者,均行MRI检查(包括肿瘤部位、肿瘤浸润程度、肿瘤播散、肿瘤分期、手术切除程度)以及病理学检查(包括组织学分型和分子分型),记录复发率。绘制Kaplan-Meier生存曲线,采用单因素和多因素Cox回归分析筛查髓母细胞瘤复发相关危险因素。结果共67例髓母细胞瘤患者,总生存率为71.64%(48/67),无进展生存率为67.16%(45/67)、复发率为32.84%(22/67),病死率为28.36%(19/67),其中复发组病死率显著高于未复发组[81.82%(18/22)对2.22%(1/45);χ^(2)=46.078,P=0.000]。Kaplan-Meier生存曲线显示,外侧型患者中位生存期短于中央型(18个月对51个月,P=0.000),大细胞型/间变性患者中位生存期短于经典型、促纤维增生/结节型、广泛结节型(10个月对50、44和31个月,P=0.000),SHH活化型患者中位生存期短于WNT活化型、3组型、4组型(19个月对32、33和57个月,P=0.003),复发患者中位生存期短于未复发患者(19个月对60个月,P=0.000)。多因素Cox回归分析显示,外侧型(RR=3.514,95%CI:1.262~9.781;P=0.016)、大细胞型/间变性(RR=6.452,95%CI:1.320~31.537;P=0.021)和3组型(RR=4.289,95%CI:1.359~13.533;P=0.013)是髓母细胞瘤复发的危险因素。结论外侧型、大细胞型/间变性组织学亚型、SHH型分子亚型和复发性髓母细胞瘤的生存期更短,且外侧型、大细胞型/间变性组织学亚型和3组型分子亚型髓母细胞瘤更易复发。

放射性^(125)I粒子植入治疗特殊部位肝肿瘤的安全性及有效性

目的:评估放射性^(125)I粒子植入治疗特殊部位肝肿瘤的安全性及有效性。方法:分析2015年12月—2021年12月采用CT引导下放射性^(125)I粒子植入治疗49例60个特殊部位的肝脏肿瘤的临床资料。主要终点是总生存期(OS),次要终点包括无进展生存期(PFS)、疾病控制率(DCR)、客观缓解率(ORR)及肝内复发率(LRR),评估与肝内复发相关的潜在因素。结果:技术成功率为100%,少数患者出现了术后并发症,对症处理后好转。中位OS为12个月(95%CI:11.6612.34),中位PFS为12个月(95%CI:10.8713.13)。1年DCR、ORR和LRR分别为93.48%、60.87%和28.26%。治疗前与治疗后1个月的血液学指标差异无统计学意义(P>0.05)。对肿瘤复发相关因素行Cox单因素分析,结果显示肿瘤来源是影响患者肝内复发时间的因素(P=0.012)。结论:CT引导下放射性^(125)I粒子植入治疗特殊部位肝肿瘤,是一种安全、有效的治疗方法,具有较高的疾病控制率和良好的生存前景,值得临床上进一步推广应用。

不同麻醉方式对非肌层浸润性膀胱癌患者经尿道膀胱肿瘤切除术后预后的影响

目的探讨不同麻醉方式对非肌层浸润性膀胱癌(NMIBC)患者经尿道膀胱肿瘤切除术(TURBT)后预后的影响。方法回顾性分析491例采用TURBT治疗的NMIBC患者的临床资料。根据麻醉方式将患者分为静脉(静脉全身麻醉)组189例、静吸复合(静脉和吸入复合全身麻醉)组120例、局部(脊髓或硬膜外麻醉)组182例,比较3组患者术后无复发生存率。比较术后复发与无复发患者的临床资料,并采用多因素Cox回归模型分析影响NMIBC患者术后复发的危险因素。结果3组患者的无复发生存率差异具有统计学意义(P<0.05),其中静脉组与局部组的无复发生存率均高于静吸复合组(均P<0.05),而局部组与静脉组的无复发生存率比较差异无统计学意义(P>0.05)。术后复发与无复发患者的麻醉方式、既往膀胱肿瘤病史、病理分级、肿瘤数量、肿瘤大小比较,差异均有统计学意义(均P<0.05)。多因素Cox分析提示麻醉方式、既往膀胱肿瘤病史、病理分级、肿瘤大小、肿瘤数量是影响患者术后无复发生存的因素(均P<0.05),采用静吸复合麻醉的患者肿瘤复发的风险均高于静脉麻醉者和局部麻醉者(均P<0.05)。结论术中麻醉方式是影响NMIBC患者TURBT后无复发生存情况的独立危险因素之一,采用静吸复合麻醉的NMIBC患者TURBT后复发风险高于采用局部麻醉或静脉麻醉者。

新辅助化疗联合手术对局部晚期非小细胞肺癌的疗效及生存率的影响

目的探讨新辅助化疗联合手术对局部晚期非小细胞肺癌的疗效及生存率影响。方法收集2010年5月~2014年9月间在本院接受治疗的局部晚期非小细胞肺癌患者100例,将入组患者分为:单纯手术治疗的对照组57例、新辅助化疗联合手术治疗的观察组43例,回顾性分析治疗经过、研究数据。分别于治疗前和治疗后3月,采用酶联免疫吸附法(ELISA)检测血清肿瘤标志物含量,采用放射免疫法检测血清血管新生指标含量。随访2年并记录两组患者的近期生存率。结果治疗前,两组患者的血清肿瘤标志物含量、血管新生指标含量差异无统计学意义(P>0.05)。治疗后3月,观察组血清肿瘤标志物Cyfra21-1、CA125、SCC含量低于对照组,血管新生指标VEGF、HIF-1、VE-cadherin含量低于对照组(P<0.05)。观察组术后1年、2年生存率均高于对照组(P<0.05)。结论新辅助化疗联合手术可提高局部晚期非小细胞肺癌患者的近期疗效、降低肿瘤恶性程度,提高患者近期生存率。

微波消融治疗肺转移瘤的研究进展

随着恶性肿瘤发病率的提高,肺转移瘤在临床中也越来越常见。手术切除是肺转移瘤的主要治疗方法,但大多数患者因心肺功能差、转移瘤靠近心脏及血管、转移瘤数目较多等原因无法进行手术切除,放疗、化疗、靶向治疗等治疗方法疗效不佳;微波消融术作为新兴的治疗手段,具有创伤小、并发症少、安全性高、可重复消融等优点,为肺转移瘤的治疗提供了新方法。本文就微波消融术治疗肺转移瘤的研究进展作一综述。