BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen...BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.METHODS Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021,of which 112 patients were assigned to the training cohort,and the remaining 88 patients were assigned to the validation cohort.Differences between the training and validation groups were analyzed.The training cohort was subjected to multi-variate analysis to select prognostic risk factors for T4N0M0 colon cancer,followed by the construction of a nomogram model.RESULTS The 3-year overall survival(OS)rates were 86.2%and 74.4%for the training and validation cohorts,respectively.Enterostomy(P=0.000),T stage(P=0.001),right hemicolon(P=0.025),irregular review(P=0.040),and carbohydrate antigen 199(CA199)(P=0.011)were independent risk factors of OS in patients with T4N0M0 colon cancer.A nomogram model with good concordance and accuracy was constructed.CONCLUSION Enterostomy,T stage,right hemicolon,irregular review,and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer.The nomogram model exhibited good agreement and accuracy.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in...BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in patients with T2N0M0 gastric cancer.METHODS We identified 325 patients with pathological T2N0M0 stage primary gastric cancer at the National Cancer Center between 2011 and 2018.Univariate and multivariate Cox regression analyses were performed to predict factors affecting prognosis.Vascular invasion,tumor site,and body mass index were assessed,and a scoring system was established.We compared the survival outcomes and benefits of adjuvant chemotherapy between the different subgroups.RESULTS Five-year survival rates of the score 0,1,2,and 3 groups were 92%,95%,80%,and 50%,respectively(P<0.001).In the score 2-3 group,five-year survival rates for patients in the adjuvant chemotherapy group and postoperative observation group were 95%and 61%,respectively(P=0.021).CONCLUSION For patients with T2N0M0 stage gastric cancer and two or more risk factors,adjuvant chemotherapy after D2 gastrectomy may have a survival benefit.展开更多
目的探讨在T2N0M0期低位直肠癌治疗中,应用直线切割吻合器行经肛门局部切除术联合放化疗的疗效及安全性。方法回顾性分析2017年2月至2019年2月在河北北方学院附属第一医院接受诊治的57例T2N0M0期低位直肠癌患者的临床资料,按不同手术方...目的探讨在T2N0M0期低位直肠癌治疗中,应用直线切割吻合器行经肛门局部切除术联合放化疗的疗效及安全性。方法回顾性分析2017年2月至2019年2月在河北北方学院附属第一医院接受诊治的57例T2N0M0期低位直肠癌患者的临床资料,按不同手术方式分成经肛门局部切除术联合放化疗组(TAE组,27例)和传统根治术组(RS组,30例)。比较两组患者一般资料、手术相关指标、Wexner便秘评分及生活质量量表(QLQ-C30)评分、术后并发症及随访情况。结果两组手术时间、术后住院天数、术中出血量比较,TAE组明显低于RS组,差异有统计学意义(P<0.05)。术后1个月评估,TAE组术后Wexner评分明显低于RS组(2.10±1.40 vs 6.60±2.10,t=9.041,P<0.01),QLQ-C30评分明显高于RS组(90.31±3.32 vs 71.59±6.35,t=13.716,P<0.01)。TAE组并发症发生率较RS组有所降低,但差异无统计学意义(3.70%vs 23.33%,P>0.05)。两组均随访3年及以上,仅TAE组复发1例,RS组无复发。结论对T2N0M0期低位直肠癌使用直线切割吻合器行经肛门局部切除术联合放化疗的治疗方法,可缩短手术时间、术后住院天数,减少术中出血量,改善术后排便功能及患者生活质量,不增加远期复发率。展开更多
基金Supported by Health Science and Technology Project of Tianjin Health Commission,No.ZC20190Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-005ATianjin Medical University Clinical Research Fund,No.22ZYYLCCG04.
文摘BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.METHODS Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021,of which 112 patients were assigned to the training cohort,and the remaining 88 patients were assigned to the validation cohort.Differences between the training and validation groups were analyzed.The training cohort was subjected to multi-variate analysis to select prognostic risk factors for T4N0M0 colon cancer,followed by the construction of a nomogram model.RESULTS The 3-year overall survival(OS)rates were 86.2%and 74.4%for the training and validation cohorts,respectively.Enterostomy(P=0.000),T stage(P=0.001),right hemicolon(P=0.025),irregular review(P=0.040),and carbohydrate antigen 199(CA199)(P=0.011)were independent risk factors of OS in patients with T4N0M0 colon cancer.A nomogram model with good concordance and accuracy was constructed.CONCLUSION Enterostomy,T stage,right hemicolon,irregular review,and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer.The nomogram model exhibited good agreement and accuracy.
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
基金the National Natural Science Foundation of China,No.82072734.
文摘BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in patients with T2N0M0 gastric cancer.METHODS We identified 325 patients with pathological T2N0M0 stage primary gastric cancer at the National Cancer Center between 2011 and 2018.Univariate and multivariate Cox regression analyses were performed to predict factors affecting prognosis.Vascular invasion,tumor site,and body mass index were assessed,and a scoring system was established.We compared the survival outcomes and benefits of adjuvant chemotherapy between the different subgroups.RESULTS Five-year survival rates of the score 0,1,2,and 3 groups were 92%,95%,80%,and 50%,respectively(P<0.001).In the score 2-3 group,five-year survival rates for patients in the adjuvant chemotherapy group and postoperative observation group were 95%and 61%,respectively(P=0.021).CONCLUSION For patients with T2N0M0 stage gastric cancer and two or more risk factors,adjuvant chemotherapy after D2 gastrectomy may have a survival benefit.
文摘目的探讨在T2N0M0期低位直肠癌治疗中,应用直线切割吻合器行经肛门局部切除术联合放化疗的疗效及安全性。方法回顾性分析2017年2月至2019年2月在河北北方学院附属第一医院接受诊治的57例T2N0M0期低位直肠癌患者的临床资料,按不同手术方式分成经肛门局部切除术联合放化疗组(TAE组,27例)和传统根治术组(RS组,30例)。比较两组患者一般资料、手术相关指标、Wexner便秘评分及生活质量量表(QLQ-C30)评分、术后并发症及随访情况。结果两组手术时间、术后住院天数、术中出血量比较,TAE组明显低于RS组,差异有统计学意义(P<0.05)。术后1个月评估,TAE组术后Wexner评分明显低于RS组(2.10±1.40 vs 6.60±2.10,t=9.041,P<0.01),QLQ-C30评分明显高于RS组(90.31±3.32 vs 71.59±6.35,t=13.716,P<0.01)。TAE组并发症发生率较RS组有所降低,但差异无统计学意义(3.70%vs 23.33%,P>0.05)。两组均随访3年及以上,仅TAE组复发1例,RS组无复发。结论对T2N0M0期低位直肠癌使用直线切割吻合器行经肛门局部切除术联合放化疗的治疗方法,可缩短手术时间、术后住院天数,减少术中出血量,改善术后排便功能及患者生活质量,不增加远期复发率。
