Study on the causes of local recurrence of rectal cancer after curative resection: analysis of 213 cases

AIM To study the local recurrent rate and the causes of rectal cancer after surgery. METHODS The clinicopathological data of 213 rectal cancer patients and the follow up information were analyzed. The overall recurrent rate and the recurrent rates from different surgical appreaches were calculated. The main causes of recurrence were investigated. RESULTS Among the 213 cases, 73 (34 27%) had local recurrence. The recurrent time ranged from 3 months to 62 months after the first operation. Most of the recurrence ( 65/73 , 89 04%) occurred within 3 years after operation. CONCLUSION Local recurrence had no significant correlation with surgical methods or pathological types, but closely related to Dukes′ stages, location of primary tumors and the length of the distal rectum resected. Early resection and a wide tumor free resection margin are key factors to prevent local recurrence.

Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP). CLIP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not published. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma replaced by tumor), TNM stage, CLIP score, and resection margin were the risk factors for early recurrence, whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. In univariate survival analysis, Child-Pugh stages, resection margin, tumor size, microsatellite, venous invasion, tumor type, tumor extension, TNM stages, and CLIP score were associated with prognosis. The multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox tropic examination were used, a retrospective clinicopathologic analysis was made in 156 cases of hepatocellular carcinoma after hepatectomy. RESULTS Of the 156 cases, 68 4%, 57 3%, 46 7%, 31 5% and 28 6% had 1, 2, 3, 4 and 5 postoperative tumor free years respectively with a total recurrence rate of 53 2% (83/156). In the 83 recurrent cases, 65 were of intrahepatic sabclinical type, with a re resection rate of 78 3% (65/83). The relevant factors involved in recurrence were: males, tumor number and size, capsule infiltration, portal veins involvement, etc. Those factors obviously influenced the prognosis of the patients with postoperative hepatocellular carcinoma ( P <0 05). 63 1% tumor nodes (41/65) of recurrent liver cancinomas were located at the ipsilateral segment of the primary ones. CONCLUSION Males, tumor number and size, capsule infiltration and portal veins involvement are the factors for postoperative hepatocellular carcinoma recurrence after surgery. The recurrence is mainly unicentral. Right front lobe is the liver segment with a high recurrence rate.

Do the expressions of gap junction gene connexin messenger RNA in noncancerous liver remnants of patients with hepatocellular carcinoma correlate with postoperative recurrences?

AIM: To investigate whether the changes of gap junction gene connexin messenger RNA in the noncancerous liver tissue of patients with hepatocellular carcinoma (HCC) could play a significant role in its postresection recurrence.METHODS: Seventy-nine consecutive patients having undergone curative resection for HCC entered this study.Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, connexin (Cx) 26, connexin (Cx)32 and connexin (Cx) 43 mRNAs were determined prospectively in noncancerous liver tissues from these 79 patients and in the liver tissues from 15 controls. The correlations between connexin mRNA expression and the clinicopathological variables and outcomes (tumor recurrence and recurrence related mortality) were studied.RESULTS: Compared with liver tissues of control patients,the expression of Cx 32 mRNA in noncancerous liver tissues was significantly lower (mean: 0.715 vscontrol 1.225,P＜0.01), whereas the decreased Cx 26 mRNA (mean:0.700 vs of control 1.205,P＞0.05) and increased Cx 43 mRNA (mean: 0.241 vscontrol 0.100, P＞0.05) had no statistical significance. We defined the value of Cx 32 mRNA or Cx 26mRNA below 0.800 as a lower value. By multivariate analysis for noncancerous livers, a lower value of Cx 32 mRNA correlated significantly with a risk of HCC recurrence and recurrence-related mortality. The lower value of Cx 26 mRNA did not correlate with recurrence and mortality. The increased value of Cx43 mRNA also did not correlate with postoperative recurrence and recurrence-related mortality. By multivariate analysis, other significant predictors of HCC recurrence included vascular permeation, cellular dedifferentiation, and less encaps-ulation. The other significant parameter of recurrence related mortality was vascular permeation.CONCLUSION: The decreased expression of Cx 32 mRNA in noncancerous liver tissues plays a significant role in the prediction of postoperative recurrence of HCC.

Complex pattern of colon cancer recurrence including a kidney metastasis: A case report

We report a case of a 77-year-old female with a local recurrence of cancer after right hemicolectomy which infiltrated the pancreatic head affording pancreatoduodenectomy, who developed 3 years later recurrent tumor masses localized in the mesentery of the jejunum and in the lower pole of the left kidney. Partial nephrectomy and a segment resection of the small bowel were performed. Histological examination of both specimens revealed a necrotic metastasis of the primary carcinoma of the colon. Although intraluminal implantation of colon cancer cells in the renal pelvic mucosa from ureteric metastasis has been described, metastasis of a colorectal cancer in the kidney parenchyma is extremely rare and can be treated in an organ preserving manner. A complex pattern of colon cancer recurrence with unusual and rare sites of metastasis is reported.

Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression

We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist(PIVKA)- II was 1 137 mAU/mL.A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm×55 mm in liver S6,with slightly high density content and without marginal enhancement.Angiography revealed that the tumor in S4 with a size of 25 mm×20 mm was a typical hypervascular HCC,and transarterial chemoembolization was performed.However,the tumor in S6 was hypovascular and atypical of HCC,and thus no therapy was given.In December 2000,the cystic mass regressed spontaneously to 57 min×44 mm,and aspiration cytology revealed bloody fluid,and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it.The PIVKA-II level normalized in February 2001.In July 2001,the tumor regressed further but presented with an enhanced area at the posterior margin.In November 2001,the enhanced area extended,and a biopsy revealed well-differentiated HCC,although the previous tumor in S4 disappeared.Angiography demonstrated two tumor stains,one was in S6,which was previously hypovascular, and the other was in S8.Subsequently,the PIVKA-II level started to rise with the doubling time of 2-3 wk,and the tumor grew rapidly despite repeated transarterial embolization with gel foam.In February 2003,the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe.Considering the acute onset of the symptoms,we speculate that local ischemia possibly due to rapid tumor growth,resulted in intratumoral bleeding and/or hemorrhagic necrosis,and finally spontaneous regression of the initial tumor in S6.

Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report

BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARY A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor,it was diagnosed as recurrence of PTC.Furthermore,results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records,the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment,the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSION Needle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.

胰腺导管腺癌行腹腔镜下胰十二指肠切除术后早期复发的列线图模型及其预测价值分析

目的探究胰腺导管腺癌(PDAC)患者行腹腔镜胰十二指肠切除术(LPD)后肿瘤早期复发的危险因素并建立预测模型。方法回顾性分析2016年4月—2022年7月于吉林大学第一医院行LPD的240例PDAC患者的临床资料,以术后肿瘤早期复发(复发时间≤12个月)为研究结局。按照7∶3比例,随机将患者分为训练组(n=168)与验证组(n=72)。训练组术后早期复发70例(41.67%),非早期复发98例(58.33%)。验证组术后早期复发32例(44.44%),非早期复发40例(55.56%)。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。Logistic回归分析影响术后早期复发的危险因素。采用受试者工作特征曲线下面积(AUC)评估模型的区分度,AUC>0.75为该模型有足够的区分度。用Bootstrap重采样法随机抽样1000次验证,并用验证组再次验证。使用校准曲线和Hosmer-Lemeshow拟合优度检验评估校准度,决策曲线评估临床实用性。结果单因素、多因素分析结果显示:术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC行LPD术后早期复发的独立危险因素[OR(95%CI)分别为6.265(1.938~20.249)、10.878(4.090~28.932)、3.679(1.435~9.433)、0.209(0.080~0.551)、0.167(0.058~0.480),P值均<0.05]。以此为基础构建列线图模型,AUC=0.895(95%CI:0.846~0.943,P<0.001),校准曲线Hosmer-Lemeshow检验表明模型具有良好的校准度(P=0.173)。决策曲线显示列线图具有良好的临床应用价值。结论术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC LPD术后早期复发的独立危险因素,以此为依据构建列线图模型可有效预测术后早期复发。

术前CT影像组学联合CT及病理特征预测局部进展期食管鳞癌术后早期复发

目的观察术前CT影像组学联合病理及CT特征预测局部进展期食管鳞癌(LAESCC)早期复发(ER)的价值。方法回顾性分析334例LAESCC,按7∶3比例将患者分为训练集(n=234)或验证集(n=100),对其进行随访,记录术后有无ER(即术后12个月内肿瘤复发)。采用单因素及多因素logistic回归比较训练集有、无ER患者临床、CT表现及术前病理资料,筛选ER独立危险因素,构建CT-术前病理模型。基于训练集静脉期CT图像提取及筛选LAESCC影像组学特征并建立影像组学模型,以之联合独立危险因素建立联合模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估各模型诊断效能。结果334例中,168例ER、166例无ER;训练集有、无ER均为117例、验证集51例ER、49例无ER。CT显示LAESCC长度、cT分期、cN分期及术前病理分化程度均为ER独立危险因素(P均<0.05);CT-术前病理模型在训练集和验证集的AUC分别为0.759和0.783。共选出10个最佳影像组学特征,以之建立的影像组学模型在训练集和验证集的AUC分别为0.770和0.730,联合模型在训练集和验证集的AUC分别为0.838和0.826。联合模型在训练集的AUC高于术前CT-病理模型及影像组学模型(P均<0.01)。结论CT影像组学联合CT及术前病理特征能有效预测LAESCC术后ER。

肝细胞癌复发进程中DNA修复调节的蛋白质组学分析及验证

目的分析肝细胞癌(HCC)复发进程中DNA修复调节的作用及机制。方法串联质量标签(TMT)标记的定量蛋白质组学方法分析HCC 2年内复发和5年预后良好的肝癌组织样本,分析富集在DNA复制、错配修复、碱基切除修复、核苷酸切除修复4条通路的蛋白表达差异,分析在HCC复发进程中起主要作用的调控通路及靶点,预测可能的调控机制。计量资料2组间比较采用成组t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。结果真核生物复制复合体通路MCM2(P=0.018)、MCM3(P=0.047)、MCM4(P=0.014)、MCM5(P=0.008)、MCM6(P=0.006)、MCM7(P=0.007)、PCNA(P=0.019)、RFC4(P=0.002)、RFC5(P<0.001)、LIG1(P=0.042)蛋白表达均显著降低;核苷酸切除修复通路中PCNA(P=0.019)、RFC4(P=0.002)、RFC5(P<0.001)、LIG1(P=0.042)共4个蛋白表达水平均显著减少;碱基切除修复通路PCNA(P=0.019)和LIG1(P=0.042)在HCC复发组中均显著降低;错配修复富集通路中MSH2(P=0.026)、MSH6(P=0.006)、RFC4(P=0.002)、RFC5(P<0.001)、PCNA(P=0.019)、LIG1(P=0.042)共6个蛋白在肝癌复发组织中均显著减少。差异蛋白涉及MCM复合体、DNA聚合酶复合体ε、连接酶LIG1、长补丁碱基剪切修复复合体(long patch BER)、DNA错配修复蛋白复合体的重要组分。对DNA修复调节的重要差异蛋白进行临床样本验证分析,结果表明复发组中除MCM6表现出下降趋势外,MCM5(P=0.008)、MCM7(P=0.007)、RCF4(P=0.002)、RCF5(P<0.001)和MSH6(P=0.006)蛋白相对表达量均显著降低。结论HCC复发过程中,DNA修复进程中多个复合体蛋白组分存在显著减少或缺失。

食管癌术后局限性颈部/上纵隔淋巴结转移再手术效果探讨

目的探讨食管癌术后颈部或上纵隔淋巴结转移再手术的治疗效果。方法前瞻性收集2019年1月至2022年9月在安阳市肿瘤医院胸外科复查的食管癌术后患者,发现颈部或上纵隔淋巴结转移,CT显示无外侵,可以手术切除的患者,共31例。根据患者的意愿分为观察组和对照组。观察组16例选择再手术治疗,术后辅助或不辅助放化疗;对照组15例选择单纯放化疗。对比两组的基线资料、随访生存情况,主要研究终点为局部复发和区域复发。结果两组患者的基线数据比较无明显差异,观察组出现2例颈部淋巴瘘,2例喉返神经损伤,1个月后声音嘶哑均恢复正常。手术时间平均为43 min,术后平均住院时间5.8 d,平均住院花费15042元。观察组1 a生存率100%,局部控制率为80%。对照组无治疗后并发症,1 a生存率93.3%,局部控制率为46.7%,相对危险度(relative risk,RR)为0.5,归因危险度(attributable risk,AR)为0.46,对照组平均住院时间为45 d,平均住院花费为42352元。两组比较显示:观察组1 a局部控制率显著优于对照组,以局部复发为研究终点,绘制Kaplan-Meier生存曲线,观察组显著优于对照组(P=0.048)。结论对于食管癌术后局限性颈部/上纵隔淋巴结转移的患者,再手术治疗安全、创伤小、花费低、局部控制率高。

膀胱癌组织微RNA-212、微RNA-137、微RNA-200表达与临床病理特征的相关性及预测经尿道膀胱肿瘤切除术后复发的效能研究

目的 探讨膀胱癌组织微RNA-212(miRNA-212)、微RNA-137(miRNA-137)、微RNA-200(miRNA-200)表达与临床病理特征的相关性及预测经尿道膀胱肿瘤切除(TURBT)术后复发的效能。方法 选取2017年6月至2021年6月河北燕达医院100例膀胱癌病人,比较癌组织和癌旁组织及不同病理特征病人miRNA-212、miRNA-137、miRNA-200表达,并根据术后复发情况分为复发组、未复发组。比较两组miRNA-212、miRNA-137、miRNA-200表达,采用受试者操作特征(ROC)曲线分析miRNA-212、miRNA-137、miRNA-200预测复发的价值,比较不同miRNA-212、miRNA-137、miRNA-200表达水平病人复发率。结果 癌组织miRNA-212为2.03±0.56低于癌旁组织4.52±1.18(P<0.05),癌组织miRNA-137、miRNA-200表达分别为2.69±0.45、24.56±7.39,高于癌旁组织的1.28±0.30、7.33±2.21(P<0.05);随着组织学分级、TNM分期递增,miRNA-212表达逐渐降低,miRNA-137、miRNA-200表达逐渐升高(P<0.05);肌层浸润性膀胱癌病人miRNA-212低于非肌层浸润性膀胱癌,miRNA-137、miRNA-200高于非肌层浸润性膀胱癌(P<0.05);复发组miRNA-212(1.73±0.39)低于未复发组(2.28±0.44)(P<0.05),复发组miRNA-137、miRNA-200分别为3.06±0.72、37.96±12.18,高于未复发组2.35±0.40、22.86±7.50(P<0.05);miRNA-212高水平病人复发率低于低水平病人,miRNA-137、miRNA-200高水平病人复发率高于低水平病人(P<0.05)。结论 膀胱癌组织miRNA-212、miRNA-137、miRNA-200表达与临床病理特征相关,联合检测对TURBT后复发具有良好的预测能力,可作为预测术后复发的一种方案。

血清HBV-LP联合PRKRA对HBV相关原发性肝癌术后复发风险的预测价值

目的 分析血清乙型肝炎病毒大蛋白(HBV-LP)和干扰素诱导型双链RNA依赖性蛋白激酶激活剂A(PRKRA)水平对乙型肝炎病毒相关原发性肝癌(HBV-PLC)术后复发风险评估的价值。方法 收集确诊为HBV-PLC病人105例,根据术后是否复发分为未复发组(38例)和复发组(67例)。比较两组病人临床基线资料、生化指标结果和病理资料;采用ELISA法检测病人血清HBV-LP和PRKRA水平;采用Pearson相关性分析血清HBV-LP和PRKRA的关系,Cox回归模型分析HBV-PLC术后复发的危险因素;绘制受试者工作特征(ROC)曲线,分析HBV-LP联合PRKRA检测对HBV-PLC术后复发风险的预测价值。结果 两组病人性别、年龄、吸烟史、饮酒量、血清生化指标和肝硬化等差异无统计学意义(P>0.05),两组甲胎蛋白(AFP)<25μg/L、肿瘤大小、肿瘤包膜、肝转移、血管侵袭和肿瘤分化程度差异有统计学意义(χ^(2)=4.217~10.849,P<0.05)。与未复发组比较,复发组病人血清HBV-LP和PRKRA水平明显升高(t=6.501、3.615,P<0.01)。HBV-PLC病人血清HBV-LP与PRKRA水平呈正相关(r=0.839,P<0.01)。肿瘤直径(2~5 cm)、肿瘤包膜、肿瘤低分化、血清HBV-LP和PRKRA是HBV-PLC术后复发的危险因素(HR=1.083~6.938,P<0.05)。ROC曲线分析显示,血清HBV-LP和PRKRA水平及二者联合对HBV-PLC病人术后复发有预测价值,ROC曲线下面积分别为0.796、0.685、0.822。结论 血清HBV-LP和PRKRA水平升高是HBV-PLC病人术后复发的独立危险因素,二者联合检测对HBV-PLC病人术后复发具有良好的预测价值。

Detection of BCL2-IGHrearrangement on paraffin-embedded tissue sections obtained from a small submucosal tumor of the rectum in a patient with recurrent follicular lymphoma

A 59-year-old woman was admitted to our hospital because of recurrent follicular lymphoma(FL).Colonoscopic examination revealed a rectal submucosal tumor(SMT)without any erosions and ulcers.In this patient,it was difficult to distinguish non-Hodgkin's lymphoma(NHL)invasion from other disorders of the colon including carcinoid tumor merely based on endoscopic findings.Histopathologic and immunohistochemical studies on biopsy specimens showed an infiltration of atypical lymphocytes that were positive for CD20 and BCL2 but negative for UCHL-1.Fluorescence in situ hybridization on paraffin-embedded tissue sections (T-FISH)identified a translocation of BCL2 with IGHgene. Based on these findings,the tumor was defined as an invasion of FL.T-FISH method is useful for the detection of a monoclonality of atypical lymphocytes in an SMT of the gastrointestinal tract,and particularly for the detection of chromosomal translocations specific to lymphoma subtypes.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy

Objective： To investigate the recurrence sites, risk factors, and prognosis of＇patients with persistent or recurrent squamous cell carcinoma （SCC） of the cervix within one year after undergoing concurrent chemoradiotherapy （CCRT）. Methods： Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively： These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission. These 35 patients were treated during the same period （between 2,006 and Z011） and selected randomly. Results： Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months after CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag 〉 10 ng/mL in the group with persistent or recurrent disease before treatment （P〈0.01）. Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉 10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. The 2-year survival rate was 21.7%, and the median survival time was 17 months. Conclusion： Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag 〉10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within i year after CCRT.

丙酮酸脱氢酶激酶-1在复发鼻咽癌组织中的表达及其与预后的关系

目的探讨丙酮酸脱氢酶激酶-1(pyruvate dehydrogenase kinase-1,PDK1)在局部复发鼻咽癌组织中的表达情况,并分析其与患者临床病理特征及预后的关系。方法选取2013年1月至2017年12月上海大学附属第二医院(温州市中心医院)和汕头大学医学院第一附属医院收治的92例局部复发鼻咽癌和45例初发鼻咽癌患者的临床标本,采用免疫组织化学法检测PDK1的表达情况,并分析其与患者临床病理特征的关系。采用Kaplan-Meier法进行生存分析,并采用Cox回归模型分析鼻咽癌局部复发的危险因素。结果初发鼻咽癌高表达PDK1蛋白的比例为31.11%,明显低于局部复发鼻咽癌(50.00%),差异有显著性(χ^(2)=4.38,P<0.05)。局部复发鼻咽癌组织中PDK1的表达情况与T分期、N分期、临床分期、远处转移、脑神经侵犯及颅底骨质破坏有关(P<0.05)。Kaplan-Meier生存分析表明,高表达PDK1的局部复发鼻咽癌患者5年生存率明显明显低于低表达者(P<0.05)。Cox回归模型多因素分析显示,高表达PDK1、远处转移、脑神经侵犯是鼻咽癌局部复发的独立危险因素(P<0.05)。结论高表达PDK1可能是鼻咽癌放疗后局部复发及预后不良的重要影响因素。

复发性直肠阴道隔畸胎瘤一例并文献复习

畸胎瘤是由具有多项分化潜能的生殖细胞发育而成,是较常见的生殖细胞肿瘤之一,可见于多个组织器官,以性腺最为常见,发生于性腺外尤其是直肠阴道隔者少见,查阅相关文献发现关于术后复发鲜有报道。回顾性分析我院收治的1例复发性直肠阴道隔成熟性畸胎瘤患者的临床症状、体征及相关辅助检查等临床资料,并对国内外关于直肠阴道隔畸胎瘤相关文献从疾病临床特点、诊断、治疗及预后等方面进行归纳总结,以期为性腺外畸胎瘤临床研究提供客观依据。

局部晚期/复发直肠癌行全盆腔脏器切除术的焦点和挑战

全盆腔脏器切除术(TPE)已成为治疗局部晚期/复发直肠癌的重要方式。随着手术技术的进步、围手术期管理水平的提高及多学科诊疗模式的开展,TPE在正确解剖入路的引导下提高了手术根治性、长期生存率并降低了再复发率。骨性骨盆(尤其是高位骶骨)和坐骨神经的切除有助于进一步提高R0切除率。由于切除了更多的盆腔器官和组织,TPE后空盆腔综合征发生率较高、处理棘手,生物补片和肌皮瓣重建盆底缺损可能有助于减少术后并发症。泌尿系统重建和血管重建是TPE手术的难点,选择合适的重建方式尤为重要。

基于垂体腺瘤术后临床资料建立复发预测模型

目的 基于病人的临床资料建立一种易于实施的评分系统,对垂体腺瘤的复发做出预测。方法 回顾性选取2017年1月至2021年1月徐州医科大学附属医院垂体腺瘤病人作建模组,均接受经鼻内镜下垂体腺瘤切除术,平均随访时间大于1年。对可能引起术后复发的相关因素行统计学分析,依据已证相关特征建立评分系统,通过受试者操作特征曲线(ROC曲线)曲线下面积(AUC)评价该评分系统预测复发的能力,根据约登指数分析出评分临界值,另随访同期该院36例同种疾病病人作验证组,佐证评分系统的预测效能。结果 最终被纳入建模组病人157例。建模组中,28例(17.8%)的病人在>12个月的随访中出现复发;复发的可能性可通过Ki-67指数、改进后Knosp分级、大小及肿瘤残余进行预测(均P<0.05);垂体腺瘤评分系统在预测肿瘤复发方面显示出良好的预测能力[AUC=0.92,95%CI:(0.85,0.98)],约登指数最大值为0.752,提示最佳预测临界分数为3分,当评分≥3分时,肿瘤复发可能性高;验证组评分≥3分有7例,复发4例,评分<3分有29例,复发1例(P=0.002);评分系统作为预测指标,准确率为0.889,较单一影响因素高。结论 垂体腺瘤评分系统较可靠地预测了垂体腺瘤的术后复发,以量化指标作为术后评估的一部分,可有效快速的对病人病情及预后做出预测,为后续治疗提供参考。