Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

Gallbladder cancer(GBC)is a rare disease with a poor prognosis.Simple cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes.However,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival outcomes.The oncological roles of lymphadenectomy and liver resection is distinct.Therefore,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

Prophylactic lateral pelvic lymph node dissection in stage Ⅳ low rectal cancer

AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.

Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation

AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer(IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment(P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment(P = 0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment(P = 0.0389),but not for those who received palliative treatment(P = 0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment.

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer:Results from 24 hospitals in China

BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Surgical procedure determination based ontumor-node-metastasis staging of gallbladder cancer

AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM) staging system.METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy(or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. KaplanMeier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was consideredstatistically significant.RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage Ⅰ, 25 cases of stage Ⅱ, 21 cases of stage ⅢA, 21 cases of stage ⅢB, 24 cases of stage ⅣA, 43 cases of stage ⅣB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and Ⅰ disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P = 0.826). The prognosis of stage Ⅱ patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage Ⅲ patients, radical cholecystectomy was significantly superior to other surgical options(P < 0.05). For stage ⅣA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage ⅣB, patients who underwent palliative resection significantly outlived those with non-surgical treatment(P < 0.01)CONCLUSION: For stages 0 and Ⅰ patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages Ⅱ and Ⅲ patients.

Short-and long-term outcomes of laparoscopic vs open surgery for T2 gallbladder cancer:A systematic review and meta-analysis

BACKGROUND With the development of laparoscopic techniques,gallbladder cancer(GBC)is no longer a contraindication to laparoscopic surgery(LS).Although LS is recommended for stage T1 GBC,the value of LS for stage T2 GBC is still controversial.AIM To evaluate the short-and long-term outcomes of LS in comparison to those of open surgery(OS)for stage T2 GBC.METHODS We searched the PubMed,Embase,Cochrane Library,Ovid,Google Scholar,and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC,with a cutoff date of September 2022.The Stata 15 statistical software was used for analysis.Relative risk(RR)and weighted mean difference(WMD)were calculated to assess binary and continuous outcome indicators,respectively.Begg’s test and Egger’s test were used for detecting publication bias.RESULTS A total of five studies were included,with a total of 297 patients,153 in the LS group and 144 in the OS group.Meta-analysis results showed that the LS group was better than the OS group in terms of operative time[WMD=-41.29,95%confidence interval(CI):-75.66 to-6.92,P=0.02],estimated blood loss(WMD=-261.96,95%CI:-472.60 to-51.31,P=0.01),and hospital stay(WMD=-5.67,95%CI:-8.53 to-2.81,P=0.0001),whereas there was no significant difference between the two groups in terms of blood transfusion(RR=0.60,95%CI:0.31-1.15,P=0.13),complications(RR=0.72,95%CI:0.39-1.33,P=0.29),number of lymph nodes retrieved(WMD=–1.71,95%CI:-4.27 to-0.84,P=0.19),recurrence(RR=0.41,95%CI:0.06-2.84,P=0.36),3-year and 5-year overall survival(RR=0.99,95%CI:0.82-1.18,P=0.89 and RR=1.02,95%CI:0.68-1.53,P=0.92;respectively),and 3-year and 5-year disease-free survival(RR=1.01,95%CI:0.84-1.21,P=0.93 and RR=1.15,95%CI:0.90-1.46,P=0.26;respectively).CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS,but LS is superior to OS in terms of operative time,intraoperative bleeding,and postoperative hospital stay.Nevertheless,these findings should be validated via high-quality randomized controlled trials and longer follow-ups.

Resection of the primary tumor in stage Ⅳ breast cancer

Stage Ⅳ breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage Ⅳ is intended to "prolong survival and palliate symptoms". Resection of a primary tumor is considered to be "effective only at alleviating chest symptoms and providing local control" in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treatment strategy according to breast cancer subtypes. Positron emission tomography-computed tomography can detect and diagnose the very small metastases and recurrences which can potentially be cured even if they are distant metastases. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. The goal of treatment has to be clearly identified:increase the patient's survival time, provide local control or perform histology to determine the cancer's properties. The best evidence is absolutely essential to treat patients who need surgery at the right time. We need to evaluate the treatment strategy, including primary resection for stage Ⅳ breastcancer particularly, and find new evidence by prospective analysis.

Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer

AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM) staging system.METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy(or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. KaplanMeier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was consideredstatistically significant.RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage Ⅰ, 25 cases of stage Ⅱ, 21 cases of stage ⅢA, 21 cases of stage ⅢB, 24 cases of stage ⅣA, 43 cases of stage ⅣB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and Ⅰ disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P = 0.826). The prognosis of stage Ⅱ patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage Ⅲ patients, radical cholecystectomy was significantly superior to other surgical options(P < 0.05). For stage ⅣA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage ⅣB, patients who underwent palliative resection significantly outlived those with non-surgical treatment(P < 0.01)CONCLUSION: For stages 0 and Ⅰ patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages Ⅱ and Ⅲ patients.

Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ

Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC.

Ⅳ期非小细胞肺癌患者营养风险及营养相关血液学指标分析

目的:探讨Ⅳ期非小细胞肺癌患者营养风险发生情况及营养相关血液学指标的变化,并通过指标分析为营养支持提供一定的依据。方法:采用回顾性研究方法,收集安徽医科大学第二附属医院肿瘤科2020年1月—2023年1月收治的92例首次确诊Ⅳ期非小细胞肺癌患者的临床资料,包括年龄、性别、体重指数(BMI)、营养风险筛查2002(NRS 2002)评分、血液学指标。根据年龄将患者分为老年组(66~89岁)和中青年组(18~65岁),并分析两组营养不足发生情况和血液学指标异常情况。结果:92例Ⅳ期非小细胞肺癌患者营养风险发生率为22.83%,66~89岁患者营养风险发生率明显高于18~65岁患者,差异有统计学意义(χ^(2)=8.573,P=0.003)。Ⅳ期非小细胞肺癌患者营养不足发生率为13.04%(12/92),老年组营养不足发生率(21.57%)显著高于中青年组(2.44%),差异有统计学意义(P=0.007)。Ⅳ期非小细胞肺癌患者血液指标异常率较高,超过25%的患者存在白蛋白(ALB)、血红蛋白(Hb)、白细胞(WBC)计数、淋巴细胞绝对值(LYM)。老年组白蛋白(ALB)、钾(K)、镁(Mg)异常率均明显高于中青年组,WBC异常率低于中青年组,差异均有统计学意义(P<0.05)。结论:Ⅳ期非小细胞肺癌患者存在较高的营养风险,其营养相关血液学指标显著异常。

血清TAP、proGRP、cyfra21-1与Ⅲ~Ⅳ期NSCLC新辅助化疗疗效及预后的关系

目的探讨血清肿瘤异常蛋白(TAP)、胃泌素释放肽前体(proGRP)、细胞角蛋白19片段(cyfra21-1)与Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)新辅助化疗(NCT)疗效及预后的关系。方法选取100例Ⅲ~Ⅳ期NSCLC患者为研究对象,所有患者均采用NCT治疗,根据疗效将患者分为有效组和无效组,比较不同疗效患者化疗前后TAP、proGRP、cyfra21-1水平,分析化疗后TAP、proGRP、cyfra21-1水平对NSCLC患者NCT疗效的评估价值。所有患者均随访1年,分析化疗后TAP、proGRP、cyfra21-1表达水平与预后的关系。结果化疗后,有效组TAP、proGRP、cyfra21-1水平低于无效组(P<0.05)。ROC曲线结果显示,TAP评估NSCLC患者NCT疗效的AUC和截点值分别为0.739、178.18μm 2,proGRP评估NSCLC患者NCT疗效的AUC和截点值分别为0.810、52.21 ng/L,cyfra21-1评估NSCLC患者NCT疗效的AUC和截点值分别为0.775、7.70μmol/L,联合评估NSCLC患者NCT疗效的AUC为0.913,高于单项诊断(P<0.05)。TAP、proGRP、cyfra21-1高表达患者的1年生存率均低于低表达患者(P<0.05)。结论TAP、proGRP、cyfra21-1联合评估Ⅲ~Ⅳ期NSCLC患者NCT疗效具有较高价值,且其均与NSCLC患者预后密切相关。

Who benefits from RO resection?A single-center analysis of patients with stage Ⅳ gallbladder cancer

Objectives:Most patients with gallbladder cancer(GBC)present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option to improve survival in patients with GBC.This study aimed to analyze the prognostic factors in patients with stageⅣGBC and to identify a subgroup of patients who might benefit from RO resection.Methods:A total of 285 patients with stageⅣGBC were retrospectively analyzed at our institution from January 2008 to December 2012.Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses.Results:The 1-,3-,and 5-year overall survival rates were 6.6%(15/229),0.9%(2/229),and 0(0/229),respectively.Ascites(relative risk[RR]=1.631,95%confidence interval[C/]:1.221-2.180,P=0.001),pathological grade(RR=1.337,95%Cl:1.050-1.702,P=0.018),T stage(RR=1.421,95%Cl:1.099-1.837,P=0.000),M stage(RR=1.896,95%Cl:1.409-2.552,P=0.000),and surgery(RR=1.542,95%Cl:1.022-2.327,P=0.039)were identified as independent risk factors influencing prognosis.The median survival time(MST)was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection(6.0 vs.2.7 months;P<0.001).In subgroup analyses,stage IVA patients benefited from R0 resection(MST for R0 vs.R1/R2,11.0 vs.4.0 months;P=0.003),while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage IVB GBC without distant metastasis(MST for R0 vs.R1/R2,6.0 vs.3.0 months;P=0.007).Conclusion:Ascites,pathological grade,T stage,M stage,and surgery were independent risk factors influencing prognosis in patients with stageⅣGBC.N2 lymph node metastasis did not preclude curative resection,and radical resection should be considered in patients with stageⅣGBC without distant metastasis once R0 margin was achieved.

超声内镜和多层螺旋CT对BorrmannⅣ型胃癌术前分期的比较研究

目的对超声内镜(EUS)和多层螺旋CT(MSCT)检查在BorrmannⅣ型胃癌术前分期中的作用进行比较。方法回顾性分析48例BorrmannⅣ型胃癌患者的影像学术前TNM分期,并与术后病理分期进行比较。结果 EUS和MSCT检查对T分期的准确率分别为54.2%和79.2%(P=0.009),分层分析表明MSCT对T3、T4分期的准确率高于EUS(T3:84.6%vs 57.7%,P=0.032;T4:82.4%vs 41.2%,P=0.032)。两者对N分期的准确率,均为56.3%(P=1.000),无明显差异,EUS和MSCT对淋巴转移检查的特异度和灵敏度分别为83.3%/72.2%和66.7%/91.7%。结论 EUS更适合对早期胃癌分期,而已浸润至浆膜层及有远处转移的BorrmannⅣ型胃癌患者,应优先选择MSCT检查进行分期。

64排螺旋CT对Ⅳ期胃癌术前分期的价值

目的评价64排螺旋CT对Ⅳ期胃癌术前分期的准确性。方法收集2007年7月至2008年4月期间我院胃肠外科收治的49例Ⅳ期胃癌患者的临床资料,对其中术前行64排螺旋CT(64MDCT)检查的29例患者进行回顾性分析并按日本胃癌规约对肿瘤进行分期。将CT术前分期结果与临床-手术-病理分期结果进行对照分析。结果本组病例经64MDCT术前分期,其中65.2%(15/23)T分期准确,47.8%(11/23)N分期准确,70.8%(17/24)M分期准确,58.6%TNM分期准确(17/29)。而腹膜转移患者中6/9未能经术前64MDCT检出。结论64MDCT可以对Ⅳ期胃癌进行较准确的分期,其分期准确率降低的主要原因为腹膜转移的漏诊,但64MDCT分期降低并不增加剖腹探查率。

化疗放射综合治疗Ⅳ期肺癌对生存期的影响

本文对44例接受化疗和60Co放疗综合治疗的Ⅳ期肺癌患者和25例单纯接受化疗的Ⅳ期肺癌这两组病人的疗效进行观察，放化组有效率34．1％，中位生存期11月，单化组有效率12％，中位生存期4.5月。本文显示应用适当有效的化疗和放疗综合治疗Ⅳ期肺癌能够缓解病情，延长生存期。

血清Reg Ⅳ蛋白在胃癌患者血清中的表达

目的检测RegⅣ蛋白在胃癌患者血清中的表达,探讨其作为浸润性胃癌检测标志物的可能性。方法酶联免疫分析法定量检测64例胃癌患者血清中RegⅣ蛋白的表达水平。结果肿瘤浸润至肌层(T_2)和浆膜层(T_3)的胃癌患者血清RegⅣ蛋白水平要显著高于肿瘤局限在黏膜层和黏膜下层(T_1)者(P<0.01);有淋巴结转移者血清RegⅣ蛋白水平要高于无淋巴结转移者(P<0.05);病理Ⅲ期患者血清RegⅣ蛋白水平高于病理Ⅰ期患者(P<0.05)。结论 RegⅣ蛋白可能与胃癌的生长侵袭有关。

Ⅳ期非小细胞肺癌姑息放疗的临床研究

目的探讨Ⅳ期非小细胞肺癌(NSCLC)的姑息放疗在提高生活质量的同时是否可以提高生存期,并分析不同放疗剂量和治疗方式于患者的获益情况。方法收集2007.1-2011.12就诊于武汉大学中南医院的209例Ⅳ期NSCLC患者资料,建立数据库。记录患者的治疗情况并随访。使用SPSS 13.0统计学软件对患者进行生存分析。结果 209例Ⅳ期NSCLC患者中,所有Ⅳ期NSCLC的中位生存时间为13.7个月,总的1、2年生存率分别为53.1%、18.2%;姑息放疗组患者的中位生存期及1、2年生存率均明显高于未行姑息放疗组(分别为15个月,62.9%、22.9%;12个月,43.3%、13.5%,P<0.05)。结论Ⅳ期NSCLC患者中,局部病灶行姑息放疗在缓解症状同时还可以提高生存率。

首诊Ⅳ期乳腺癌骨转移患者的临床病理特征及预后分析

目的:探讨首诊Ⅳ期乳腺癌骨转移(initially diagnosed stageⅣbreast cancer bone metastasis,IDBCBM)患者的临床病理特征、治疗和预后的关系。方法:回顾性分析2007年3月至2016年11月天津医科大学肿瘤医院收治的74例IDBCBM患者的临床资料,并行单因素分析和采用Cox回归模型进行多因素分析。结果:患者的中位年龄为53.3岁。中位总生存时间(overall survival,OS)为34.3个月,3年和5年的生存率分别为37.8%和12.2%。首发转移模式仅为骨转移的患者预后较好,中位生存时间为41.7个月,3年和5年的总生存率分别为54.5%和20.4%。在单因素分析中,分子亚型、激素受体状态、HER-2表达情况、淋巴结状态、Ki-67指数、骨转移数目(number of bone metastasis,NBM)、初始转移模式、药物治疗模式及局部治疗与预后相关;74例IDBCBM患者的Cox回归模型多因素分析显示首发骨转移模式,NBM,药物治疗模式,Ki-67均是影响患者OS的独立预后因素(均P<0.05)。结论:Ki-67的高表达、单一的药物治疗模式、NBM较多、骨合并内脏转移均与患者预后较差相关,但局部的手术和放疗是否获益尚无定论。

吉西他滨联合长春瑞滨与联合紫杉醇姑息治疗铂类耐药的Ⅳ期鼻咽癌患者的随机对照试验

目的:观察吉西他滨联合长春瑞滨与联合紫杉醇方案作为姑息治疗方案治疗铂类耐药的Ⅳ期鼻咽癌患者的有效性及安全性。方法:收集2012年7月至2014年7月含铂一线治疗失败的晚期鼻咽癌患者共105例的临床资料,随机分为吉西他滨联合长春瑞滨组(GV组)与吉西他滨联合紫杉醇组(GT组),比较两方案在总有效率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)、总生存期(OS)及不良反应发生率等方面的差异。采用Log-rank检验比较PFS及OS。结果:两组间的ORR无统计学差异(P=0.491),DCR存在统计学差异(GT组较优,P=0.034)。两组间的PFS、OS的差别均无统计学意义(P=0.387,P=0.673)。不良反应方面,GV组Ⅰ度感觉异常较多,而GT组Ⅲ度白细胞降低、Ⅰ度疲乏无力、过敏反应、肌肉关节疼痛、脱发及Ⅱ度脱发较多,差别均有统计学意义。结论:GV、GT两种方案治疗铂类耐药的晚期鼻咽癌患者在总有效率、无进展生存期及总生存期上近似,GT方案可提高患者疾病控制率(DCR),不良反应较GV方案多,多为轻中度,患者可耐受。