Copy Number Aberrations of Multiple Genes Identified as Prognostic Markers for Extrahepatic Metastasis-free Survival of Patients with Hepatocellular Carcinoma

Extrahepatic metastasis confers unfavorable patient prognosis in patients with hepatocellular carcinoma(HCC),however,reliable markers allowing prediction of extrahepatic metastasis at the time of initial diagnosis are still lacking.This study was to identify gene-level copy number aberrations(CNAs)related to extrahepatic metastasis-free survival of HCC patients,and further examine the associations between CNAs and gene expression.Array comparative genomic hybridization(aCGH)and expression array were used to analyze gene CNAs and expression levels,respectively.The associations between CNAs of a panel of 20 genes and extrahepatic metastasis-free survival were analyzed in 66 patients with follow-up period of 1.6-90.5 months.The gene expression levels between HCCs with and without gene CNA were compared in 109 patients with HCC.We observed that gains at MDM4 and BCL2L1,and losses at APC and FBXW7 were independent prognostic markers for extrahepatic metastasis-free survival of HCC patients.Integration analysis of aCGH and expression data showed that MDM4 and BCL2L1 were significantly upregulated in HCCs with gene gain,while APC and FBXW7 were significantly downregulated in HCCs with gene loss.We concluded that gene gains at MDM4 and BCL2L1,and losses at APC and FBXW7,with concordant expression changes,were associated with extrahepatic metastasis-free survival of HCC patients and have potential to act as novel prognostic markers.

Recent trends in bone metastasis treatments:A historical comparison using the new Katagiri score system

BACKGROUND Bone metastasis has various negative impacts.Activities of daily living(ADL)and quality of life(QOL)can be significantly decreased,survival may be impacted,and medical expenses may increase.It is estimated that at least 5%cancer patients might be suffering from bone metastases.In 2016,we published the Comprehensive Guidelines for the Diagnosis and Treatment of Bone Metastasis.Since then,the therapeutic outcomes for patients have gradually improved.As life expectancy is a major determinant of surgical intervention,the strategy should be modified if the prolongation of survival is to be achieved.AIM To monitor how bone metastasis treatment has changed before and after launch of our guidelines for bone metastasis.METHODS For advanced cancer patients with bone metastasis who visited the Department of Clinical Oncology at Akita University hospital between 2012 and 2023,parameters including the site and number of bone metastases,laboratory data,and survival time,were extracted from electronic medical records and the Katagiri score was calculated.The association with survival was determined for each factor.RESULTS Data from 136 patients were obtained.The 1-year survival rate for the poor prognosis group with a higher Katagiri score was 20.0%in this study,which was 6%and an apparent improvement from 2014 when the scoring system was developed.Other factors significantly affecting survival included five or more bone metastases than less(P=0.0080),and treatment with chemotherapy(P<0.001),bone modifying agents(P=0.0175)and immune checkpoint inhibitors(P=0.0128).In recent years,advances in various treatment methods have extended the survival period for patients with advanced cancer.It is necessary not only to simply extend survival time,but also to maintain ADL and improve QOL.CONCLUSION Various therapeutic interventions including surgical approach for bone metastasis,which is a disorder of locomotor organs,are increasingly required.Guidelines and scoring system for prognosis need to be revised promptly.

Significance of preoperative peripheral blood neutrophil-lymphocyte ratio in predicting postoperative survival in patients with multiple myeloma bone disease

BACKGROUND The neutrophil-lymphocyte ratio(NLR)is often used to predict a poor prognosis in patients with tumors.This study investigated the preoperative peripheral blood NLR in predicting postoperative survival(POS)in patients with multiple myeloma bone disease(MMBD).AIM To evaluate whether NLR can be used to predict the prognosis of MMBD patients after surgery.METHODS The clinical data of 82 MMBD patients who underwent surgical treatments in Beijing Chao-yang Hospital were collected.The NLR was obtained from the absolute number of neutrophils and lymphocytes,calculated by the number of neutrophils and divided by the number of lymphocytes.The peripheral blood lymphocyte percentage was used as the major marker to analyze the change in characteristics of the immune statuses of multiple myeloma patients.RESULTS The NLR cut-off values of NLR≥3 patients and NLR≥4 patients were significantly correlated with POS.The 3-and 5-year cumulative survival rates of the high NLR group(NLR≥3 patients)were 19.1%and 0.0%,respectively,which were lower than those of the low NLR group(NLR<3 patients)(67.2%and 48.3%)(P=0.000).In the high NLR group,POS(14.86±14.28)was significantly shorter than that in the low NLR group(32.68±21.76).Univariate analysis showed that the lymphocyte percentage 1 wk after the operation(19.33±9.08)was significantly lower than that before the operation(25.72±11.02).Survival analysis showed that postoperative chemotherapy,preoperative performance status and preoperative peripheral blood NLR≥3 were independent risk factors for POS.CONCLUSION The preoperative peripheral blood NLR can predict POS in MMBD patients.MMBD patients with a high preoperative NLR(NLR≥3)showed poor prognosis.

低剂量辐射对骨髓间充质干细胞survivin基因表达的影响

目的探讨低剂量辐射预处理对人骨髓间充质干细胞(human bone mesenchymal stem cells,hBMSCs)sur-vivin mRNA表达的影响。方法密度梯度离心法分离培养正常人骨髓间充质干细胞,流式细胞仪检测免疫表型,体外定向诱导hBMSC分化为脂肪细胞,特异性染色鉴定其分化能力;随机分为未予照射的对照组,以及5、10、20cGy照射的实验组,MTT法检测hBMSCs在不同剂量照射后细胞增殖情况;RT-PCR检测5、20cGy照射后细胞survivin mRNA表达。结果体外成功分离hBMSCs,流式细胞仪分析细胞表面抗原CD44和CD29强阳性,HLA-ABC弱阳性,CD34、CD45和HLA-DR阴性;hBMSCs在特定条件下可诱导分化成脂肪细胞;5、10、20cGy照射处理后细胞增殖能力明显增强,均高于对照组(P均<0.01);10cGy辐射剂量处理后48、72h较24h细胞增殖能力明显增强(P均<0.01),处理后72h较48h细胞增殖能力明显增强(P<0.01),差异具有统计学意义;5cGy和20cGy辐射后细胞的survivin mRNA表达上调,与对照组相比(P均<0.01),差异具有统计学意义。结论低剂量辐射可促进hBMSCs的增殖及survivin mRNA的表达。

短种植体的临床应用研究进展

种植修复时常面临可用骨高度不足的问题,使用短种植体可解决骨增量手术之需。短种植体作为骨增量手术的替代治疗方案,在临床上已取得较好的短期效果,但短种植体的远期存留率还偏低,仍需临床进一步验证。本文就短种植体的定义、结构特点、临床应用、临床效果及展望等相关进行综述。

不同重建方式治疗四肢原发性恶性骨肿瘤的随访研究

目的通过分析原发性恶性骨肿瘤患者在瘤段切除后经不同重建方式治疗的随访资料,探讨手术方案的选择对临床疗效的影响。方法以2016年7月1日至2022年7月1日东部战区总医院单中心收治的四肢原发性恶性骨肿瘤患者为研究对象,根据瘤段切除后重建方式分为肿瘤型假体置换组和生物重建组。回顾患者的临床随访资料,对比2组患者至随访截止时间的复发率、转移率、生存率以及最终保肢率,并总结生物重建失败的影响因素。同时,采用美国肌肉骨骼肿瘤协会评分(MSTS)、多伦多保肢评分(TESS)评价并比较不同组间患者术后功能的恢复情况。结果共收集并筛选入组患者87例,其中男52例,女35例,年龄8~71岁,平均(38.3±21.2)岁。随访15~70个月,平均随访时间26.5个月。至随访截止时间,共存活67例,死亡20例,总生存率为77.01%;无瘤存活45例,无瘤生存率为51.72%。其中,假体置换组74例、生物重建组13例(瘤体骨灭活再植钢板重建2例、自体腓骨移植钢板重建11例)。生物重建组术后1年的MSTS评分及TESS评分均明显高于假体置换组(28.33±2.09 vs 24.16±4.51、85.62±6.71 vs 80.82±3.85,P<0.01)。假体置换组术后生存率达到了75.68%。而生物重建组患者术后生存率更达到了84.62%,且根据多因素Cox比例风险回归分析结果,不同的手术方式对无瘤生存(TFS)、总生存(OS)均无显著影响(P>0.05),复发和转移发生与否才是影响OS的预测因素(P=0.003和P=0.001)。而进一步的研究显示,两种不同手术方式的选择与患者的生存率(P=0.0843)、复发率(P=0.5206)、转移率(P=0.3217)无显著相关性。假体置换组与生物重建组的二次手术率(29.73%vs 38.46%)及最终保肢率(83.78%vs 84.62%)比较,差异均无统计学意义(P>0.05)。行瘤段切除后自体腓骨移植钢板重建的患者有11例,其中出现移植骨骨不连2例;愈合时间与年龄、术前肿瘤生长部位、术中截骨长度、取骨部位及植骨量均有相关性(P<0.05)。结论随着治疗理念和手术技术的不断进步,针对原发性恶性骨肿瘤瘤段切除后的骨缺损,采用术前精准测量和周密设计的生物重建手术,可以发挥其在关节稳定、肢体功能、保障疗效等各方面的优势,从而取得较假体置换手术更佳的治疗效果。

Bone metastases from hepatocellular carcinoma:clinical features and prognostic factors

BACKGROUND: Bone metastases (BMs) from hepatocellular carcinoma (HCC) is an increasingly common disease in Asia. We assessed the clinical features, prognostic factors, and differences in outcomes related to BMs among patients with different treatments for HCC. METHODS: Forty-three consecutive patients who were diagnosed with BMs from HCC between January 2010 and December 2014 were retrospectively enrolled. The clinical features were identified, the impacts of prognostic factors on survival were statistically analyzed, and clinical data were compared. RESULTS: The median patient age was 54 years; 38 patients were male and 5 female. The most common site for BMs was the trunk (69.3%). BMs with extension to the soft tissue were found in 14 patients (32.5%). Most (90.7%) of the lesions were mixed osteolytic and osteoblastic, and most (69.8%) patients presented with multiple BMs. The median survival after BMs diagnosis was 11 months. In multivariate analyses, survival after BM diagnosis was correlated with Karnofsky performance status (P=0.008) and the Child-Pugh classification (P<0.001); BM-free survival was correlated with progression beyond the University of California San Francisco criteria (P<0.001) and treatment of primary tumors (P<0.001). BMs with extension to soft tissue were less common in liver transplantation patients. During metastasis, the control of intrahepatic tumors was improved in liver transplantation and hepatectomy patients, compared to conservatively treated patients. CONCLUSIONS: The independent prognostic factors of survival after diagnosis of BMs were the Karnofsky performance status and Child-Pugh classification. HCC patients developed BMs may also benefit from liver transplantation or hepatectomy.

Citalopram increases the differentiation efficacy of bone marrow mesenchymal stem cells into neuronal-like cells

Several studies have demonstrated that selective serotonin reuptake inhibitor antidepressants can promote neuronal cell proliferation and enhance neuroplasticity both in vitro and in vivo. It is hypothesized that citalopram, a selective serotonin reuptake inhibitor, can promote the neuronal differentiation of adult bone marrow mesenchymal stem cells. Citalopram strongly enhanced neuronal characteristics of the cells derived from bone marrow mesenchymal stem cells. The rate of cell death was decreased in citalopram-treated bone marrow mesenchymal stem cells than in control cells in neurobasal medium. In addition, the cumulative population doubling level of the citalopram-treated cells was signiifcantly increased compared to that of control cells. Also BrdU incorporation was elevated in citalopram-treated cells. These ifndings suggest that citalopram can improve the neuronal-like cell differentiation of bone marrow mesenchymal stem cells by increasing cell proliferation and survival while maintaining their neuronal characteristics.

TrkA regulates the regenerative capacity of bone marrow stromal stem cells in nerve grafts

We previously demonstrated that overexpression of tropomyosin receptor kinase A(TrkA)promotes the survival and Schwann celllike differentiation of bone marrow stromal stem cells in nerve grafts,thereby enhancing the regeneration and functional recovery of the peripheral nerve.In the present study,we investigated the molecular mechanisms underlying the neuroprotective effects of TrkA in bone marrow stromal stem cells seeded into nerve grafts.Bone marrow stromal stem cells from Sprague-Dawley rats were infected with recombinant lentivirus vector expressing rat TrkA,TrkA-shRNA or the respective control.The cells were then seeded into allogeneic rat acellular nerve allografts for bridging a 1-cm right sciatic nerve defect.Then,8 weeks after surgery,hematoxylin and eosin staining showed that compared with the control groups,the cells and fibers in the TrkA overexpressing group were more densely and uniformly arranged,whereas they were relatively sparse and arranged in a disordered manner in the TrkA-shRNA group.Western blot assay showed that compared with the control groups,the TrkA overexpressing group had higher expression of the myelin marker,myelin basic protein and the axonal marker neurofilament 200.The TrkA overexpressing group also had higher levels of various signaling molecules,including TrkA,pTrkA(Tyr490),extracellular signal-regulated kinases 1/2(Erkl/2),pErk1/2(Thr202/Tyr204),and the anti-apoptotic proteins Bcl-2 and Bcl-xL.In contrast,these proteins were downregulated,while the pro-apoptotic factors Bax and Bad were upregulated,in the TrkA-shRNA group.The levels of the TrkA effectors Akt and pAkt(Ser473)were not different among the groups.These results suggest that TrkA enhances the survival and regenerative capacity of bone marrow stromal stem cells through upregulation of the Erk/Bcl-2 pathway.All procedures were approved by the Animal Ethical and Welfare Committee of Shenzhen University,China in December 2014(approval No.AEWC-2014-001219).

Bone Scan Index Is a Prognostic Factor for Breast Cancer Patients with Bone Metastasis Being Treated with Zoledronic Acid

Bone scan index (BSI) has been used to quantify the spread of bone metastasis and be a prognostic indicator in prostate cancer with bone metastases. However, the utility of BSI in breast cancer patients with bone metastasis has not been yet established. We retrospectively reviewed 57 female breast cancer patients with osteoblastic/lytic combined type bone metastases and treated with zoledronic acid after bone metastasis was identified. Serial bone scintigrams were taken at the time of bone metastasis detection and during the 6- and 12-month follow-ups. The scintigrams were analyzed by BONE NAVITM version 1 and the BSI value was calculated. Additionally, serum cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) were measured. The patients were divided in 2 distinct groups—group A representing all follow-up BSI values ≤ initial BSI values and group B representing all follow-up BSI values ≥ initial BSI values. The interval changes of CA15-3 and CEA were divided in the same fashion. Kaplan-Meier method and log-rank test revealed that the overall survival rate was significantly greater in group A than those of group B after 6 months (p = 0.011) and 12 months (p = 0.016). Univariate analysis revealed that the overall survival rate was significantly greater in group A than those of group B, after a 6 month period (Hazard Ratio [HR] 5.841;95% confidence interval [CI] 1.248 - 27.34;p = 0.025) and 12 month period (HR: 4.22;95% CI 1.17615.15;p = 0.027). Multivariate analysis demonstrated that BSI changes after 6 and 12 months trended toward significance regarding parameters affecting survival rate (age and CA15-3) with a HR = 12.760 (95%CI 1.8110 - 89.850) at 6 months with a p = 0.010 and a HR = 5.0640 (95%CI 1.0590 - 24.220) at 12 months with a p = 0.042. BSI changes after 6 and 12 months appear to be a prognostic factor in breast cancer patients with bone metastasis treated with zoledronic acid.

Predictive Value of Clinical and Laboratory Parameters for Overt Bone Marrow Metastasis in Patients with Solid Malignancy

Bone marrow (BM) metastases are known to worsen the outcome in patients with malignancies and alter the choice of the treatment regimen. In an attempt to identify routine parameters for the prediction of BM metastasis we evaluated the clinical and laboratory data of 103 patients with metastatic solid tumors. We also assessed which of these factors appeared to influence survival. Three laboratory abnormalities were found to be predictive of metastasis on BM biopsy: thrombocytopenia 9/L OR 14.4;p = 0.02;hypocellular or dry tap aspirate OR 7.0;p = 0.02 and high serum alkaline phosphatase OR 6.5;p = 0.03. Three additional factors were found to be associated with deceased survival. Thrombocytopenia was associated with decreased survival from a median of 0.8 months to 4.1 months, p < 0.0001. Serum LDH levels more than twice the upper limit of normal were also reduced survival from 1.8 months versus 4.7 months, p = 0.03. Finally, the initial diagnosis of malignancy by bone marrow examination was associated with reduced survival from 1.8 months vs. 4.0 months, p = 0.03 in individuals where BM metastases were not the presenting feature of malignancies. Use of these simple clinical parameters may help in the early diagnosis of bone marrow metastases and improve clinical approach.

骨髓脂肪细胞促进多发性骨髓瘤细胞生存并上调抗药性

目的:探讨多发性骨髓瘤(MM)患者骨髓微环境中脂肪细胞(Ad)在MM发生、发展中的作用。方法:油红O染色分析正常供者(HD)及初诊MM(ND-MM)患者骨髓涂片中骨髓脂肪细胞(BMA)含量。分别收集正常供者及初诊MM患者间充质干细胞(MSC),采用体外共培养试验探讨MM细胞对MSC成脂分化的影响以及BMA在MM细胞生存和耐药中的作用。实时定量PCR法检测MSC及MSC衍生Ad中成脂及成骨分化相关基因PPAR-γ、DLK1、DGAT1、FABP4、FASN和ALP表达,蛋白印迹法检测含或不含PPAR-γ抑制剂G3335共培养上清中IL-6、IL-10、SDF-1α、TNF-α和IGF-1水平。结果:油红O染色结果显示,与正常对照相比,ND-MM骨髓涂片阳性BMA显著增多,且与疾病状态相关,治疗有效者骨髓BMA含量下降;MM细胞明显上调了MSC成脂分化相关基因PPAR-γ、DLK1、DGAT1、FABP4和FASN的表达水平,而成骨分化相关基因ALP则明显下调。在MM骨髓微环境中MM细胞与MSC相互作用的直接后果是以成骨细胞为代价促进MSC向Ad分化,且该类Ad的细胞因子分泌谱发生变化。PPAR-γ抑制剂G3335可部分逆转BMA释放细胞因子,由此证实BMA经PPAR-γ信号调控其细胞因子释放,而G3335则可破坏PPAR-γ介导的BMA成熟和细胞因子释放。显著增多的BMA及相关细胞因子有效增强了MM细胞的增殖、迁移和耐药性。结论:BMA及其相关细胞因子是MM细胞生存、增殖和迁移的促进因素。MM衍生的BMA能保护MM细胞免受药物诱导的细胞凋亡,在MM治疗失败和疾病进展中起着重要作用。

在后牙区应用4 mm超短种植体临床效果的Meta分析

目的 通过系统评价及Meta分析的方法评估在后牙区骨量不足植入4 mm超短种植体(ESI)的安全性和效用。方法 电子检索2010年1月1日—2022年8月31日PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方数据库有关ESI与标准种植体(SI)(≥8 mm)的随机对照试验或临床对照试验,并进行引文检索。应用RevMan 5.4版软件进行Meta分析。结果 共11篇研究符合纳入标准,其中随机对照试验6篇,临床对照试验5篇。Meta分析结果:在后牙区种植时,ESI与SI的存留率差异无统计学意义[RR=1.23,95%CI(0.66,2.27),P=0.52];ESI表现出更稳定的边缘骨水平[MD=-0.16,95%CI (-0.25,-0.07),P=0.000 7],更少的生物并发症[RR=0.34,95%CI (0.19,0.62),P=0.000 4],然而机械并发症更多[RR=2.89,95%CI (1.05,7.92),P=0.04]。结论 基于有限的证据,在后牙牙槽嵴高度低于5 mm时应用ESI可以获得媲美SI的临床效果,且具备技术敏感性低、术后生物并发症少等优势。由于ESI长期随访证据不足、样本量有限,仍需要更多临床试验评估ESI的长期效用。

早期应用唑来膦酸干预实体瘤骨相关事件疗效分层分析

目的 探讨前瞻性应用唑来膦酸(ZOL)早期干预实体瘤骨转移、骨相关事件(SREs)的疗效和生存期。方法 2016年1月~2020年12月入组165例患者,中位年龄52岁。按简单随机方法分为:观察组为治疗结束即使用ZOL,对照组为同期治疗结束的、不使用ZOL、定期随访的患者。对两组患者的疗效、生存进行分析,对具体应用ZOL的次数与疗效、生存的关系等进行分层分析。结果 观察组骨转移3例(1.8%)、对照组26例(15.8%),差异有统计学意义(χ^(2)=10.792, P<0.05);观察组SREs 2例(1.2%),对照组19例(11.5%),差异有统计学意义(χ^(2)=8.284, P<0.05)。两组患者的总生存期(OS)和中位生存期(MST)差异无统计学意义(χ^(2)=1.347, P>0.05);两组1~5年的无骨转移进展生存期(TTPS)和中位进展生存期(MPST)比较,差异有统计学意义(χ^(2)=4.155, P=0.040)。观察组是否发生骨转移与使用ZOL的次数无明显关系(χ^(2)=2.505, P>0.05)。使用ZOL后仍发生骨转移的患者与未发生骨转移患者的生存比较:1~5年的OS和MST相比,差异无统计学意义(χ^(2)=0.002, P>0.05);两组1~5年的TTPS和MPST相比,差异无统计学意义(χ^(2)=1.709, P>0.05)。观察组使用ZOL次数的多少对生存的影响:使用ZOL次数较少(1~3次)、中量(4~6次)与较多(7次以上)三组相比,差异无统计学意义(χ^(2)=2.892, P>0.05),但少和中量的OS、TTPS曲线分开明显。Cox回归模型多因素分析,性别、年龄、分期、使用ZOL后是否出现骨转移、使用ZOL次数未影响OS及TTPS。结论 实体瘤尚未骨转移患者,经使用ZOL早期干预后,观察组的骨转移、SREs明显低于对照组,TTPS延长;分层分析:发生骨转移与使用ZOL次数、对生存的影响尚需进一步观察,可能使用次数较多者对生存有益。ZOL早期干预实体瘤骨转移、SREs具明显优势。

恶性肿瘤骨转移疼痛患者治疗及预后的临床分析

目的分析骨转移患者骨痛发病特点、内科治疗效果及预后,并对镇痛药物用药合理性进行分析,以提高临床对骨转移疼痛的诊治水平。方法对123例伴有疼痛的恶性肿瘤骨转移患者进行规范三阶梯止痛治疗及抗肿瘤治疗,并对其临床特征进行回顾性分析。结果总疼痛缓解率85.4%,疼痛程度明显减轻(P<0.05)。各麻醉类药物DUI值均接近1,用药趋向合理。Kaplan-Meier生存分析显示,中度疼痛者生存明显优于重度疼痛者(P=0.015);疼痛明显缓解者生存明显优于未明显缓解者(P=0.021);无内脏转移者生存优于伴有内脏转移者(P=0.000)。COX多因素分析结果显示,疼痛程度、是否内脏转移是影响预后的独立危险因素。结论规范治疗可使多数骨转移疼痛患者症状改善,并在一定程度上延长生存时间。阿片类药物对中重度疼痛具有理想的止痛效果,不良反应可以耐受。

三种手术方式治疗高血压脑出血的临床疗效比较

目的分析小骨窗开颅、钻孔引流术和骨瓣开颅三种手术方式治疗高血压脑出血的临床疗效和安全性。方法选取该院神经外科2012年6月至2015年2月收治的280例患有高血压脑出血且行手术治疗的患者作为研究对象,回顾性分析其临床资料,其中采用小骨窗开颅术的有90例,采用锥颅钻孔引流术的有110例,而采用骨瓣开颅术的有80例。统计并分析三组患者的存活率和远期临床疗效。结果三组患者在住院期间共有58例死亡,其生存率为79.3%。小骨窗开颅术组、锥颅钻孔引流术组、骨瓣开颅术组的生存率分别为73.3%、78.2%、87.5%,比较差异无统计学意义(P>0.05);小骨窗开颅术组、锥颅钻孔引流术组、骨瓣开颅术组愈合率分别为57.2%、58.7%、30.1%。小骨窗开颅术组和锥颅钻孔引流术组患者的愈合率明显大于骨瓣开颅术组,差异有统计学意义(P<0.05);治疗6周后,锥颅钻孔引流术组和骨瓣开颅术组的患者临床疗效明显高于小骨窗开颅术组;治疗后12周,锥颅钻孔引流术组和骨瓣开颅术组的神经功能缺损评分明显低于小骨窗开颅术组,差异均有统计学意义(P<0.05);小骨窗开颅术组患者手术时长明显长于锥颅钻孔引流术组和骨瓣开颅术组,小骨窗开颅术组患者术中输血量、术后切口脑脊液渗漏发生概率和住院时长均明显少于锥颅钻孔引流术组和骨瓣开颅术组患者,差异均有统计学意义(P<0.05)。结论小骨窗开颅术、锥颅钻孔引流术和骨瓣开颅术清除患者脑内血肿时具有不同的临床疗效,可不同程度提高患者生存率和预后。

伴白细胞计数异常的B细胞非霍奇金淋巴瘤临床特征及预后分析

目的探讨初诊时伴有白细胞(white blood cell,WBC)计数异常的B细胞非霍奇金淋巴瘤(B-cell non-Hodgkin lymphoma,B-NHL)患者的临床特征及治疗方案,评价疗效,分析生存情况。方法回顾性分析2011年1月至2017年12月就诊于山西医科大学第二医院伴有白细胞计数异常(WBC>10×109/L或<4×109/L)的B-NHL患者临床资料,根据白细胞计数异常程度分为3组:白细胞计数明显增高组(WBC>30×109/L)、轻度增高组(WBC 10~30×109/L)、减低组(WBC<4×109/L),总结患者临床特点、治疗方案,评价早期治疗效果及生存情况,分析预后相关因素。结果 68例伴有白细胞计数异常的B-NHL,白细胞计数明显增高13例,轻度增高26例,减低29例;其中位就诊年龄63(19~80)岁,自出现症状至诊断的中位时间为2(0.2~120)个月,男女性别比为1.4∶1。病理亚型以边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma,MZL)、弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)为主;分期均为Ⅲ/Ⅳ期或白血病期。有B症状者占57%(39/68)、乳酸脱氢酶(lactate dehydrogenase,LDH)升高者占54%(32/59),伴贫血和/或血小板减少占67.7%(46/68),淋巴细胞百分比增高者占56.7%(38/68),骨髓侵犯达91.7%(55/60),伴骨髓纤维化者占28%(15/53)。评价早期疗效40例,完全缓解(complete response,CR)率为17.5%(7/40),总反应率(overall response rate,ORR)为55.0%(22/40);ORR与LDH、血小板计数、首次治疗后骨髓改善情况相关(P=0.028,P=0.048,P=0.031)。随访截至2018年1月31日,有效随访43例,中位随访时间22(1~70)个月,中位生存期(overall survival,OS)为24个月(95%CI:8.722~39.278),无进展生存期(progression-free survival,PFS)为13个月(95%CI:2.721~23.279),轻度增高组PFS优于其他两组(P1=0.017,P2=0.026)。单因素分析,侵袭性组织学、B症状、贫血、血小板减少、治疗方案、治疗后能否早期达CR或PR是OS的预后因素;LDH、白细胞分组、是否治疗、治疗后能否早期达CR或PR为PFS的影响因素。多因素分析,B症状为OS的影响因素,治疗后能否早期达CR或PR是OS、PFS的共同影响因素。结论伴有白细胞计数异常的B-NHL患者早期就诊率高,但分期均晚,大多数患者出现骨髓侵犯,常合并贫血、血小板减少。该类患者早期ORR低、整体PFS短,白细胞计数轻度增高患者的PFS较好,OS有待进一步观察;早期ORR是OS、PFS的影响因素。白血病期患者接受急性淋巴细胞白血病诱导强化方案治疗可获得较高的ORR。

原发性肝癌骨转移的放射治疗疗效及相关预后因素的分析

目的 分析原发性肝癌骨转移患者的放射治疗疗效及预后的相关因素。方法 回顾性分析了 5 2例原发性肝癌伴骨转移放射治疗的效果 ,放疗方法采用常规分割 ,每周 5次 ,每次 2Gy ,中位肿瘤剂量 4 0 .0Gy。生存率用Kaplan Meier法计算 ,单因素分析采用log rank方法 ,多因素分析采用COX回归模型。 结果 1、2、3年生存率分别为 2 7.6 %、11.8%、8.9%。经单因素和多因素分析表明肝内病灶的控制情况、肝功能状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器转移因素是独立的预后因子 (P值均 <0 .0 1)。骨转移灶的数目、诊断骨转移时AFP的水平与生存率无明显相关。结论 原发性肝癌骨转移患者经外照射后症状明显缓解 ,但远期疗效很差 ,绝大多数在一年内死亡。肝内病灶控制与否、肝功能的状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器的转移与预后相关。

四肢恶性骨肿瘤的不同保肢重建方法

背景:目前保肢手术已经成为四肢恶性骨肿瘤的规范治疗方式,其目的是不但要提高患者的生存率,而且要保存良好的肢体功能。目的:就四肢恶性骨肿瘤人工关节置换及同种异体骨移植等各种保肢方式进行综述。方法:由第一作者应用计算机检索PubMed数据库1992年1月至2012年10月及中国期刊网全文数据库1994年1月至2012年12月有关四肢恶性骨肿瘤保肢治疗的文章,英文检索词为"malignant bone tumor,salvage treatment,allograft bone graft,prosthesis and microwave",中文检索词为"恶性骨肿瘤,保肢治疗,大段异体骨,肿瘤假体,微波灭活治疗"。排除重复性研究及Meta分析,共保留31篇文献进行综述。结果与结论:①对于四肢特别是关节周围的恶性骨肿瘤,大多采用人工关节置换、大段同种异体骨移植以及微波灭活治疗。②大段同种异体骨移植后并发症发生率较高,微波灭活治疗技术有新的进展,进一步的研究仍在进行当中。③瘤段骨灭活再植以及乙醇灭活治疗多适用于基层医院。

Ⅳ期非小细胞肺癌287例放疗后的生存分析

背景与目的:很多Ⅳ期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的患者需要放疗,特别是对脑、骨转移者放疗有很好的治疗作用。本研究旨在分析放疗对Ⅳ期NSCLC患者生存的影响。方法:对287例资料完整的Ⅳ期NSCLC放疗患者进行回顾性分析。脑放疗为平行对穿两野全脑照射,骨放疗为单野局部照射,对原发灶、区域淋巴结和其它转移部位用2维常规分割或3维适形放疗(3dimensionalconformalradiotherapy,3D-CRT)。脑和骨放疗通常采用4周20次共40Gy或2周10次共30Gy的治疗方案,原发灶和区域淋巴结的中位照射剂量是50Gy(20～70Gy),其它转移部位的中位照射剂量是46Gy(40～60Gy)。结果:全部患者中位生存期9个月(8～10个月),1年和2年生存率分别是30.2%和8.9%。有化疗和无化疗者中位生存期分别为10个月和8个月(P=0.049)。有脑转移、骨转移、其它转移者中位生存期分别为8个月、9个月、10个月,1年生存率分别24.8%、28.7%和37.5%,2年生存率分别为6.7%、7.0%和15.3%。单因素分析发现对生存有显著影响的因素为病理类型和年龄。腺癌患者的生存期高于鳞癌和其它病理类型,中位生存期分别为10个月、7个月、9个月(P=0.046);≤60岁的患者生存期显著高于>60岁的患者,中位生存期分别为11月、8个月(P=0.012);单纯骨转移患者的中位生存期要大于合并有其它转移者(10个月与6个月,P=0.033),而单纯脑转移和同时合并有其它转移的两组患者中位生存期却无明显差异(9个月与8个月,P=0.3742);肿瘤原发灶和区域淋巴结是否放疗对患者生存时间影响不大(10个月与8个月,P=0.066);是否伴有其它慢性疾病对患者的生存期无明显影响(9个月与10个月,P=0.306)。对脑和骨转移的患者采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。结论:病理类型、年龄对Ⅳ期NSCLC患者的放疗疗效有显著影响,全脑和骨转移采用4周20次40Gy或2周10次30Gy放疗对生存期无明显影响。