Conditional survival probability of distant-metastatic hepatocellular carcinoma: A population-based study

BACKGROUND The prognosis of many patients with distant metastatic hepatocellular carcinoma(HCC)improved after they survived for several months.Compared with tradi-tional survival analysis,conditional survival(CS)which takes into account changes in survival risk could be used to describe dynamic survival probabilities.AIM To evaluate CS of distant metastatic HCC patients.METHODS Patients diagnosed with distant metastatic HCC between 2010 and 2015 were extracted from the Surveillance,Epidemiology and End Results database.Univariate and multivariate Cox regression analysis were used to identify factors for overall survival(OS),while competing risk model was used to identify risk factors for cancer-specific survival(CSS).Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after initial diagnosis,and standardized difference(d)was used to evaluate the survival differences between subgroups.Nomograms were constructed to predict CS.Positiveα-fetoprotein expression,higher T stage(T3 and T4),N1 stage,non-primary site surgery,non-chemotherapy,non-radiotherapy,and lung metastasis were independent risk factors for actual OS and CSS through univariate and multivariate analysis.Actual survival rates decreased over time,while CS rates gradually increased.As for the 6-month CS,the survival difference caused by chemotherapy and radiotherapy gradually disappeared over time,and the survival difference caused by lung metastasis reversed.Moreover,the influence of age and gender on survival gradually appeared.Nomograms were fitted for patients who have lived for 2,4 and 6 mo to predict 6-month conditional OS and CSS,respectively.The area under the curve(AUC)of nomograms for conditional OS decreased as time passed,and the AUC for conditional CSS gradually increased.CONCLUSION CS for distant metastatic HCC patients substantially increased over time.With dynamic risk factors,nomograms constructed at a specific time could predict more accurate survival rates.

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.

Radiomics of rectal cancer for predicting distant metastasis and overall survival

BACKGROUND Rectal cancer(RC)patient stratification by different factors may yield variable results.Therefore,more efficient prognostic biomarkers are needed for improved risk stratification,personalized treatment,and prognostication of RC patients.AIM To build a novel model for predicting the presence of distant metastases and 3-year overall survival(OS)in RC patients.METHODS This was a retrospective analysis of 148 patients(76 males and 72 females)with RC treated with curative resection,without neoadjuvant or postoperative chemoradiotherapy,between October 2012 and December 2015.These patients were allocated to a training or validation set,with a ratio of 7:3.Radiomic features were extracted from portal venous phase computed tomography(CT)images of RC.The least absolute shrinkage and selection operator regression analysis was used for feature selection.Multivariate logistic regression analysis was used to develop the radiomics signature(Rad-score)and the clinicoradiologic risk model(the combined model).Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC.The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.RESULTS A total of 51(34.5%)patients had distant metastases,while 26(17.6%)patients died,and 122(82.4%)patients lived at least 3 years post-surgery.The values of both the Rad-score(consisted of three selected features)and the combined model were significantly different between the distant metastasis group and the nonmetastasis group(0.46±0.21 vs 0.32±0.24 for the Rad-score,and 0.60±0.23 vs 0.28±0.26 for the combined model;P<0.001 for both models).Predictors contained in the combined model included the Rad-score,pathological N-stage,and T-stage.The addition of histologic grade to the model failed to show incremental prognostic value.The combined model showed good discrimination,with areas under the curve of 0.842 and 0.802 for the training set and validation set,respectively.For the survival analysis,the combined model was associated with an improved OS in the whole cohort and the respective subgroups.CONCLUSION This study presents a clinicoradiologic risk model,visualized in a nomogram,that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.

Perioperative rh-endostatin with chemotherapy improves the survival of conventional osteosarcoma patients: a prospective non-randomized controlled study

Objective: Anti-angiogenic drugs are an emerging treatment option against malignant tumors. The aim of this study was to determine whether the addition of perioperative rh-endostatin to chemotherapy could improve the probability of distant metastasis-free survival(DMFS) and overall survival(OS) in patients newly diagnosed with non-metastatic conventional osteosarcoma.Methods: This was a controlled non-randomized clinical study that included 388 patients without clinically detectable metastatic disease enrolled from January 2008 to April 2012. The control treatment group had 272 patients; 180 were male and 92, female,with a median age of 17 years. The treatment group had 58 patients; 36 were male and 22, female, with a median age of 16 years.The control group received preoperative chemotherapy followed by surgery and postoperative chemotherapy. The treatment group received 4 cycles of rh-endostatin perioperatively in addition to chemotherapy as per the control group. Patients were followed up from 6-101 months with a median follow-up period of 50.2 months.Results: The 5-year DMFS of the control group(61%) was significantly lower than that of the rh-endostatin group(79%)(P = 0.013). The 5-year OS of the control group(74%) was significantly lower than that of the rh-endostatin treatment group(87%)(P = 0.029). No difference in adverse drug reactions was found between these 2 groups.Conclusions: The addition of perioperative rh-endostatin to chemotherapy could significantly improve the DMFS and OS of patients with non-metastatic osteosarcoma.

Clinical features and survival of patients with multiple primary malignancies

BACKGROUND Multiple primary malignancies(MPM)are characterized by two or more primary malignancies in the same patient,excluding relapse or metastasis of prior cancer.We aimed to elucidate the clinical features and survival of MPM patients.AIM To elucidate the clinical features and survival of MPM patients.METHODS A retrospective study of MPM patients was conducted in our hospital between June 2016 and June 2019.Overall survival(OS)was calculated using the Kaplan-Meier method.The log-rank test was used to compare the survival of different groups.RESULTS A total of 243 MPM patients were enrolled,including 222 patients with two malignancies and 21 patients with three malignancies.Of patients with two malignancies,51(23.0%)had synchronous MPM,and 171(77.7%)had metachronous MPM.The most common first cancers were breast cancer(33,14.9%)and colorectal cancer(31,14.0%).The most common second cancers were non-small cell lung cancer(NSCLC)(66,29.7%)and gastric cancer(24,10.8%).There was no survival difference between synchronous and metachronous MPM patients(36.4 vs 35.3 mo,P=0.809).Patients aged>65 years at diagnosis of the second cancer had a shorter survival than patients≤65 years(28.4 vs 36.4 mo,P=0.038).Patients with distant metastasis had worse survival than patients without metastasis(20.4 vs 86.9 mo,P=0.000).Following multivariate analyses,age>65 years and distant metastasis were independent adverse prognostic factors for OS.CONCLUSION During follow-up of a first cancer,the occurrence of a second or more cancers should receive greater attention,especially for common concomitant MPM,to ensure early detection and treatment of the subsequent cancer.

Cycle number of neoadjuvant chemotherapy might influence survival of patients with T1-4N2-3M0 nasopharyngeal carcinoma

Objective： Stage N2-3 nasopharyngeal carcinoma（NPC） shows a high risk of distant metastasis, which will finally cause death. This study aimed to evaluate the impact of neoadjuvant chemotherapy（NACT） of various cycles before radical radiotherapy on distant metastasis and survival of patients with stage N2-3 diseases.Methods： In this study, a total of 1,164 consecutive patients with non-metastatic N2-3 NPC were recruited and prospectively observed. Then 231 patients who received NACT of 4 cycles（NACT=4 group） were matched 1：2：1 to 462 patients treated with NACT of 2 cycles（NACT=2 group） and 231 patients treated without NACT（NACT=0 group）, according to age, histological subtype, N stage and NACT regimen. Five candidate variables（sex, T stage, concurrent chemotherapy, intensity-modulated radiation therapy and cycle number of NACT） were analyzed for their association with patients＇ survival.Results： After matching, the overall survival（OS）, disease-free survival（DFS）, local-recurrence-free survival（RFS） and distant-metastasis-free survival（MFS） of the NACT=4 group（89.2%, 81.0%, 83.3% and 84.8%,respectively） were better than those of the NACT=2 group（83.3%, 72.5%, 81.2% and 77.9%, respectively） and the NACT=0 group（74.0%, 63.2%, 74.0% and 68.8%, respectively）. In multivariate analysis, the cycle number of NACT maintained statistical significance on the OS, DFS, RFS and MFS（all P〈0.05）.Conclusions： For N2-3 NPC, cycle number of NACT appeared to be an independent factor associated with an improvement of survival.

基于SEER数据库构建远处转移性子宫内膜癌的生存预测模型

目的探究远处转移性子宫内膜癌(endometrial cancer,EC)患者的临床特征与生存之间的相关性,并构建生存预测模型以指导临床实践。方法从SEER数据库中回顾性收集2010-2017年间伴有远处转移EC患者的相关临床病理资料。通过单因素和多因素Cox回归分析确定独立预后因素,并基于预测因素的贡献程度建立列线图模型;采用C指数、ROC曲线、校准曲线和临床决策曲线(decision curve analysis,DCA)等方法对模型的预测价值进行评价和内部验证。另外,收集2013年10月至2019年12月就诊于重庆医科大学附属第一医院妇科的远处转移性EC患者资料,对模型进行外部验证。结果共纳入SEER数据库中1807例符合纳入排除标准的远处转移性EC患者。多因素Cox分析结果显示,肿瘤大小、肿瘤分级和组织学亚型是远处转移性EC的独立危险因素;种族、手术和化疗是远处转移性EC的独立保护因素,并用于构建列线图。在训练队列中,模型的C指数为0.711(95%CI:0.695~0.727);在内部验证队列中,模型的C指数为0.744(95%CI:0.721~0.768);ROC曲线显示本模型具有良好的预测精准度和区分度;校准曲线显示模型的预测生存率与实际生存率具有良好的一致性;与此同时,DCA结果显示模型具有良好的临床应用潜能。共纳入21例本中心远处转移性EC患者作为外部验证数据集,结果显示模型预测能力良好。结论本研究建立了远处转移性EC的生存预测模型,可用于协助临床医师评估患者预后及制定个性化的治疗决策。

鼻咽癌患者根治性放化疗后远处转移、预后生存调查及影响因素分析

目的:分析根治性放疗治疗后远处转移鼻咽癌患者预后生存情况及预测因子。方法:回顾性分析2015年3月至2020年10月本院收治的108例鼻咽癌患者的临床资料。所有患者在初诊时均予以根治性放疗和化疗。对患者随访资料进行记录,统计3年内远处转移及生存情况,并分析影响患者预后生存的危险因子。结果:截止随访结束,108例患者95(87.96%)例患者发生远处转移,中位转移时间为14.42±2.62 m,以骨转移、肺转移及纵膈淋巴结转移处多见。108例患者中位生存时间为13.41±4.81 m,生存率为26.31%。95例远处转移患者中,4例患者仅进行营养干预;6例患者采取转移灶姑息放疗;48例予以单纯全身化疗;37例予以全身辅助化疗+局部姑息放疗。初诊时N分期、转移后化疗周数及转移部位为影响经根治性放疗治疗后远处转移鼻咽癌患者预后生存的独立危险因素(P<0.05)。结论:初诊时N分期、转移后化疗周数及转移部位均为经根治性放疗治疗后远处转移鼻咽癌患者预后生存的预测因子,对合并危险因素的高危患者进行合理干预有利于提升治疗后远处转移患者生存率。

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.

Locoregional radiotherapy in patients with distant metastases of nasopharyngeal carcinoma at diagnosis

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma(NPC); however, it is not known whether locoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of locoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing locoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations (P<0.05). Both locoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival(OS). The mortality risk was similar in the group undergoing locoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio(HR)=0.9, P=0.529]; this risk was 60% lower than that of the group undergoing supportive treatment(HR=0.4, P=0.004) and 130% higher than that of the group undergoing both systemic chemotherapy and locoregional radiotherapy(HR=2.3, P<0.001). In conclusion, locoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.

术后同步放化疗治疗ⅠB1~Ⅱ期高危宫颈癌患者的疗效及安全性

目的探讨术后同步放化疗治疗ⅠB1~Ⅱ期高危宫颈癌患者的疗效及安全性。方法根据术后治疗方法的不同将98例ⅠB1~Ⅱ期高危宫颈癌患者分为A组(n=61,同步放化疗)和B组(n=37,单纯化疗)。两组患者均随访5年,比较两组患者的复发、远处转移及生存情况。比较两组患者治疗期间不良反应发生情况。结果A组患者术后3、5年复发率及远处转移率均低于B组(P﹤0.05)。两组患者3年生存率比较,差异无统计学意义(P﹥0.05);A组患者5年生存率高于B组(P﹤0.05)。两组患者胃肠道反应、骨髓抑制、肝肾功能损伤发生情况比较,差异均无统计学意义(P﹥0.05)。结论与单纯化疗相比,同步放化疗能够降低ⅠB1~Ⅱ期高危宫颈癌患者术后3、5年复发率及远处转移率,提高5年生存率,且不增加不良反应。

高危神经母细胞瘤放射治疗预后分析

目的分析放射治疗(简称放疗)对儿童高危神经母细胞瘤(NB)预后的影响。方法回顾性分析100例高危NB患儿的临床资料。通过单因素分析筛选NB患儿复发和生存的影响因素,随访放疗组与未放疗组NB患儿的无复发生存期和总生存期,采用Kaplan-Meier法进行生存分析,采用Log-rank检验比较放疗组与未放疗组无复发生存率和总生存率的差异。结果100例NB患儿中,复发34例,未复发66例,生存74例,死亡26例。单因素分析结果显示,年龄、肿瘤远处转移、放疗是NB患儿肿瘤复发的影响因素(P<0.05),年龄、肿瘤远处转移、MYCN基因扩增是NB患儿生存情况的影响因素(P<0.05)。生存分析结果显示,放疗组与未放疗组NB患儿的无复发生存率比较差异有统计学意义(P<0.05),但2组NB患儿的总生存率比较差异无统计学意义(P>0.05)。结论年龄、肿瘤远处转移、放疗是NB复发的影响因素,年龄、肿瘤远处转移、MYCN基因扩增是NB患儿生存情况的影响因素。放疗能显著提升高危NB患儿的无复发生存率,但不能显著提升总生存率。

乳腺癌原发灶T淋巴细胞浸润与预后的关系

目的探讨Ⅰ～Ⅲ期乳腺癌原发灶中T淋巴细胞与临床病理特征以及预后的关系。方法回顾性收集2000年1月至2002年12月解放军总医院手术的130例Ⅰ～Ⅲ期乳腺癌患者的临床资料及石蜡切片,用免疫组织化学方法检测乳腺癌原发灶中CD4+和CD8+淋巴细胞浸润强度并分析其与乳腺癌临床病理特征及预后的关系。结果 CD4+细胞癌巢浸润在COX多元分析中是无病生存(HR=0.248,95%CI=0.113-0.543,P=0.000)、远处无转移生存(DDFS)(HR=0.361,95%CI=0.157-0.830,P=0.017)、总生存(OS)(HR=0.297,95%CI=0.119-0.741,P=0.009)的独立预后因素,与较好预后相关。CD8+间质细胞密度和CD8+细胞癌巢浸润在激素受体阴性(雌激素受体和孕激素受体均为阴性)患者分别是OS(HR=0.286,95%CI=0.101-0.807,P=0.018)和DDFS(HR=0.293,95%CI=0.104-0.825,P=0.020)的独立预后因素,均与较好的预后相关。CD8+间质细胞密度和CD8+细胞癌巢浸润在激素受体阳性(雌激素受体和孕激素受体至少1个阳性)患者分别是OS(HR=4.854,95%CI=1.435-16.415,P=0.011)和DDFS(HR=10.493,95%CI=1.226-89.795,P=0.032)的独立预后因素,均与较差的预后相关。在激素受体阳性患者,术后辅助内分泌治疗可显著改善CD8+间质细胞密度低患者的OS。结论乳腺癌原发灶CD4+细胞癌巢浸润与较好的预后相关。乳腺癌原发灶CD8+间质细胞密度和CD8+细胞癌巢浸润在激素受体阴性患者与较好的预后相关,但在激素受体阳性患者与较差的预后相关。术后辅助内分泌治疗的远期疗效与乳腺癌原发灶CD8+间质细胞密度相关,进而影响CD8+细胞与乳腺癌预后的关系。以上结论为探索免疫相关的乳腺癌预后指标提供了线索。

放疗加化疗治疗晚期鼻咽癌的临床分析

目的 评价综合治疗晚期鼻咽癌的疗效。方法 1 993年 3月至 1 996年 3月 ,1 88例 、 a期鼻咽癌患者随机分为两组 (化放组和放疗组 ) ,每组 94例。放疗用 60 Co机或直线加速器照射。鼻咽癌原发灶 DT68～ 76Gy/7- 7.5 w,颈部 DT5 0～ 70 Gy/5 - 7w。化疗组在放疗前和放疗后分别用 PDD+ 5 - Fu方案化疗。结果 3、5年生存率放化疗组分别为 68.1 %、5 5 .3% ,放疗组分别为 5 4 .2 %、37.2 % ;远处转移率化放组为 35 .1 % ,放疗组为 47.9% ,统计学上都有显著性差异 ( P<0 .0 5 )。

应用无复发生存率和无远处转移生存率进行肿瘤预后的评价——附411例鼻咽癌资料分析

目的：阐述无复发生存率（ＦＬＦ）和无远处转移生存率（ＦＤＭ）在肿瘤预后研究中的重要性和必要性。方法：４１１例初次放射治疗的鼻咽癌病例资料纳入研究，以生存率、无复发生存率和无远处转移生存率为预后指标，通过ＣＯＸ比例风险模型，分析比较影响鼻咽癌生存、复发和远处转移的因素。结果：与生存有关的因素为性别，’９２分期，Ｎ分期，颈部射线；放射治疗后鼻咽肿瘤残留与鼻咽复发存在密切关系，与远处转移密切相关的因素是Ｎ分期。结论：只有应用无复发生存率（ＦＬＦ）和无远处转移生存率（ＦＤＭ）为指标，才能明确影响肿瘤复发的因素和转移的因素，这两个指标在评价治疗措施和肿瘤分期研究中均有意义。

乳腺癌原发灶B淋巴细胞浸润与预后的关系

目的探讨早期乳腺癌原发灶B细胞与临床病理特征以及预后的关系。方法回顾性收集2000年1月～2002年12月在解放军总医院手术的130例Ⅰ～Ⅲ期乳腺癌患者的临床资料及石蜡切片,用免疫组织化学法检测乳腺癌原发灶间质中CD20阳性B淋巴细胞的浸润情况并分析其与CD8和CD4阳性淋巴细胞密度的关系,以及分析CD20阳性细胞浸润与乳腺癌临床病理特征及预后的关系。结果在部分乳腺癌(37.69%,49/130)间质可见CD20^+B细胞聚集分布,并可观察到CD3^+T细胞聚集在CD20^+B细胞聚集区的周围形成淋巴滤泡样结构。总体分析时,CD20^+细胞聚集与预后不相关。在激素受体阴性(雌激素受体和孕激素受体均为阴性)患者的COX多元分析中,CD20^+细胞聚集与较好的DDFS(HR=0.251,95%CI=0.071-0.894,P=0.033)、OS(HR=0.325,95%CI=0.103-1.028,P=0.056)相关。而在激素受体阳性(雌激素受体和孕激素受体至少有一个阳性)患者,CD20^+细胞聚集与DFS(P=0.997)、DDFS(P=0.759)、OS(P=0.700)均不相关。在激素受体阳性患者,术后辅助内分泌治疗可显著改善CD20^+细胞聚集阴性患者的OS(P=0.001)。结论 CD20^+细胞聚集在激素受体阴性乳腺癌患者有预后预测价值。术后辅助内分泌治疗的远期疗效与乳腺癌原发灶CD20^+细胞聚集相关,并进而影响CD20^+细胞聚集与乳腺癌预后的关系。

异体输血对结直肠癌患者预后影响的meta分析

目的评估异体输血（allogeneic blood transfusion,ABT）对行手术治疗的结直肠癌（colorectal cancer,CRC）患者远期预后的影响。方法计算机检索PubMed、EMbase、The Cochrane Library以及中国生物医学文献数据库中ABT与CRC患者预后的相关研究,并辅以文献追溯法查找相关文献。检索时限均从建库至2014年3月。由2名评价者按纳入与排除标准独立选择文献、提取资料并评价质量后,采用Stata 12.0软件进行meta分析。结果最终纳入8个研究,共5 479例患者。Meta分析结果显示：与未输血组相比,输血组总生存风险和疾病特异性生存风险分别增加了21%（HR=1.21,95%CI：1.09-1.33,P〈0.001）和47%（HR=1.47,95%CI：1.17-1.84,P=0.001）,差异有统计学意义;而输血组无病生存风险、局部复发风险和远处转移风险与未输血组的差异无统计学意义。结论 ABT可以增加CRC手术患者的总生存风险与疾病特异性生存风险,因此积极采取围手术期血液保护策略以降低ABT率具有重要的临床意义。

Ki67和nm23蛋白在鼻咽癌中的表达及临床意义

目的通过观察Ki67、nm23蛋白在鼻咽慢性炎症、鼻咽癌组织中的表达,探讨Ki67、nm23与鼻咽癌临床病理特征的相关性。方法采用免疫组织化学方法(SP法)检测23例鼻咽慢性炎症组织和59例鼻咽癌病理组织中Ki67、nm23的表达情况,再对Ki67、nm23的不同程度表达与鼻咽癌患者的临床分期、淋巴结转移、远处转移及5年生存率之间的关系进行统计学分析。结果 1与鼻咽黏膜慢性炎症组相比,鼻咽癌患者中Ki67的阳性表达率较高,nm23阳性表达率较低,差异有统计学意义(P<0.01)。2鼻咽癌患者中Ki67阳性表达与临床分期及远处转移之间呈正相关;生存期>5年的患者Ki67阳性率低于生存期<5年的患者。3鼻咽癌患者nm23基因的阳性表达与临床分期、颈淋巴结转移及远处转移之间呈负相关;生存期>5年的患者nm23阳性率高于生存期<5年的患者。4 Ki67与nm23两者的表达有相关性。通过生存曲线分析发现,Ki67蛋白低表达同时nm23蛋白高表达患者比Ki67蛋白高表达同时nm23蛋白低表达患者的生存时间更长。结论鼻咽癌中Ki67、nm23的表达与肿瘤的浸润、转移密切相关,两者有望成为评估预后的相关指标。

灵芝孢子粉对荷VX2乳腺癌兔生存期和远处转移的影响

目的探讨灵芝的孢子粉对荷VX2乳腺癌兔的生存期和远处转移的影响。方法将成功接种荷VX2乳腺癌兔随机分为灵芝组和对照组,对照组以0.5%羧甲基纤维素钠6.67ml/(kg.d)灌胃,灵芝组灵芝孢子粉2g/(kg.d)灌胃。解剖自然死亡或结束时处死的兔子。用Kaplan-Meier进行生存曲线分析,Log Rank进行生存曲线显著性检验,并比较两组的远处转移。结果结束时(10周)灵芝组60%生存,而对照组只有20%生存,两组生存曲线差别有统计学意义(P<0.05)。灵芝组有80%转移,而对照组全部(100%)有远处转移;兔最终死于远处转移。结论灵芝孢子粉能够延长荷VX2乳腺癌兔的生存期,可能延缓转移和减少远处转移。

高度恶性骨恶性纤维组织细胞瘤预后分析(附42例报告)

目的:骨的恶性纤维组织细胞瘤(MFHb)是一种少见的骨源性肉瘤,化疗对其疗效显著,在综合治疗中有重要作用。目前尚无研究对MFHb的临床、病理及治疗进行预后分析,化疗对局部控制的作用亦未阐明。本研究旨在分析MFHb的预后相关因素,探讨化疗在保肢及局部治疗方面的作用。方法:回顾性分析了42例高度恶性MFHb患者,中位年龄为41岁(11～69岁)。对临床、病理与治疗变量对总生存(OS)、无转移生存(DRFS)的影响进行Kaplan-Meier的单因素分析及Cox比例风险模型的多因素分析,同时分析化疗对保肢及局部复发的影响。结果:所有患者随访31个月(2～180个月),18例患者死亡,2年和5年OS分别为79%和45%。共20例出现远处转移,2年和5年DRFS分别为79%和47%。多因素分析中,R2切除和肿瘤位于中轴部位明显影响预后。化疗可增加局部进展期患者的保肢率。结论:高度恶性MFHb预后较差,R2切除和肿瘤位于中轴部位预示预后不良。化疗在增加保肢率方面有一定作用。