Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancrea...Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.展开更多
目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料...目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料,涵盖肿瘤分期、ALI评分、年龄、性别、吸烟史、饮酒史、糖尿病、高血压、高血脂、冠心病、肿瘤分化情况、HPV感染及肿瘤部位等信息。根据患者是否发生咽瘘,分为咽瘘组10例和非咽瘘组104例,并通过单因素和多因素Logistic回归分析筛选术后咽瘘的独立影响因素。根据是否发生复发或转移,分为复发转移组22例和非复发转移组92例;根据随访结果,分为预后不良组25例和预后良好组89例,并采用Cox回归分析筛选影响复发转移及预后的因素。最后通过绘制受试者工作特征(ROC)曲线评估各项指标的预测效能。结果多因素Logistic回归分析显示,肿瘤分期(Ⅰ~Ⅱ期)[HR:0.040(95%CI=0.004~0.392)]和ALI评分[HR:0.885(95%CI=0.805~0.972)]为咽瘘发生的独立保护因素(P<0.05)。多因素Cox回归分析确认,肿瘤分期(Ⅰ~Ⅱ期)[OR=0.180(95%CI=0.063~0.518)]和ALI评分[OR=0.970(95%CI=0.939~0.992)]为复发转移以及不良预后的独立保护因素(P<0.05)。ROC曲线分析显示,ALI预测咽瘘的AUC为0.910,95%CI=0.849~0.970,截断值为29.877,敏感度和特异性分别为0.827和1.000;ALI预测复发转移的AUC为0.804,95%CI=0.698~0.910,截断值为34.398,敏感度和特异性分别为0.794%和0.682;ALI预测不良预后的AUC为0.846,95%CI=0.768~0.925,截断值为47.750,敏感度和特异性分别为0.920和0.618。结论ALI评分是喉癌患者术后发生咽瘘、复发转移及预后的独立保护因素,具有较好的预测效能,可为临床早期识别高风险患者并优化治疗方案提供参考。展开更多
Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showe...Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.展开更多
基金Supported by National Natural Science Foundation of China,No.81400680Tianjin Natural Science Foundation,No.17JCQNJC12800
文摘Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.
文摘目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料,涵盖肿瘤分期、ALI评分、年龄、性别、吸烟史、饮酒史、糖尿病、高血压、高血脂、冠心病、肿瘤分化情况、HPV感染及肿瘤部位等信息。根据患者是否发生咽瘘,分为咽瘘组10例和非咽瘘组104例,并通过单因素和多因素Logistic回归分析筛选术后咽瘘的独立影响因素。根据是否发生复发或转移,分为复发转移组22例和非复发转移组92例;根据随访结果,分为预后不良组25例和预后良好组89例,并采用Cox回归分析筛选影响复发转移及预后的因素。最后通过绘制受试者工作特征(ROC)曲线评估各项指标的预测效能。结果多因素Logistic回归分析显示,肿瘤分期(Ⅰ~Ⅱ期)[HR:0.040(95%CI=0.004~0.392)]和ALI评分[HR:0.885(95%CI=0.805~0.972)]为咽瘘发生的独立保护因素(P<0.05)。多因素Cox回归分析确认,肿瘤分期(Ⅰ~Ⅱ期)[OR=0.180(95%CI=0.063~0.518)]和ALI评分[OR=0.970(95%CI=0.939~0.992)]为复发转移以及不良预后的独立保护因素(P<0.05)。ROC曲线分析显示,ALI预测咽瘘的AUC为0.910,95%CI=0.849~0.970,截断值为29.877,敏感度和特异性分别为0.827和1.000;ALI预测复发转移的AUC为0.804,95%CI=0.698~0.910,截断值为34.398,敏感度和特异性分别为0.794%和0.682;ALI预测不良预后的AUC为0.846,95%CI=0.768~0.925,截断值为47.750,敏感度和特异性分别为0.920和0.618。结论ALI评分是喉癌患者术后发生咽瘘、复发转移及预后的独立保护因素,具有较好的预测效能,可为临床早期识别高风险患者并优化治疗方案提供参考。
基金supported by grants from the National Natural Science Foundation of China(82270682)the Natural Science Foundation of Zhejiang Province(LQ21H030007 and LQ20H30006)。
文摘Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.
