<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatme...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resec</span><span style="font-family:Verdana;">tion, lack of lymph node dissection, tumour stage, and preoperative blood</span><span style="font-family:Verdana;"> transfusions are all significant predictors for reduced survival after surgery for colon cancer.</span></span>展开更多
AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retr...AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.展开更多
文摘目的探究分化型甲状腺癌患者术中喉前淋巴结(delphian lymph node,DLN)及气管前淋巴结(pretracheal lymph node,PLN)冰冻病理检查对中央区淋巴结转移及复发危险分层的预测价值。方法回顾性收集2023年1月至2024年12月期间于华中科技大学同济医学院附属协和医院甲状腺乳腺外科接受首次手术治疗并行术中DLN、PLN冰冻病理检查的133例单侧分化型甲状腺癌患者的临床资料。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估DLN和PLN转移数量及转移百分比对中央区淋巴结转移及复发危险分层的预测效能,并比较术中冰冻病理与术后常规病理结果的一致性。结果多因素分析结果显示,年龄(<20岁或>50岁)是DLN、PLN转移的保护因素(OR=0.332,P=0.012),腺外侵犯是DLN、PLN转移的风险因素(OR=2.823,P=0.017)。DLN和PLN转移数量及转移百分比预测中央区淋巴结转移总数>5枚的ROC曲线下面积(area under the curve,AUC)分别为0.913[95%CI(0.841,0.986),P<0.001]和0.910[95%CI(0.837,0.983),P<0.001],最佳截断值分别为1.5枚和45.00%。DLN和PLN转移数量及转移百分比预测复发危险分层为中高危的AUC分别为0.818[95%CI(0.740,0.895),P<0.001]和0.800[95%CI(0.720,0.880),P<0.001],最佳截断值分别为0.5枚和26.79%。与术后常规病理结果比较,DLN、PLN术中冰冻病理检查的灵敏度为88.00%(66/75),特异度为100%(58/58),阳性预测值为100%(66/66),阴性预测值为86.57%(58/67)。术中冰冻与术后病理转移情况的Kappa值为0.849[95%CI(0.761,0.937),P<0.001],术中冰冻与术后病理转移百分比的组内相关系数值为0.917[95%CI(0.885,0.940),P<0.001],表明两者具有高度一致性。结论DLN、PLN术中冰冻病理检查可以较好地预测中央区淋巴结转移及复发危险分层,有助于识别可能从扩大手术范围中获益的患者。
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resec</span><span style="font-family:Verdana;">tion, lack of lymph node dissection, tumour stage, and preoperative blood</span><span style="font-family:Verdana;"> transfusions are all significant predictors for reduced survival after surgery for colon cancer.</span></span>
文摘AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.
