Accurate methods for identifying pelvic lymph node metastasis(LNM)of prostate cancer(PCa)prior to surgery are still lacking.We aimed to investigate the predictive value of peripheral monocyte count(PMC)for LNM of PCa ...Accurate methods for identifying pelvic lymph node metastasis(LNM)of prostate cancer(PCa)prior to surgery are still lacking.We aimed to investigate the predictive value of peripheral monocyte count(PMC)for LNM of PCa in this study.Two hundred and ninety-eight patients from three centers were divided into a training set(n=125)and a validation set(n=173).In the training set,the independent predictors of LNM were analyzed using univariate and multivariate logistic regression analyses,and the optimal cutoff value was calculated by the receiver operating characteristic(ROC)curve.The sensitivity and specificity of the optimal cutoff were authenticated in the validation cohort.Finally,a nomogram based on the PMC was constructed for predicting LNM.Multivariate analyses of the training cohort demonstrated that clinical T stage,preoperative Gleason score,and PMC were independent risk factors for LNM.The subsequent ROC analysis showed that the optimal cutoff value of PMC for diagnosing LNM was 0.405×10^(9)l^(−1)with a sensitivity of 60.0%and a specificity of 67.8%.In the validation set,the optimal cutoff value showed significantly higher sensitivity than that of conventional magnetic resonance imaging(MRI)(0.619 vs 0.238,P<0.001).The nomogram involving PMC,free prostate-specific antigen(fPSA),clinical T stage,preoperative Gleason score,and monocyte-to-lymphocyte ratio(MLR)was generated,which showed a robust predictive capacity for predicting LNM before the operation.Our results indicated that PMC as a single agent,or combined with other clinical parameters,showed a robust predictive capacity for LNM in PCa.It can be employed as a complementary factor for the decision of whether to conduct pelvic lymph node dissection.展开更多
目的老年食管癌发病率近年来呈上升的趋势,但关于其临床病理特征及预后因素的研究,尤其是老年食管小细胞癌(primary esophageal small cell of carcinomas,PESC)的研究极为少见。本研究通过探讨老年原发性局限期PESC的临床病理特征及预...目的老年食管癌发病率近年来呈上升的趋势,但关于其临床病理特征及预后因素的研究,尤其是老年食管小细胞癌(primary esophageal small cell of carcinomas,PESC)的研究极为少见。本研究通过探讨老年原发性局限期PESC的临床病理特征及预后影响因素,以期为临床提供参考。方法回顾性分析河北医科大学第四医院2004-01-01-2012-12-31收治的34例经手术切除的原发性老年局限期PESC患者的临床资料,其中单纯手术组19例,术后辅助治疗组15例(手术+化疗9例,手术+放化疗6例)。分析其临床病理特征和淋巴结转移情况,Kaplan-Meier法统计不同治疗方式的局控、远转和生存情况,Cox回归进行多因素分析。结果 17例患者发生淋巴结转移,淋巴结转移率为50.0%(17/34)。41枚发生淋巴结转移,淋巴结转移度为13.1%(41/314)。胸上段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为28.6%、0、0和0;胸中段PESC分别为16.7%、10.9%、9.4%和16.4%;胸下段PESC分别为0、0、17.4%和24.1%。T3-4期患者淋巴结转移度显著高于T1-2期(20.6%vs 4.5%,χ2=8.050,P=0.005);病变长度≥5cm组淋巴结转移度显著高于<5cm组(17.0%vs 8.0%,χ2=5.611,P=0.018);多因素分析未发现影响淋巴结转移的独立危险因素。单纯手术组患者1、3、5年局控率与生存率分别为82.1%、54.7%、54.7%和42.1%、15.8%、5.3%,术后辅助治疗组分别为86.2%、65.6%、65.6%和93.3%,46.7%,31.1%,两组比较局控率差异无统计学意义(χ2=0.001,P=0.972),术后辅助治疗组生存率优于单纯手术组,χ2=4.105,P=0.043。单纯手术组患者1、3、5年远转率分别为54.3%、71.4%和85.7%,显著高于术后辅助治疗组的13.3%、30.0%和30.0%,χ2=6.632,P=0.010。多因素分析显示,化疗与否是老年局限期PESC生存的独立影响因素,P=0.017。结论老年PESC淋巴结转移程度与转移模式并未随年龄的增长而发生明显变化,淋巴结转移模式与食管鳞癌较为相似,但远处转移率显著高于食管鳞癌。单纯手术治疗预后极差,术后辅助放化疗可延长其生存。系统性化疗在老年患者体质能耐受的情况下仍是治疗基石之选择。展开更多
基金This study was supported by the National Natural Science Foundation of China(NSFC 81602248)the Natural Science Foundation of Guangdong Province(No.2017A030313686)to MKC.
文摘Accurate methods for identifying pelvic lymph node metastasis(LNM)of prostate cancer(PCa)prior to surgery are still lacking.We aimed to investigate the predictive value of peripheral monocyte count(PMC)for LNM of PCa in this study.Two hundred and ninety-eight patients from three centers were divided into a training set(n=125)and a validation set(n=173).In the training set,the independent predictors of LNM were analyzed using univariate and multivariate logistic regression analyses,and the optimal cutoff value was calculated by the receiver operating characteristic(ROC)curve.The sensitivity and specificity of the optimal cutoff were authenticated in the validation cohort.Finally,a nomogram based on the PMC was constructed for predicting LNM.Multivariate analyses of the training cohort demonstrated that clinical T stage,preoperative Gleason score,and PMC were independent risk factors for LNM.The subsequent ROC analysis showed that the optimal cutoff value of PMC for diagnosing LNM was 0.405×10^(9)l^(−1)with a sensitivity of 60.0%and a specificity of 67.8%.In the validation set,the optimal cutoff value showed significantly higher sensitivity than that of conventional magnetic resonance imaging(MRI)(0.619 vs 0.238,P<0.001).The nomogram involving PMC,free prostate-specific antigen(fPSA),clinical T stage,preoperative Gleason score,and monocyte-to-lymphocyte ratio(MLR)was generated,which showed a robust predictive capacity for predicting LNM before the operation.Our results indicated that PMC as a single agent,or combined with other clinical parameters,showed a robust predictive capacity for LNM in PCa.It can be employed as a complementary factor for the decision of whether to conduct pelvic lymph node dissection.
文摘目的老年食管癌发病率近年来呈上升的趋势,但关于其临床病理特征及预后因素的研究,尤其是老年食管小细胞癌(primary esophageal small cell of carcinomas,PESC)的研究极为少见。本研究通过探讨老年原发性局限期PESC的临床病理特征及预后影响因素,以期为临床提供参考。方法回顾性分析河北医科大学第四医院2004-01-01-2012-12-31收治的34例经手术切除的原发性老年局限期PESC患者的临床资料,其中单纯手术组19例,术后辅助治疗组15例(手术+化疗9例,手术+放化疗6例)。分析其临床病理特征和淋巴结转移情况,Kaplan-Meier法统计不同治疗方式的局控、远转和生存情况,Cox回归进行多因素分析。结果 17例患者发生淋巴结转移,淋巴结转移率为50.0%(17/34)。41枚发生淋巴结转移,淋巴结转移度为13.1%(41/314)。胸上段PESC上纵隔、中纵隔、下纵隔和腹腔淋巴结转移度分别为28.6%、0、0和0;胸中段PESC分别为16.7%、10.9%、9.4%和16.4%;胸下段PESC分别为0、0、17.4%和24.1%。T3-4期患者淋巴结转移度显著高于T1-2期(20.6%vs 4.5%,χ2=8.050,P=0.005);病变长度≥5cm组淋巴结转移度显著高于<5cm组(17.0%vs 8.0%,χ2=5.611,P=0.018);多因素分析未发现影响淋巴结转移的独立危险因素。单纯手术组患者1、3、5年局控率与生存率分别为82.1%、54.7%、54.7%和42.1%、15.8%、5.3%,术后辅助治疗组分别为86.2%、65.6%、65.6%和93.3%,46.7%,31.1%,两组比较局控率差异无统计学意义(χ2=0.001,P=0.972),术后辅助治疗组生存率优于单纯手术组,χ2=4.105,P=0.043。单纯手术组患者1、3、5年远转率分别为54.3%、71.4%和85.7%,显著高于术后辅助治疗组的13.3%、30.0%和30.0%,χ2=6.632,P=0.010。多因素分析显示,化疗与否是老年局限期PESC生存的独立影响因素,P=0.017。结论老年PESC淋巴结转移程度与转移模式并未随年龄的增长而发生明显变化,淋巴结转移模式与食管鳞癌较为相似,但远处转移率显著高于食管鳞癌。单纯手术治疗预后极差,术后辅助放化疗可延长其生存。系统性化疗在老年患者体质能耐受的情况下仍是治疗基石之选择。
