BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
The retrospective study by Gan et al evaluated the three-year survival rate and prognostic factors in 100 patients with primary gastric cancer who underwent laparoscopic surgery at a Chinese hospital between 2019 and ...The retrospective study by Gan et al evaluated the three-year survival rate and prognostic factors in 100 patients with primary gastric cancer who underwent laparoscopic surgery at a Chinese hospital between 2019 and 2021.The observed three-year survival rate was 73%.Multivariate analysis identified age,tumornodes-metastasis stage,tumor size,depth of invasion,lymph node metastasis,extent of lymph node dissection,postoperative adjuvant chemo-radiotherapy,postoperative carcinoembryonic antigen levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of survival.Older age,advanced disease stage,larger tumors,deeper invasion,lymph node involvement,and elevated carcinoembryonic antigen were associated with poorer outcomes,while thorough lymph node dissection and adjuvant therapy improved survival.The study highlights the complex interplay of clinical and pathological factors affecting prognosis after laparoscopic surgery.Strengths include detailed perioperative data and robust analysis,though limitations are noted in its retrospective design and patient selection.The findings emphasize the need for multidisciplinary,individualized treatment planning,considering both disease and patient-related factors,to optimize outcomes in localized gastric cancer.Prospective studies are warranted to validate these results and refine treatment strategies.展开更多
BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM T...BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.展开更多
AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2...AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.展开更多
AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on su...AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on survival and recurrence in these patients.METHODS:From January 1994 to January 2006,236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189(80%) of these patients underwent resection of CLM with curative intention.Preoperative,intraoperative and postoperative data,including primary tumor and CLM pathology results,were retrospectively reviewed.Patients were divided into two time periods:a first period from January 1994 to January 2000(n = 93),and a second period from February 2000 to January 2006(n = 143).RESULTS:Global survival at 1,3 and 5 years in patients undergoing hepatic resection was 91%,54% and 47%,respectively.Patients with preoperative extrahepatic disease,carcinoembryonic antigen(CEA) levels over 20 ng/dL,more than four nodules or extrahepatic invasion at pathological analysis had worse survival.Tumor recurrence rate at 1 year was 48.3%,being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL.Although patients in the second time period had more adverse prognostic factors,no differences in overall survival and recurrence were observed between the two periods.CONCLUSION:Despite advances in surgical technique and better adjuvant treatments and preoperative imaging,careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.展开更多
BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was ...BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was undertaken to assess the effect of combined vascular resection in HCCA patients and to analyze the prognostic factors.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colore...BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colorectal liver metastases.For patients who cannot undergo radical resection of liver metastases for various reasons,ablation therapy,interventional therapy,and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.AIM To explore the prognostic factors and treatments of liver metastases of CRC.METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011.According to different treatments,the patients were divided into the following four groups:Surgical resection group(36 patients);ablation group(23 patients);intervention group(15 patients);and drug group(13 patients).The clinicopathological data and postoperative survival of the four groups were analyzed.The Kaplan-Meier method was used for survival analysis,and the Cox proportional hazards regression model was used for multivariate analysis.RESULTS The median survival time of the 87 patients was 38.747±3.062 mo,and the 1-and 3-year survival rates were 87.5%and 53.1%,respectively.The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis:The degree of tumor differentiation,the number of metastases,the size of metastases,and whether the metastases are close to great vessels.The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs,intervention,or ablation alone,and the median survival time was 48.83±4.36 mo.The drug group had the worst prognosis,with a median survival time of only 13.5±0.7 mo(P<0.05).For patients with liver metastases of CRC near the great vessels,the median survival time(27.3 mo)of patients undergoing surgical resection was better than that of patients using other treatments(20.6 mo)(P<0.05).CONCLUSION Patients with a low degree of primary tumor differentiation,multiple liver metastases(number of tumors>4),and maximum diameter of liver metastases>5 cm have a poor prognosis.Among drug therapy,intervention,ablation,and surgical treatment options,surgical treatment is the first choice for liver metastases.When liver metastases are close to great vessels,surgical treatment is significantly better than drug therapy,intervention,and ablation alone.展开更多
AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecut...AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.展开更多
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 ...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.展开更多
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical recor...This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.展开更多
Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized ch...Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.展开更多
BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors rem...BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.展开更多
AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer an...AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.展开更多
AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrecto...AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1).We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2).We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis)of 41 cases matched with Group 1 according to demographic and pathological characteristics.RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients.In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns:lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.展开更多
The prognosis in patients with pancreatic cancer is poor and this cancer is the fourth leading cause of cancer-related death worldwide. Although surgical resection is the only curative treatment of choice for pancreat...The prognosis in patients with pancreatic cancer is poor and this cancer is the fourth leading cause of cancer-related death worldwide. Although surgical resection is the only curative treatment of choice for pancreatic cancer, the majority of patients are diagnosed at an advanced stage, thus only 10%-15% of them are suitable for curative resection and the overall survival is less than 5%. Chemotherapy for metastatic disease is to palliate symptoms of patients and to improve survival. Therefore, prognostic factors are important and a correct definition of poor prognostic factors may help to guide more aggressive adjuvant or aggressive treatment protocols in patients with pancreatic cancer. This article reviews the prognostic factors affecting survival of patients with pancreatic cancer in the light of recent advances in the literature.展开更多
Objective： Primary uterine leiomyosarcomas （ULMS） are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary...Objective： Primary uterine leiomyosarcomas （ULMS） are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary ULMS. Methods： We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network （RCN）. Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS, aged 18-80 years, complete International Federation of Gynecology and Obstetrics （FIGO） stage information, complete information on treatment, and a minimum follow-up of 6 months. Local control （LC） and locoregional control （LRC）, overall survival （OS） and disease-free survival （DFS） rates were computed using the Kaplan-Meier method. Univariate analysis was implemented using the log rank test, and multivariate analysis using the Cox model. Results： All patients underwent surgery. Seventy-five patients （68%） received adjuvant radiotherapy （RT）, including brachytherapy in 18 （I 6%）. Seventeen patients （15 %） received adjuvant chemotherapy. Median follow-up was 58 （range, 6-240） months. Five-year OS and DFS rates were 50% and 34%, and LC and LRC rates were 88% and 72%, respectively. On multivariate analysis, independent favorable prognostic factors were younger age, FIGO stage I, small tumor size, previous uterine disease, and no vascular invasion for OS and DFS. FIGO stage was the only favorable factor influencing LRC. Adjuvant local or systemic treatments did not improve the outcomes. Eight patients treated with RT presented a grade 3 acute toxicity, and only one patient with grade 3 late toxicity. Conclusions： In this large population of primary ULMS patients, we found good results in terms of LC and LRC. Nevertheless, OS remains poor, mainly due to the occurrence of distant metastases. An early diagnosis seemed to improve the prognosis of the patients. Adjuvant local or systemic treatments, or more aggressive surgical procedures such as the Wertheim procedure, did not seem to impact the outcome.展开更多
BACKGROUND:Liver transplantation currently represents the ultimate therapy for bleeding esophageal varices in patients with liver cirrhosis.It is the only therapy that cures both portal hypertension and the underlying...BACKGROUND:Liver transplantation currently represents the ultimate therapy for bleeding esophageal varices in patients with liver cirrhosis.It is the only therapy that cures both portal hypertension and the underlying liver disease.The outcome of liver transplantation is thought to be correlated with several factors.In this study,the clinical outcome of living-related liver transplantation(LRLT) was evaluated in patients with variceal bleeding,and the prognostic indicators of short-term survival in these patients were identified. METHODS:We reviewed retrospectively 121 patients with a history of variceal bleeding who had received LRLT from 1998 to 2006.The clinical outcomes were analyzed,and the risk factors for short-term survival were defined. RESULTS:The 3-month survival rate of patients with variceal bleeding was 83.4%,while that of non-bleeders was 87%.Sepsis was the commonest cause of death in both groups.Portal vein diameter and blood transfusion were the only independent prognostic factors for short-term survival among variceal bleeders. CONCLUSION:The outcome of LRLT in recipients with variceal bleeding is based on the improvement of portal hemodynamics,by minimizing intraoperative blood loss and subsequent blood transfusion.展开更多
The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of ...The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study.SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy.The maximum values were recorded for statistical analysis.Medical records were reviewed to determine tumor size,histological grade,lymph node status and immunohistochemical results.Tumor subtypes were categorized as luminal A,luminal B,human epidermal growth factor receptor 2(HER2)positive and triple negative.The correlations between SWV and histological prognostic factors were analyzed.It was found that tumor size showed positive association with SWV(r=0.465,P<0.001).Larger tumors had significantly higher SWV than smaller ones(P=0.001).Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade(P=0.015).The Ki67 expression,tumor subtypes and lymph node status showed no statistically significant correlations with SWV,although triple negative tumors and lymph node-positive tumors showed higher SWV values.It was concluded that tumor size was significantly associated with SWV.Higher histological grade was associated with increased SWV.There was no statistically significant correlations between SWV and other histological prognostic factors.展开更多
BACKGROUND Distant metastasis,particularly visceral metastasis(VM),represents an important negative prognostic factor for prostate cancer(PCa)patients.However,due to the lower rate of occurrence of VM,studies on these...BACKGROUND Distant metastasis,particularly visceral metastasis(VM),represents an important negative prognostic factor for prostate cancer(PCa)patients.However,due to the lower rate of occurrence of VM,studies on these patients are relatively rare.Consequently,studies focusing on prognostic factors associated with PCa patients with VM are highly desirable.AIM To investigate the prognostic factors for overall survival(OS)in PCa patients with lung,brain,and liver metastases,respectively,and evaluate the impact of site-specific and number-specific VM on OS.METHODS Data on PCa patients with VM were extracted from the Surveillance,Epidemiology,and End Results database between 2010 and 2015.Univariate and multivariate Cox regression analyses were used to analyze the association between clinicopathological characteristics and survival of patients with different site-specific VM.Kaplan-Meier analyses and Log-rank tests were performed to analyze the differences among the groups.RESULTS A total of 1358 PCa patients with site-specific VM were identified from 2010 to 2015.Older age(>70 years)(P<0.001),higher stage(T3/T4)(P=0.004),and higher Gleason score(>8)(P<0.001)were found to be significant independent prognostic factors associated with poor OS in PCa patients with lung metastases.Higher stage(T3/T4)(P=0.047)was noted to be the only independent risk factor affecting OS in PCa patients with brain metastases.Older age(>70 years)(P=0.010)and higher Gleason score(>8)(P=0.001)were associated with shorter OS in PCa patients with liver metastases.PCa patients with isolated lung metastases exhibited significantly better survival outcomes compared with PCa patients with other single sites of VM(P<0.001).PCa patients with a single site of VM exhibited a superior OS compared with PCa patients with multiple sites of VM(P<0.001).CONCLUSION This is the first Surveillance,Epidemiology,and End Results-based study to determine prognostic factors affecting OS in PCa patients with different sitespecific VM.Clinical assessments of these crucial prognostic factors become necessary before establishing a treatment strategy for these patients with metastatic PCa.展开更多
Background: Pancreatic neuroendocrine tumors(PNETs) display wide heterogeneity with highly variable prognosis. This study aimed to identify variables related to survival after surgical resection of PNET.Methods: A tot...Background: Pancreatic neuroendocrine tumors(PNETs) display wide heterogeneity with highly variable prognosis. This study aimed to identify variables related to survival after surgical resection of PNET.Methods: A total of 143 patients were identified from a prospectively maintained database. Patient characteristics were analyzed and prognostic factors for overall survival and progression-free survival were evaluated. The WHO, ENETS and AJCC scoring systems were applied to the cohort, and their ability to predict patient outcomes were compared.Results: Multivariate analysis found that female gender, lymph node metastases and increasing WHO2010 grade to be independently associated with reduced overall survival(P < 0.05). Patients requiring multi-visceral resection or debulking surgery found to be associated with shortest survival. ROC analysis found the ENETS and AJCC scoring systems to be similarly predictive of 5-year overall survival. Modified Ki67 significantly improved its accuracy in predicting 5-year overall survival(AUROC: 0.699 vs 0.605;P < 0.01).Conclusions: Multi-visceral or debulking surgery is associated with poor outcomes. There seems to be no significant difference between enucleation and anatomical segmental resection. Available scoring systems have reasonable accuracy in stratifying disease severity, with no system identified as being superior.Prognostic stratification with modified grading systems needs further validation before applied in clinical practice.展开更多
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘The retrospective study by Gan et al evaluated the three-year survival rate and prognostic factors in 100 patients with primary gastric cancer who underwent laparoscopic surgery at a Chinese hospital between 2019 and 2021.The observed three-year survival rate was 73%.Multivariate analysis identified age,tumornodes-metastasis stage,tumor size,depth of invasion,lymph node metastasis,extent of lymph node dissection,postoperative adjuvant chemo-radiotherapy,postoperative carcinoembryonic antigen levels,surgical duration,extent of gastric resection,and postoperative complications as independent predictors of survival.Older age,advanced disease stage,larger tumors,deeper invasion,lymph node involvement,and elevated carcinoembryonic antigen were associated with poorer outcomes,while thorough lymph node dissection and adjuvant therapy improved survival.The study highlights the complex interplay of clinical and pathological factors affecting prognosis after laparoscopic surgery.Strengths include detailed perioperative data and robust analysis,though limitations are noted in its retrospective design and patient selection.The findings emphasize the need for multidisciplinary,individualized treatment planning,considering both disease and patient-related factors,to optimize outcomes in localized gastric cancer.Prospective studies are warranted to validate these results and refine treatment strategies.
文摘BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.
文摘AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.
基金Supported by An investigation grant from Abertis Infraestructuras S.A
文摘AIM:To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases(CLM) and to describe the effects of time-related changes on survival and recurrence in these patients.METHODS:From January 1994 to January 2006,236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189(80%) of these patients underwent resection of CLM with curative intention.Preoperative,intraoperative and postoperative data,including primary tumor and CLM pathology results,were retrospectively reviewed.Patients were divided into two time periods:a first period from January 1994 to January 2000(n = 93),and a second period from February 2000 to January 2006(n = 143).RESULTS:Global survival at 1,3 and 5 years in patients undergoing hepatic resection was 91%,54% and 47%,respectively.Patients with preoperative extrahepatic disease,carcinoembryonic antigen(CEA) levels over 20 ng/dL,more than four nodules or extrahepatic invasion at pathological analysis had worse survival.Tumor recurrence rate at 1 year was 48.3%,being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL.Although patients in the second time period had more adverse prognostic factors,no differences in overall survival and recurrence were observed between the two periods.CONCLUSION:Despite advances in surgical technique and better adjuvant treatments and preoperative imaging,careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.
基金supported by a grant from the National Natural Science Foundation of China(81172039)
文摘BACKGROUND： Hilar cholangiocarcinoma （HCCA） is a devastating malignancy arising from the bifurcation of the hepatic duct, whether combined vascular resection benefits HCCA patients is controversial. This study was undertaken to assess the effect of combined vascular resection in HCCA patients and to analyze the prognostic factors.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors in China,and the liver is the most common metastatic site in patients with advanced CRC.Hepatectomy is the gold standard treatment for colorectal liver metastases.For patients who cannot undergo radical resection of liver metastases for various reasons,ablation therapy,interventional therapy,and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.AIM To explore the prognostic factors and treatments of liver metastases of CRC.METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011.According to different treatments,the patients were divided into the following four groups:Surgical resection group(36 patients);ablation group(23 patients);intervention group(15 patients);and drug group(13 patients).The clinicopathological data and postoperative survival of the four groups were analyzed.The Kaplan-Meier method was used for survival analysis,and the Cox proportional hazards regression model was used for multivariate analysis.RESULTS The median survival time of the 87 patients was 38.747±3.062 mo,and the 1-and 3-year survival rates were 87.5%and 53.1%,respectively.The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis:The degree of tumor differentiation,the number of metastases,the size of metastases,and whether the metastases are close to great vessels.The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs,intervention,or ablation alone,and the median survival time was 48.83±4.36 mo.The drug group had the worst prognosis,with a median survival time of only 13.5±0.7 mo(P<0.05).For patients with liver metastases of CRC near the great vessels,the median survival time(27.3 mo)of patients undergoing surgical resection was better than that of patients using other treatments(20.6 mo)(P<0.05).CONCLUSION Patients with a low degree of primary tumor differentiation,multiple liver metastases(number of tumors>4),and maximum diameter of liver metastases>5 cm have a poor prognosis.Among drug therapy,intervention,ablation,and surgical treatment options,surgical treatment is the first choice for liver metastases.When liver metastases are close to great vessels,surgical treatment is significantly better than drug therapy,intervention,and ablation alone.
文摘AIM:To investigate the prognostic factors of T4 gastric cancer patients without distant metastasis who could undergo potentially curative resection. METHODS:We retrospectively analyzed the clinical data of 71 consecutive patients diagnosed with T4 gastric cancer and who underwent curative gastrectomy at our institutions.The clinicopathological factors that could be associated with overall survival were evaluated.The cumulative survival was determined by the Kaplan-Meier method,and univariate comparisons between the groups were performed using the log-rank test.Multivariate analysis was performed using the Cox proportional hazard model and a step-wise procedure. RESULTS:The study patients comprised 53 men (74.6%)and 18 women(25.4%)aged 39-89 years (mean,68.9 years).Nineteen patients(26.8%)had postoperative morbidity:pancreatic fistula developed in 6 patients(8.5%)and was the most frequent complication,followed by anastomosis stricture in 5 patients (7.0%).During the follow-up period,28 patients(39.4%)died because of gastric cancer recurrence,and 3(4.2%) died because of another disease or accident.For all patients,the estimated overall survival was 34.1%at 5 years.Univariate analyses identified the following statistically significant prognostic factors in T4 gastric cancer patients who underwent potentially curative resection: peritoneal washing cytology(P<0.01),number of metastatic lymph nodes(P<0.05),and venous invasion(P <0.05).In multivariate analyses,only peritoneal washing cytology was identified as an independent prognostic factor(HR=3.62,95%CI=1.37-9.57)for longterm survival. CONCLUSION:Positive peritoneal washing cytology was the only independent poor prognostic factor for T4 gastric cancer patients who could be treated with potentially curative resection.
基金supported by grants from Zhejiang Provincial Clinical Scientific Research Foundation of China(2013ZYC-A17)Ministry of Health of China(WKJ-ZJ-12)Health Bureau of Zhejiang Province(2013KYB098)
文摘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.
文摘This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
文摘Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.
基金Supported by Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province,No.2018KFJJ09National Natural Science Foundation of China,No.81827804
文摘BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
基金Supported by the Gastric Cancer Laboratory and Pathology Department of Chinese Medical University,Shenyang,Chinathe Science and Technology Program of Shenyang,No. 1081232-1-00
文摘AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was employed to compare the efficiency of both models.Univariate analysis indicated that age at diagnosis,past history,cancer location,distant metastasis status,surgical curative degree,combined other organ resection,Borrmann type,Lauren's classification,pT stage,total dissected nodes and pN stage were prognostic factors in both log-normal and Cox models.RESULTS:In the final multivariate model,age at diagnosis,past history,surgical curative degree,Borrmann type,Lauren's classification,pT stage,and pN stage were significant prognostic factors in both log-normal and Cox models.However,cancer location,distant metastasis status,and histology types were found to be significant prognostic factors in log-normal results alone.According to AIC,the log-normal model performed better than the Cox proportional hazard model (AIC value:2534.72 vs 1693.56).CONCLUSION:It is suggested that the log-normal regression model can be a useful statistical model to evaluate prognostic factors instead of the Cox proportional hazard model.
文摘AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up.METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1).We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2).We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis)of 41 cases matched with Group 1 according to demographic and pathological characteristics.RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients.In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns:lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for recurrence.CONCLUSION The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.
文摘The prognosis in patients with pancreatic cancer is poor and this cancer is the fourth leading cause of cancer-related death worldwide. Although surgical resection is the only curative treatment of choice for pancreatic cancer, the majority of patients are diagnosed at an advanced stage, thus only 10%-15% of them are suitable for curative resection and the overall survival is less than 5%. Chemotherapy for metastatic disease is to palliate symptoms of patients and to improve survival. Therefore, prognostic factors are important and a correct definition of poor prognostic factors may help to guide more aggressive adjuvant or aggressive treatment protocols in patients with pancreatic cancer. This article reviews the prognostic factors affecting survival of patients with pancreatic cancer in the light of recent advances in the literature.
文摘Objective： Primary uterine leiomyosarcomas （ULMS） are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary ULMS. Methods： We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network （RCN）. Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS, aged 18-80 years, complete International Federation of Gynecology and Obstetrics （FIGO） stage information, complete information on treatment, and a minimum follow-up of 6 months. Local control （LC） and locoregional control （LRC）, overall survival （OS） and disease-free survival （DFS） rates were computed using the Kaplan-Meier method. Univariate analysis was implemented using the log rank test, and multivariate analysis using the Cox model. Results： All patients underwent surgery. Seventy-five patients （68%） received adjuvant radiotherapy （RT）, including brachytherapy in 18 （I 6%）. Seventeen patients （15 %） received adjuvant chemotherapy. Median follow-up was 58 （range, 6-240） months. Five-year OS and DFS rates were 50% and 34%, and LC and LRC rates were 88% and 72%, respectively. On multivariate analysis, independent favorable prognostic factors were younger age, FIGO stage I, small tumor size, previous uterine disease, and no vascular invasion for OS and DFS. FIGO stage was the only favorable factor influencing LRC. Adjuvant local or systemic treatments did not improve the outcomes. Eight patients treated with RT presented a grade 3 acute toxicity, and only one patient with grade 3 late toxicity. Conclusions： In this large population of primary ULMS patients, we found good results in terms of LC and LRC. Nevertheless, OS remains poor, mainly due to the occurrence of distant metastases. An early diagnosis seemed to improve the prognosis of the patients. Adjuvant local or systemic treatments, or more aggressive surgical procedures such as the Wertheim procedure, did not seem to impact the outcome.
文摘BACKGROUND:Liver transplantation currently represents the ultimate therapy for bleeding esophageal varices in patients with liver cirrhosis.It is the only therapy that cures both portal hypertension and the underlying liver disease.The outcome of liver transplantation is thought to be correlated with several factors.In this study,the clinical outcome of living-related liver transplantation(LRLT) was evaluated in patients with variceal bleeding,and the prognostic indicators of short-term survival in these patients were identified. METHODS:We reviewed retrospectively 121 patients with a history of variceal bleeding who had received LRLT from 1998 to 2006.The clinical outcomes were analyzed,and the risk factors for short-term survival were defined. RESULTS:The 3-month survival rate of patients with variceal bleeding was 83.4%,while that of non-bleeders was 87%.Sepsis was the commonest cause of death in both groups.Portal vein diameter and blood transfusion were the only independent prognostic factors for short-term survival among variceal bleeders. CONCLUSION:The outcome of LRLT in recipients with variceal bleeding is based on the improvement of portal hemodynamics,by minimizing intraoperative blood loss and subsequent blood transfusion.
基金grants from the Fundamental Research Funds for the Central Universities(No.2172015YGYL019)the Fundamental Research Funds for the Central Universities(No.2015LC021)+1 种基金National Natural Science Foundation of China(No.81000616)Hubei Key Laboratory of Molecular Imaging Research Funds(No.02.03.2015-149).
文摘The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study.SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy.The maximum values were recorded for statistical analysis.Medical records were reviewed to determine tumor size,histological grade,lymph node status and immunohistochemical results.Tumor subtypes were categorized as luminal A,luminal B,human epidermal growth factor receptor 2(HER2)positive and triple negative.The correlations between SWV and histological prognostic factors were analyzed.It was found that tumor size showed positive association with SWV(r=0.465,P<0.001).Larger tumors had significantly higher SWV than smaller ones(P=0.001).Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade(P=0.015).The Ki67 expression,tumor subtypes and lymph node status showed no statistically significant correlations with SWV,although triple negative tumors and lymph node-positive tumors showed higher SWV values.It was concluded that tumor size was significantly associated with SWV.Higher histological grade was associated with increased SWV.There was no statistically significant correlations between SWV and other histological prognostic factors.
基金Supported by Department of Science and Technology of Jilin Province,No.20170623009TCJilin Province Development and Reform Commission,No.3J117B963428
文摘BACKGROUND Distant metastasis,particularly visceral metastasis(VM),represents an important negative prognostic factor for prostate cancer(PCa)patients.However,due to the lower rate of occurrence of VM,studies on these patients are relatively rare.Consequently,studies focusing on prognostic factors associated with PCa patients with VM are highly desirable.AIM To investigate the prognostic factors for overall survival(OS)in PCa patients with lung,brain,and liver metastases,respectively,and evaluate the impact of site-specific and number-specific VM on OS.METHODS Data on PCa patients with VM were extracted from the Surveillance,Epidemiology,and End Results database between 2010 and 2015.Univariate and multivariate Cox regression analyses were used to analyze the association between clinicopathological characteristics and survival of patients with different site-specific VM.Kaplan-Meier analyses and Log-rank tests were performed to analyze the differences among the groups.RESULTS A total of 1358 PCa patients with site-specific VM were identified from 2010 to 2015.Older age(>70 years)(P<0.001),higher stage(T3/T4)(P=0.004),and higher Gleason score(>8)(P<0.001)were found to be significant independent prognostic factors associated with poor OS in PCa patients with lung metastases.Higher stage(T3/T4)(P=0.047)was noted to be the only independent risk factor affecting OS in PCa patients with brain metastases.Older age(>70 years)(P=0.010)and higher Gleason score(>8)(P=0.001)were associated with shorter OS in PCa patients with liver metastases.PCa patients with isolated lung metastases exhibited significantly better survival outcomes compared with PCa patients with other single sites of VM(P<0.001).PCa patients with a single site of VM exhibited a superior OS compared with PCa patients with multiple sites of VM(P<0.001).CONCLUSION This is the first Surveillance,Epidemiology,and End Results-based study to determine prognostic factors affecting OS in PCa patients with different sitespecific VM.Clinical assessments of these crucial prognostic factors become necessary before establishing a treatment strategy for these patients with metastatic PCa.
文摘Background: Pancreatic neuroendocrine tumors(PNETs) display wide heterogeneity with highly variable prognosis. This study aimed to identify variables related to survival after surgical resection of PNET.Methods: A total of 143 patients were identified from a prospectively maintained database. Patient characteristics were analyzed and prognostic factors for overall survival and progression-free survival were evaluated. The WHO, ENETS and AJCC scoring systems were applied to the cohort, and their ability to predict patient outcomes were compared.Results: Multivariate analysis found that female gender, lymph node metastases and increasing WHO2010 grade to be independently associated with reduced overall survival(P < 0.05). Patients requiring multi-visceral resection or debulking surgery found to be associated with shortest survival. ROC analysis found the ENETS and AJCC scoring systems to be similarly predictive of 5-year overall survival. Modified Ki67 significantly improved its accuracy in predicting 5-year overall survival(AUROC: 0.699 vs 0.605;P < 0.01).Conclusions: Multi-visceral or debulking surgery is associated with poor outcomes. There seems to be no significant difference between enucleation and anatomical segmental resection. Available scoring systems have reasonable accuracy in stratifying disease severity, with no system identified as being superior.Prognostic stratification with modified grading systems needs further validation before applied in clinical practice.
