Objective To use a meta-analysis method to establish quantitatively the association between the HER-2/neu gene amplification/enhanced protein expression status and the 5-year post-operative survival rate or median survival time in women with epithelial ovarian carcinoma. Methods We searched and screened Chinese and English literature published since 1989 to collect all retrospective cohort studies on the prognostic significance of HER-2/neu status in this population. The survival data were analyzed using Ludwig’s centered signed rank and the DerSimonian-Laird method. Results In total, 25 studies involving 3 251 patients were included. HER-2/neu was positive in 27.1% (95%CI 0 to 54.8%) of patients, which was not related to the pathological stage, type or grade of epithelial ovarian carcinoma. In HER-2/neu positive cases, the median survival time was shortened by 0.65 years, and the 5-year survival rate was lowered. The hazard ratio (HR) for mortality was 1.22 (95%C 1.09 to 1.36). By subgroup analysis, HER-2/neu protein expression was found to be most significant in prognostic assessment. Patients with a b positive value of HER-2/neu had an increased HR for the 5-year survival; and platinum-based chemotherapy was demonstrated to be less effective in HER-2/neu positive ovarian carcinoma. Conclusion In gynecological oncology, it is reasonable to measure HER-2/neu as a routine pathological marker to predict a patient’s prognosis and to determine the most appropriate adjuvant chemotherapy regimen.
目的 探讨结肠癌患者术后3年生存情况的影响因素。方法 回顾2006年1月至2007年12月期间笔者所在科室收治的确诊为结肠癌且随访资料完整的169例患者临床资料，从术前CEA水平、肿瘤病理分型、分化程度和体质指数（BMI）方面分析影响结肠癌预后的因素。结果 术前CEA水平、肿瘤分化程度及BMI对术后3年生存期的差异有统计学意义（P＜0.05），术前CEA水平对术后3年生存率的差异均有统计学意义（P＜0.05）；术前CEA水平、病理分型、分化程度对术后发生转移的差异有统计学意义（P＜0.05）。结论 术前CEA水平是结肠癌预后的高危因素。
目的 探讨血管内皮生长因子（VEGF）及受体Flt-1蛋白表达与卵巢恶性肿瘤临床病理和预后的关系。 方法 2000年1月-2004年6月，以SABC免疫组织化学方法检测48例卵巢恶性肿瘤组织中VEGF及其受体Flt-1蛋白的表达。 结果 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的病理学类型、分化级别及临床分期无明显相关性（P＞0.05）。有淋巴结转移者VEGF和Flt-1蛋白的表达阳性率均明显高于无淋巴结转移者（P＜0.05）。 VEGF 和Flt-1共同表达者平均总生存期为27.88个月，明显短于没有共同表达者的36.04个月（95%CI 为33.42～38.65，P=0.022 3）。 结论 VEGF和Flt-1蛋白表达与卵巢恶性肿瘤的淋巴结转移相关，可作为预测肿瘤转移及预后的指标。
目的 分析125I 放射性粒子组织间永久植入治疗胰腺癌的效果。 方法 回顾分析采用胆肠Roux-en-Y吻合旁路手术加125I 放射性粒子组织间永久植入治疗的10例进展期胰腺癌患者的临床资料。结果 术后4个月内CT观察9例胰腺肿瘤显著缩小，患者腹痛、腰背部疼痛症状均有不同程度地缓解或消失，平均生存期为(12.7±7.80)个月，超过进展期胰腺癌平均6～10个月的生存期。结论 该治疗方法可以显著提高进展期胰腺癌患者的生存和生活质量。
Objective To approach the surgical therapeutic efficacy of local recurrence of rectal cancer. Methods Fifty-six patients with local recurrence of rectal cancer suffered from reoperation from January 2003 to January2011 in this hospital were collected. Chi-square test was performed to analyze the complete excision rates of reoperation for different recurrent time after radical resection and different surgical procedures after primary radical resection of rectalcancer. The method of log-rank test was used for survival analysis of the Miles and Dixon procedure. Results ①The opera-tion time and intraoperative bleeding of reoperation for local recurrence of rectal cancer were more than those of the primary radical resection of rectal cancer （P＜0.05）. ②The complete resection rate of the local recurrence of rectal cancer in 5 years after primary radical resection of rectal cancer was higher than that of the local recurrence of rectal cancer within 2 years after primary radical resection of rectal cancer， and the difference was statistically significant （P＜0.01）. ③The complete resection rate of the local recurrence of rectal cancer of the technique of Dixon in the primary radical resection of rectal cancer was higher than that of Miles， and the difference was statistically significant （P＜0.05）. ④The median survival time and 2-year survival rate and 5-year survival rate of the technique of Dixon in the reoperation were longer or higher than those of Miles， and the differences were statistically significant （P＜0.05）. Conclusions Surgical procedure and postoperative recurrence time after primary operation can both influence complete excision rate of reoperation for local recurrence of rectal cancer. And reoperation for local recurrence of rectal cancer can prolong the survival time.
ObjectiveTo systematically evaluate the potential value of C-reactive protein to albumin ratio (CAR) as an indicator of prognosis and survival in patients with pancreatic cancer. MethodsThe literatures were searched comprehensively in the PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang, CNKI, and CQVIP databases from the establishment of the databases to May 20, 2021. The combined hazard ratio (HR) and 95% confidence interval (95%CI) were used to evaluate the correlation between the CAR and the overall survival (OS), progression-free survival (PFS), or disease-free survival (DFS) in the patients with pancreatic cancer. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of the non-randomized controlled studies, and the Stata SE 15.0 software was used for meta-analysis. ResultsA total of 2 985 patients with pancreatic cancer were included in this meta-analysis of 15 studies. The results of meta-analysis showed that the higher CAR value, the shorter OS [effect size (ES)=0.60, 95%CI (0.50, 0.69), Z=12.04, P<0.001], DFS [ES=0.63, 95%CI (0.47, 0.78), Z=3.61, P<0.001], and PFS [ES=0.41, 95%CI (0.19, 0.63), Z=7.91, P<0.001] in the patients with pancreatic cancer. The results of subgroup analysis of OS according to different countries, sample size, mean age, follow-up time, CAR cut-off value, and NOS score showed that the higher CAR value was related to the shorter OS (P<0.05). The result of linear regression analysis showed that there was no correlation between the CAR cut-off value and lnHR of OS (r2=0.947, P=0.455). Conclusion From results of this study, CAR is closely related to OS of patients, and it is expected to be used as a new reference index for monitoring and judging prognosis of patients with pancreatic cancer.
Objective To evaluate the predictive performance of the geometric characteristics, centerline (CL) of pulmonary nodules for prognosis in patients with surgically treatment in the National Lung Screening Trial (NLST). MethodsCT images of 178 patients who underwent surgical treatment and were diagnosed with non-small cell lung cancer (NSCLC) in the low-dose CT (LDCT) cohort from the NLST image database were selected, including 99 males and 79 females, with a median age of 64 (59, 68) years. CT images were processed using commercial software Mimics 21.0 to record the volume, surface area, CL and the area perpendicular to the centerline of pulmonary nodules. Receiver operating characteristic (ROC) curve was used to compare the predictive performance of LD, AD and CL on prognosis. Univariate Cox regression was used to explore the influencing factors for postoperative disease-free survival (DFS) and overall survival (OS), and meaningful independent variables were included in the multivariate Cox regression to construct the prediction model. ResultsThe area under the curve (AUC) of CL for postoperative recurrence and death were 0.650 and 0.719, better than LD (0.596, 0.623) and AD (0.600, 0.631). Multivariate Cox proportional risk regression analysis showed that pulmonary nodule volume (P=0.010), the maximum area perpendicular to the centerline (MApc) (P=0.028) and lymph node metastasis (P<0.001) were independent risk factors for DFS. Meanwhile, age (P=0.010), CL (P=0.043), lymph node metastasis (P<0.001), MApc (P=0.022) and the average area perpendicular to the centerline (AApc) (P=0.016) were independently associated with OS. ConclusionFor the postoperative outcomes of NSCLC patients in the LDCT cohort of the NLST, the CL of the pulmonary nodule prediction performance for prognosis is superior to the LD and AD, CL can effectively predict the risk stratification and prognosis of lung cancer, and spheroid tumors have a better prognosis.
Objective To investigate the relevance among sarcopenia, peripheral inflammatory, and nutritional factors, as well as the impact of sarcopenia on the prognosis of gastric cancer. Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included. The skeletal muscle index (SMI) of the third lumbar vertebra level was calculated using CT images, and male patients with SMI<52.4 cm2/m2 and female patients with SMI<38.5 cm2/m2 were considered sarcopenia. The key clinicopathological features of patients were collected for prognostic analysis. ResultsAmong the 174 patients with gastric cancer, 73 patients (41.95%) were diagnosed with sarcopenia. Compared with those of non-sarcopenia, the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index (BMI). In addition, males demonstrated a significantly higher rate of sarcopenia. Further, patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia. The two groups showed significant differences in type 2 diabetes, peripheral C-reaction protein (CRP), interleukin-6 (IL-6), albumin, prealbumin, and hemoglobin. Overall, the multivariate analysis and Kaplan-Meier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients. Conclusion Sarcopenia is closely related to higher levels of inflammation, malnutrition, and poor prognosis in patients with gastric cancer. Therefore, we should diagnose sarcopenia patients as early as possible, and give nutritional support to the patients.
ObjectiveTo compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. MethodsA retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1∶1, and the survival of the two groups before and after matching was analyzed. ResultsA total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged ≥70-80 years and 75 patients aged ≥80-90 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. ConclusionCompared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged ≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.
ObjectiveThis study aimed to identify independent risk factors for head and neck squamous cell carcinoma (HNSCC) based on the surveillance, epidemiology, and end results (SEER) database and to develop a nomogram model for predicting patient survival outcomes. MethodsPatients diagnosed with HNSCC from 1975 to 2021 were selected from the SEER database. After applying inclusion and exclusion criteria, 2 271 patients were included and randomly divided into a training cohort and a validation cohort in a 7∶3 ratio. Independent prognostic factors were identified using LASSO regression, Cox regression analysis, and the Akaike information criterion (AIC). A nomogram model was constructed, and its discrimination and calibration were assessed using the concordance index (C-index), time-dependent area under the curve (time-dependent AUC), and calibration curves. The nomogram model was compared with the American Joint Committee on Cancer (AJCC) staging system using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI) to evaluate clinical utility and risk stratification performance. ResultsFive independent prognostic factors (age, marital status, N stage, tumor stage, and radiotherapy) were selected to build the nomogram model for HNSCC. The C-index values of the model were 0.731 4 (95%CI 0.714 5 to 0.748 5) in the training cohort and 0.735 1 (95%CI 0.709 1 to 0.761 0) in the validation cohort. The time-dependent AUC values were all above 0.7, indicating good discriminatory ability. Moreover, decision curve analysis showed that the nomogram model provided higher clinical net benefits at different threshold probabilities and performed better than the AJCC staging system in identifying high-risk patients. ConclusionThis study develops a nomogram model based on the SEER database to predict survival outcomes in patients with HNSCC. The model demonstrates high discrimination and clinical utility, offering a personalized prognostic tool for clinicians.