ObjectiveTo study the relationship between clinical features of patients with phyllodes tumor of breast (PTB) and reccurence, distant metastasis, and prognosis.MethodsThe clinical data of 96 patients with PTB treated in this hospital from March 2011 to December 2018 were retrospectively analyzed. The correlation of clinical features with local recurrence and distant metastasis were analyzed by the Chi-square test and logistic regression. The Kaplan-Meier method was used to compute disease-free survival (DFS). The correlation of clinical features with prognosis was analyzed by the log-rank test and Cox regression.ResultsNinety-four patients with PTB showed the unilateral single nodule, 2 patients showed the bilateral nodule. The benign tumor had 36 patients, borderline tumor had 34 patients, malignant tumor had 26 patients. A total of 27 patients had local recurrence, 4 patients had distant metastasis, 4 patients died during the follow-up period. The 1-, 3-, and 5-year accumulate DFS rate was 81.2%, 64.9%, and 64.9%, respectively. The accumulate 5-year overall survival rate was 92.3%. The multivariate analysis showed that the age, types of tumor, and surgical method were related to the local recurrence (P<0.050), and no clinicopathological factors were found to be related to the distant metastasis (P>0.050). It was found that type of tumor was the independent factor affecting prognosis (P<0.050).ConclusionsFor PTB, the recurrence rate is higher, the age and tumor types are the independent recurrent factors. Surgical treatment is the primary management, extend resection and mastectomy are alternative operation.
ObjectiveTo study the correlation of lymph node metastasis and recurrence with body mass index (BMI) and estrogen receptor (ER) in papillary thyroid carcinoma (PTC).MethodThe relevant literatures were retrieved in the past six years through the CNKI, VIP, Wanfang, CBM, PubMed, Medline, Embase, Cochrane Library, etc. databases for meta-analysis of relationship of lymph node metastasis and recurrence of PTC with BMI or ER and its subtypes.ResultsThe meta-analysis showed that the lymph node metastasis of PTC was associated with the BMI and ERα [OR=1.27, 95% CI (1.12, 1.42), P<0.000 1; OR=2.68, 95% CI (1.86, 3.86), P<0.000 01, respectively ], and which not associated with the ER and ERβ [OR=0.87, 95% CI (0.56, 1.35), P=0.53; OR=1.22, 95% CI (0.78,1.89), P=0.39, respectively ]. The ERα was associated with the PTC recurrence [OR=1.87, 95% CI (1.04, 3.35), P=0.04 ], but the BMI was not the risk factor for the recurrence of PTC [OR=1.187 1, 95% CI (0.930 0, 1.515 3), P=0.17 ].ConclusionsAlthough BMI was not found to be associated with PTC recurrence, high BMI promotes PTC metastasis, so lymph node dissection in obese patients should be more careful and comprehensive. Positive ERα increases risk of lymph node metastasis and recurrence of PTC, which can be used as a negative factor in evaluating prognosis of PTC and provide a new idea for endocrine therapy of PTC.
Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
ObjectiveTo analyze the risk factors and develop a nomagram predictive model for early recurrence after curative resection for hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of the patients with HCC who underwent radical hepatectomy at the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2021 were retrospectively collected. The univariate and multivariate logistic regression analysis were used to screen for the risk factors of early recurrence for HCC after radical hepatectomy, and a nomogram predictive model was established based on the risk factors. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the predictive performance of the model, and the decision curve analysis (DCA) curve was used to evaluate its clinical practicality. ResultsA total of 302 patients were included based on the inclusion and exclusion criteria, and 145 (48.01%) of whom experienced early recurrence. The results of multivariate logistic regression model analysis showed that the preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), γ-glutamate transferase (GGT), alpha fetoprotein (AFP), tumor size, and microvascular invasion (MVI) were the influencing factors of early recurrence for HCC after radical resection (P<0.05). The nomogram was established based on the risk factors. The area under the ROC curve of the nomogram was 0.858 [95%CI (0.816, 0.899)], and the Brier index of the calibration curve of the nomogram was 0.152. The predicted result of the nomogram was relatively close to the true result (Hosmer-Lemeshow test, P=0.913). The DCA result showed that the clinical net benefit of intervention based on the predicted probability of the model was higher than that of non-intervening in all HCC patients and intervening in all HCC patients when the threshold probability was in the range of 0.1 to 0.8. ConclusionsThe results of this study suggest that for the patients with the risk factors such as preoperative NLR greater than 2.13, PLR greater than 108.15, GGT greater than 46.0 U/L, AFP higher than 18.96 μg/L, tumor size greater than 4.9 cm, and presence of preoperative MVI need to closely pay attention to the postoperative early recurrence. The nomogram predictive model constructed based on these risk factors in this study has a good discrimination and accuracy, and it could obtain clinical net benefit when the threshold probability is 0.1 to 0.8.
ObjectiveTo explore the prognostic value of normal 24 hour video electroencephalography (VEEG) with different frequency on antiepileptic drugs (AEDs) withdrawal in cryptogenic epilepsy patients with three years seizure-free. MethodsA retrospective study was conducted in the Neurology outpatient and the Epilepsy Center of Xi Jing Hospital. The subject who had been seizure free more than 3 years were divided into continual normal twice group and once group according to the nomal frequence of 24 hour VEEG before discontinuation from January 2013 to December 2014, and then followed up to replase or to December 2015. The recurrence and cumulative recurrence rate of the two group after withdrawal AEDs were compared with chi-square or Fisher's exact test and Kaplan-Meier survival curve. A Cox proportional hazard model was used for multivariate analysis to identify the risk factors for seizure recurrence after univariate analysis. P value < 0.05 was considered significant, and all P values were two-tailed. Results95 epilepsy patients with cause unknown between 9 to 45 years old were recruited (63 in normal twice group and 32 in normal once group). The cumulated recurrence rates in continual two normal VEEG group vs one normal VEEG group were 4.8% vs 21.9% (P=0.028), 4.8% vs 25% (P=0.006) and 7.9% vs 25%(P=0.03) at 18 months, 24 months and endpoint following AEDs withdrawal and there was statistically difference between the two groups. Factors associated with increased risk were adolescent onset epilepsy (HR=2.404), history of withdrawal recurrence (HR=7.186) and abnormal VEEG (epileptic-form discharge) (HR=8.222) during or after withdrawal AEDs. The recurrence rate of each group in which abnormal VEEG vs unchanged VEEG during or after withdrawal AEDs was respectively 100% vs 4.92% (P=0.005), 80% vs 19.23%(P=0.009). ConclusionsContinual normal 24h VEEG twice before withdrawal AEDs had higher predicting value of seizure recurrence and it could guide physicians to make the withdrawal decision. Epileptic patients with adolescent onset epilepsy, history of seizure recurrence and abnormal VEEG (epileptic-form discharge) during or after withdrawal AEDs had high risk of replase, especially patients with the presence of VEEG abnormalities is associated with a high probability of seizures occurring. Discontinuate AEDs should be cautious.
ObjectiveTo investigate the value of multi-disciplinary team (MDT) for the diagnosis and treatment of postoperative recurrence of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of a patient with giant HCC (66 mm×60 mm×102 mm) who was multiple intrahepatic metastases with portal vein tumor thrombus after radical resection, admitted to the Department of Hepatobiliary Surgery of Sichuan Provincial People’s Hospital, were gathered. ResultsThe patient was a middle-aged male. The multiple recurrent intrahepatic metastases combined with portal vein right branch thrombosis was found at 1 month after radical hepatectomy. After MDT discussion and evaluation, the hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy (chemical drugs regimen was FOLFOX, immunotherapy drug was sindilizumab, targeted therapy drug was lenvatinib) was administered. After 3 times conversion therapy, and most of the intrahepatic lesions liquefied and necrotic and shrunk markedly or disappeared. After further discussion and evaluation by MDT, radical surgical resection was performed. The postoperative pathological examination results showed granulomatous inflammation with necrosis, and no exact liver cancer cells were detected. At 6 months after surgery, no tumor recurrence was observed.ConclusionsFor early recurrence combined with portal vein thrombosis after radical resection for HCC, hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy may still be effective and even has an opporunity of surgical therapy. MDT discussion can provide the best treatment plan for patient with recurrent liver cancer, leading to a better clinical outcome for them.
Objective To investigate the situation and prospect of local recurrence of rectal cancer by using CT and MRI. Method Relevant references about the imaging diagnosis of local recurrence of rectal cancer， which were published domestic and abroad in recent years， were collected and reviewed. Results In the diagnosis of local recurrence of rectal cancer， the sensitivity of CT was higher than that of MRI， while the specificity and accuracy were not. Perfusion CT， dynamic contrast-enhanced MRI， and diffusion weighted imaging were valuable in diagnosing local recurrence of rectal cancer， as new diagnostic techniques. Conclusion Both CT and MRI are important and valuable methods in diagnosing for local recurrence of rectal cancer.
Objective To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER) database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgerybetween 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0) (WCLCD∶SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and1 067 lobectomies in 1 cm<T≤2 cm at a ratio of 1∶4 according to the propensity scores. Results The results of multivariable logistic regression showed that older age (HR=1.04, 95%CI 1.03-1.05, P<0.001), male (HR=1.60, 95%CI 1.37-1.88, P<0.001), squamous carcinoma (HR=1.65, 95%CI 1.40-1.95, P<0.001), lymph node removed (HR=0.97, 95%CI 0.96-0.99, P<0.001) were risk factors for recurrence after surgery. We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm. Analyses of 1 441 patients with PSSNLC after matching (WCLCD∶SEER=325∶1 116) indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database ( 89.8% vs. 77.1%, P<0.001). Conclusion Older age, male, squamous carcinoma, and lymph node removed are the risk factors for recurrence of PSSNLC. Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0. The patients in the WCLCD shows better survival compared with of the patients in the SEER database.
Objective To investigate the correlation between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and clinicopathological characteristics and prognosis in patients with gastrointestinal stromal tumor (GIST). Methods The clinicopathological data and blood routine results of 101 patients with GIST who were treated surgically in the General Hospital Western Theater Command PLA from December 2014 to December 2018 were collected retrospectively, samples were obtained to calculate NLR, PLR and SII. The optimal cutoff value of NLR, PLR and SII were evaluated by receiver operating characteristic (ROC) curve. The Chi-square test and t-test were used to analyze the relationship between NLR, PLR, SII and clinicopathological characteristics of GIST. The Kaplan-Meier plots and the log-rank test were used to analyze the influence factors affecting the recurrence-free survival (RFS) of patients with GIST. Multivariate Cox regression analyses was used to identify the independent influence factors affecting the RFS of patients with GIST. Results The preoperative peripheral blood NLR, PLR and SII of patients with GIST were correlated with the tumor site, tumor diameter and modified NIH risk stratification (P<0.05), but not with the mitotic count of tumor cells (P>0.05). Kaplan-Meier plots and log-rank test showed that NLR, PLR, SII, surgical method, tumor site, tumor diameter, mitosis rate and modified NIH risk stratification were the influential factors of RFS in with GIST. The multivariate Cox regression analysis revealed that postoperative whether to accept regular imatinib adjuvant therapy (HR=32.876, P<0.001), modified NIH risk stratification (HR=129.182, P<0.001), and PLR (HR=5.719, P=0.028) were independent influence factors affecting the RFS of patients with GIST. Conclusions Preoperative peripheral blood PLR, NLR, and SII are correlated with clinicopathological characteristics such as the tumor location, tumor diameter and modified NIH risk stratification, and are the influencing factors of postoperative RFS in patients with GIST. PLR is an independent predictor of RFS in patients with GIST.
ObjectiveTo compare the clinical effects of lobectomy and sublobar resection in the treatment of lung metastasis and to analyze the factors affecting patient prognosis. MethodsA retrospective analysis was performed on the clinical data of 165 patients with pulmonary metastasis who underwent thoracic surgery at the Affiliated Tumor Hospital of Xinjiang Medical University between March 2010 and May 2021, including 67 males and 98 females, with a median age of 52 (44, 62) years. According to the operation methods, patients were divided into a lobectomy group and a sublobar resection group. The clinical data of the patients were compared between the two groups. The Cox proportional hazard model was used for univariate and multivariate analyses. ResultsThe 3- and 5-year overall survival rates were 60.0% and 34.3%, respectively, and the median survival time was 24 months. The 3- and 5-year disease-free survival rates were 39.4% and 23.7%, respectively. Compared with the lobectomy group, the sublobar resection group had shorter operation time for pulmonary metastases (P<0.001), less intraoperative blood loss (P<0.001), less drainage volume on the first day after surgery (P<0.001), less incidence of prolonged air leak (P=0.004), shorter drainage tube indwelling time (P=0.002), and shorter postoperative hospital stay (P=0.023). The disease-free survival time after sublobar resection and lobectomy was 26 months and 24 months, respectively, with no statistical difference (P=0.970). The total survival time of the two groups was 73 months and 69 months, respectively, with no significant difference (P=0.697). Multivariate analysis showed that sex [HR=0.616, 95%CI (0.390, 0.974), P=0.038], disease-free interval [HR=1.753, 95%CI (1.082, 2.842), P=0.023], and postoperative adjuvant therapy [HR=2.638, 95%CI (1.352, 5.147), P=0.004] were independent influencing factors for disease-free survival of patients who underwent pulmonary metastasectomy. Disease-free interval [HR=2.033, 95%CI (1.062, 3.894), P=0.032] and preoperative carcinoembryonic antigen level [HR=2.708, 95%CI (1.420, 5.163), P=0.002] were independent factors influencing the overall survival of patients in this group. ConclusionSublobar resection provides a safe and effective treatment option for patients with pulmonary metastasis on the premise of ensuring R0 resection of lung metastasis. Sex, disease-free interval, preoperative carcinoembryonic antigen level, and adjuvant therapy after pulmonary metastasectomy are the independent influencing factors for the prognosis.