【Abstract】Objective To evaluate the value of pTNM classification in predicting the prognosis of hepatic cell carcinoma after liver transplantation. Methods Fifty-nine HCC cases undergoing liver transplantation between April 1993 and January 2003 were retrospectively reviewed. Fiftynine cases were staged by using the pTNM classification. Results The 1-year survival rates were 66.67%, 66.67%, 40.91% and 31.75% for Ⅰ，Ⅱ，Ⅲa and Ⅳa stages，2-year survival rates were 66.67%, 66.67%, 21.29% and 31.75%, the difference was not statistically significant. Conclusion The pTNM classification is not good enough to predict the prognosis of hepatic cell carcinoma after liver transplantation.
Objective To analyze the relationship between age and prognosis of colorectal patients in the database from colorectal cancer (DACCA). Methods The DACCA version selected for this data analysis was updated on January 5, 2022. The data items analyzed included age, sex, tumor site, tumor pathological nature, obstruction, pathological TNM (pTNM) stage, positive lymph node ratio, survival status and survival time. According to China’s age segmentation standard, the included data were grouped into younger group (<35 years old), middle-aged group (35–59 years old) and elderly group (>59 years old). Overall survival (OS) and disease specific survival (DFS) were analyzed in three age group, and OS and DSS in three age group were analyzed in pTNM stage stratification. Results Three thousand six hundred and twenty-five rows of data were obtained from DACCA database according to the screening conditions. The survival analysis results of different age groups show that: The middle-aged group had better OS compared with the elderly group at 1-year (97.4% vs. 96.0%, P=0.037), 3-year (90.9% vs. 88.0%, P=0.030) and 5-year (81.7% vs. 75.7%, P=0.002). Also, the middle-age group had better 5-year DSS (82.2% vs. 77.7%, P=0.020). There was no statistical difference in survival between the younger group and the elderly group (P>0.05). The survival analysis results of different age groups in each pTNM stage show that: ① The middle-aged group had better medium-term and long-term OS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5-year OS in the middle-aged group were better than those in the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005). In the pTNM Ⅱ stage, the 5- and 10-year OS in the middle-aged group were better than those in the elderly group (96.5% vs. 91.3%, P=0.018; 88.2% vs. 54.3%, P<0.001). In pTNM Ⅲ stage, 10-year OS in the middle-aged group was better than that in the elderly group (36.5% vs. 36.0%, P<0.001). In pTNM Ⅳ stage, the 5- and 10- year of OS in the middle-aged group were better than those in the elderly group (67.7% vs. 58.4%, P=0.016; 19.1% vs. 7.2%, P=0.049). ② The middle-aged group had better medium-term and long-term DSS than the elderly group. In the pTNM Ⅰ stage, the 3- and 5- year DSS in the middle-aged group wrer better compared to the elderly group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). In the pTNM Ⅱ stage, the 10-year DSS in the middle-aged group outperformed that in the elderly group (88.2% vs. 61.9%, P=0.002). In the pTNM Ⅳ stage, the 5- and 10-year DSS in the middle-aged group were better than the elderly group (68.3% vs. 59.1%, P=0.020; 20.9% vs. 7.7%, P=0.040). ③ Except pTNM I stage, there was no significant difference in survival of other pTNM stages between young group and old group (P>0.05). In the pTNM Ⅰ stage, 3- and 5- year OS were better in the younger group compared with the elderly group (100% vs. 93.4%, P=0.004; 100% vs. 91.4%, P=0.005), and better 3- and 5- year DSS in the younger group (100% vs. 96.9%, P=0.047; 100% vs. 94.9%, P=0.049). Conclusions The age of colorectal cancer patients may have an impact on long-term survival. Middle-aged patients have better prognosis compared with elderly patients, and the younger group patients have better prognosis in pTNM stage Ⅰ only.
目的 評估非小細胞肺癌患者中癌癥相關性乏力的發生情況及其與患者臨床病理特征和生存期之間的相互關系。 方法 應用簡明疲勞量表中文版評估2008年12月－2009年12月間收治的72例初治肺癌患者，入組患者均完成根治性手術及術后生存隨訪。 結果 72例早期非小細胞肺癌患者中，無乏力9例（12.5%），輕度乏力48例（66.7%），中度乏力15例（20.8%），重度乏力0例（0%），乏力總體發生率為87.5%。乏力指數與患者的年齡、性別、吸煙史均無相關性，與患者的體力狀況評分（ECOG PS）、TNM分期呈正相關，與中位生存期呈負相關，均有統計學意義（P＜0.05）。 結論 癌癥相關性乏力作為非小細胞肺癌患者中普遍存在的一種癥狀，不僅能夠反映患者當時的主觀感受和生活狀況，還可能是判斷患者術后病理分期及最終總生存期的預測因素。
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
The TNM staging of lung cancer which is now widely used in clinic was formally proposed in 1997. It has played quite an important role in directing the diagnosis and treatment of lung cancer as well as the clinical research in the past decade. However, at the same time, there are some insufficiencies which are emerging gradually. By collecting the clinical information from 100 869 patients, in 2007, International Association for the Study of Lung Cancer(IASLC) made a deep analysis on the relativity between TNM staging and prognosis, and put forward the suggestions to revise the Seventh Edition of the TNM staging of lung cancer: (1) According to the size of tumor, the primary T staging is divide into T1a (the maximum tumor diameter≤2 cm), T1b (3 cm≥the maximum tumor diameter＞2 cm), T2a (5 cm≥the maximum tumor diameter＞3 cm) and T2b (7 cm≥the maximum tumor diameter＞5 cm); (2) T 2c (the maximum tumor diameter gt;7 cm) and additional nodules in the same lobe are classified as T3, while nodules in the ipsilateral nonprimary lobe are classified as T4;(3) Cancerous hydrothorax, pericardial effusion and the additional nodules in the contralateral lung are classified as M1a, while the extrapulmonary metastases are classified as M1b. It is believed that the new revised edition will has higher international authority and identification degree, and it will play a more meticulous and accurate guiding role in the treatment of lung cancer and its predicting prognosis in the future. At the same time, it will provide a new starting point to the research of lung cancer.
ObjectiveTo quantitate expression of microRNA-21 (miRNA-21) in gastric cancer of different tumor stages and discuss its clinical value. Method The relative expressions of miRNA-21 were quantitated in the cancer tissues, corresponding normal gastric tissues adjacent to gastric cancer, and serums of 50 gastric cancer patients received opera-tion and confirmed gastric cancer by pathology and the serums of nongastric cancer patients in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and its Chongming Branch from January 2015 to January 2016 by real time quantitative PCR. ResultsThe relative expression level of miRNA-21 in the gastric cancer tissues was significantly higher than that in the normal gastric tissues adjacent to gastric cancer. Among the TNM stageⅠ, Ⅱ, Ⅲ of gastric cancer patients, the relative expression levels of miRNA-21 in the cancer tissues were 2.17 (1.48-2.90), 4.08 (2.30-4.86), 8.64 (5.82-18.20), respectively and the differences among these three stages were statistically significant (P<0.05). The relative expression level of the serum miRNA-21 in the gastric cancer patients was significantly higher than that in the nongastric cancer patients, which in the serums for stageⅠ, Ⅱ, and Ⅲpatients were 31.00 (24.60-37.15), 39.10 (28.90-39.80), 44.15 (38.95-56.68), respectively and the differences among three stages were statistically significant (P<0.05). The relative expression level of miRNA-21 in the serums and cancer tissues had a positive correlation (r=0.86, P<0.05). ConclusionMiRNA-21 appears to have a potential association with TNM stage of gastric cancer, which cautiously suggests that it might be a potential indicator for prediction of preoperative TNM stage of gastric cancer.
Objective To improve esophageal lymph node staging and investgate an ideal esophageal lymph node metastasis staging method. Methods The clinical pathological data and followup data of the 236patients who had undergone thoracic esophagectomy with at least 6 lymph nodes (LN) removed from January 1985 to December 1989 were analyzed retrospectively. Cox proportional hazard model was used to screen risk factors, and Logrank test was applied to perform survival analysis according to lymph node metastasis staging (number, distance and extent). Results The 10-year follow-up rate was 92.3%（218/236）. The overall 1-year, 5-year and 10-year survival rates were 80.2%, 43.1% and 34.2% respectively. One hundred and twelve (47.4%) patients had LN metastasis, and their 5-year survival rates were lower than that of patients without LN metastasis (14.8% vs. 66.6%; χ2=77.18, P=0.000). Cox regression analysis showed that besides depth of invasion, differentiation grade and LN metastasis, the number, distance and extent of LN metastasis were the independent risk factors which could influence prognosis. A further analysis was given via univariate Logrank test. When grouped according to the number of LN metastasis, there were significant differences in overall survival rates (χ2=96.00,P=0.000), but no significant difference was found in survival rates between N2 and N3 group(Pgt;0.05). When grouped according to the distance of LN metastasis, there were significant differences in overall survival rates (χ2=79.29, P=0.000), but no significant difference was found in survival rates among S1, S2 and S3 group(Pgt;0.05). When grouped according to the extent of LN metastasis (0, 1, and ≥2 fields), there were significant differences in overall survival rates (χ2=87.47, P=0.000), and so were the survival rates among groups (χ2=5.14, P=0.023). Conclusion Revising the current Nclassification of TNM staging of esophageal cancer according to the extent of LN metastasis(0, 1, and ≥2 fields) is more reasonable, and can reflect the prognosis of patients with esophageal cancer after esophagectomy better.
ObjectiveTo detect the expression of Prox1 (prospero-related homeobox 1) gene in primary hepatocellular carcinoma (HCC), and to analyze the correlation of Prox1 gene expression with pathological grade and clinical stage of HCC. MethodsThe expressions of Prox1 gene in carcinoma tissues and adjacent cancerous tissues in HCC as well as normal liver tissues were detected by semi-quantitative RT-PCR, then the correlation of Prox1 gene expression with HCC pathological grade and clinical stage were analyzed. ResultsThe expression of Prox1 gene in carcinoma tissues (0.243±0.102) and adjacent cancerous liver tissues (0.537±0.235) was significantly lower than that in normal liver tissue (0.812±0.372), respectively （ Plt;0.01 or Plt;0.05）. Furthermore, the expression of Prox1 gene in carcinoma tissues was significantly lower than that adjacent cancerous liver tissues (Plt;0.05). The expressions of Prox1 gene in different pathological grade (F=97.950, Plt;0.001) and clinical stage were significantly different (F=228.300, Plt;0.001), and when compared with each other, the differences of pathological grade and clinical stage were also significant (Plt;0.001 or Plt;0.01). The expressions of Prox1 gene in HCC carcinoma tissue were negatively correlated with pathological grade (r=-0.930, Plt;0.01) and clinical stage (r=-0.980, Plt;0.01) of HCC. ConclusionsExpression of Prox1 gene may be related to the initiation and development of HCC, however, that whether Prox1 gene functions as tumor suppressor in HCC needs further investigation.