ABSTRACT
Objective To study factors affecting prognosis of patients with intrahepatic cholangiocarcinoma (ICC),focusing on the correlation between extent of lymph node dissection and prognosis of patients with ICC.Methods The clinical data of ICC patients who underwent radical resection at the Hepatobiliary and Pancreatic Surgery of Affiliated Cancer Hospital of Zhengzhou University from October 2013 to October 2017 were retrospectively analyzed.According to the extent of lymph node dissection,the patients were divided into the non-dissected lymph node group,the routine dissection lymph node group and the extended lymph node dissection group.The prognoses of the three groups were compared.The Cox stepwise regression model was used to analyze the independent risk factors for prognosis of patients with ICC.Results The 178 patients included 109 males and 69 females.Their ages ranged from 30 to 81 years (average 59 years).There were 80 patients in the non-dissected group,34 patients in the routine lymph node dissection group,and 64 patients in the extended lymph node dissection group.The overall survival rates of the 178 patients at 3 years after liver resection was 29.2％ (52/178),overall median survival 25.8 months.The 3-year survival rates of the non-dissected group,routine dissection group,and extended dissection group were 10.0％ (8/80),52.9％ (18/34),40.6％ (26/64),respectively.The differences among the three groups were significant (P ＜ 0.05).Comparison among the three groups showed that there was no significant difference in survival rates between the routine dissection group and the extended dissection group (P ＞ 0.05).There was a significant difference in survival rates between the non-dissected group and the extended lymph node dissection group (P ＜0.05).Univariate analysis showed that CA19-9,tumor diameter,portal tumor thrombus,and lymph node dissection were related to prognosis of patients with ICC (P ＜ 0.05).Multivariate analysis showed CA19-9,tumor diameter,and extent of lymph nodes clearance were related to patient survival (P ＜ 0.05).Conclusions CA19-9,tumor diameter,and extent of lymph node dissection were independent risk factors of survival in patients with ICC.For patients with ICC who undergo surgical resection,conventional laparoscopic lymph node dissection can achieve good results,and there is no need to extend lymph node dissection.
ABSTRACT
<p><b>OBJECTIVE</b>To establish a fluorogenic probe quantitative RT-PCR (FQ-RT-PCR) method for detection of bcr/abl mRNA fusion gene expression level in leukemia cells, and provide a useful tool for leukaemia diagnosis and minimal residual disease inspectation.</p><p><b>METHOD</b>The conventional RT-PCR was used to amplify bcr/abl gene from cultured K562 cells, the quantitative standard template was constructed with A-T clone method. The fluo-rogenic quantitative RT-PCR method by using Applied Biosystems 7700 Sequence Detector for detecting the expression of bcr/abl fusion gene was successfully. The sensitivity, stability and repetitiveness of this method was determined. The peripheral blood samples from 14 CML patients, one of whom before and one month after bone marrow transplantation (BMT) and 4 cases of ALL in the early stages were detected.</p><p><b>RESULTS</b>The sensitivity of FQ-RT-PCR for detecting bcr/abl fusion gene was about 10(-5) micro g RNA from K562 cell and 10 copies recombined plasmid. The repetition CT value (cycle threshold) and the coefficient variation (CV) among tubes and batches were 2.0% and 3.7%, respectively. The median bcr/abl fusion gene expression level of 14 CML patients was 5.15 x 10(4) copies/ micro g RNA. The products analyzed by electrophoresis showed that 11 cases were b2a2 and 3 cases b3a2. 1.2 x 10(5) copies/ micro g RNA in one CML patient before BMT was changed to 2.3 x 10(3) copies/ micro g RNA one month after BMT. B2a2 was observed in one of the four (25.0%) patients with ALL, and its level of expression was 8.2 x 10(5) copies/ micro g RNA.</p><p><b>CONCLUSION</b>The established FQ-RT-PCR method is sensitive, specific, reliable, accurate and good at repetitiveness. The results expressed in copies were easy for evaluation and comparation. Two different bcr/abl fusion gene form - b2a2, b3a2 can be detected by the method. It can be widely applied to diagnosis and detection of minimal residual disease for CML and some ALL patients.</p>