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Purpose@#The purpose of this study was to evaluate the diagnostic value of soluble Axl (sAxl) in hepatocellular carcinoma (HCC) in comparison with serum α-fetoprotein (AFP). @*Materials and Methods@#Eighty HCC patients, 80 liver cirrhosis patients (LC), 80 patients with hepatitis B virus (HBV) infection, and 80 healthy controls (HC) were enrolled. sAxl levels were measured by an enzyme-linked immunosorbent assay, serum AFP levelswere measured by an electrochemiluminescence immunoassay. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic performances. @*Results@#The results show that levels of sAxl were high expression in patients with HCC (p LC > HC > HBV. Logistic regression and ROC curve analysis identified the optimal cut-off for sAxl in differentiating all HCC and non-HCC patients was 1,202 pg/mL (area under the receiver operating characteristic [AUC], 0.888; 95% confidence interval [CI], 0.852 to 0.924) with sensitivity 95.0%, specificity 73.3%. Furthermore, differential diagnosis of early HCC with non-HCC patients for sAxl showed the optimal cut-off was 1,202 pg/mL (AUC, 0.881; 95% CI, 0.831 to 0.931; sensitivity, 94.1%; specificity, 73.3%). Among AFP-negative HCC patients with non-HCC patients, the cut-off was 1,301 pg/mL (AUC, 0.898; 95% CI, 0.854 to 0.942) with a sensitivity of 84.6%, a specificity of 76.3%. The optimal cut-off for sAxl in differentiating all HCC and chronic liver disease patients was 1,243 pg/mL (AUC, 0.840; 95% CI, 0.791 to 0.888) with sensitivity 93.8%, specificity 61.9%. The combination of AFP and sAxl increased diagnostic value for HCC. @*Conclusion@#sAxl outperforms AFP in detecting HCC, especially in early HCC and in AFP-negative HCC. Combination sAxl with AFP improved the specificity for early HCC diagnosis. In summary, sAxl is a candidate serum marker for diagnosing HCC.
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Objective:To evaluate the clinical value and the prognostic factors of postoperative radiotherapy in type B3 thymoma pa-tients. Methods:A total of 159 patients with thymoma were treated by surgery and postoperative radiotherapy. According to Masaoka staging system, 12, 33, 62, and 52 patients had stageⅠ,Ⅱ,Ⅲ, andⅣlesions, respectively. Myasthenia gravis existed in 38 patients. Altogether 58 patients underwent chemotherapy. Overall survival, disease-free survival, and local control rates were calculated by Ka-plan-Meier method. Prognostic factors were analyzed by Cox regression model. Results:With a median follow-up of 52 months (8-125 months), the overall 5-year survival rate was 81.6%. The 5-year progression-free survival rate was 76.2%. The 5-year local control rate was 82.6%. The recurrence rate was 32.6%, and the metastatic rate was 9.3%. In the univariate analysis, tumor size, Masaoka stage, re-section margin, radiotherapy, and chemotherapy were significantly associated with 5-year overall survival and progression-free surviv-al (P<0.05). In the multivariate analysis, Masaoka stage, resection margin, and radiotherapy were independent prognostic factors of 5-year progression-free survival (P<0.05). Radiotherapy could improve the regional control rate and the overall survival of patients in Ma-saoka stagesⅢ-Ⅳ. Conclusion:The major failure mode for type B3 thymoma is the recurrence of pleure. Radiotherapy can improve the regional control rate and the overall survival of patients in advanced stages. Masaoka staging, surgical margin, and radiotherapy are the independent prognostic factors for type B3 thymoma treated by postoperative radiotherapy.
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<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of endovascular stent insertion for non-small cell lung cancer patients with superior vena cava syndrome.</p><p><b>METHODS</b>We retrospectively studied 123 patients referred to our hospital for the treatment of non-small cell lung cancer presenting with superior vena cava syndrome. Patients were devided in two groups according to the use of endovascular stent insertion in superior vena cava syndrome or not. 64 patients underwent endovascular stent insertion was designed as the stenting group and 59 without stenting as control group. The differences between the two groups in complete response, complication and survival were analyzed.</p><p><b>RESULTS</b>The complete response rate of superior vena cava obstruction was 92.0% for the stenting group, and 42.0% for the control group, showing a significant difference between the two groups (P < 0.001). The median time to complete response was (3.76 ± 2.83) days in the stenting group, significantly shorter than that of the control group (28.08 ± 16.06) days (P < 0.001). The relapse rate after complete response was 12.0% in the stenting group and 16.0% in the control group, showing a non-significant difference between the two groups (P = 0.607). The median time to relapse was 2.7 months in the stenting group and 1.1 months in the control group (P = 0.533). In the stenting group, stent stenosis occurred in 1 case and thrombosis was observed in 3 cases. The incidence rate of complications was 6.3%. Thrombosis occurred in 1 case of the control group, with an incidence rate of complications of 1.7%, showing a non-significant difference between the two groups (P = 0.201). Seven among the 123 patients were still alive at the endpoint of following up. The median survival time was 8.0 months (stenting group) and 5.5 months (control group) (P = 0.382).</p><p><b>CONCLUSIONS</b>Endovascular stent insertion is effective and safe for non-small lung cell cancer patients with superior vena cava syndrome, and it may be recommended as the first choice for palliative treatment of superior vena cava obstruction.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , General Surgery , Lung Neoplasms , General Surgery , Neoplasm Recurrence, Local , Palliative Care , Remission Induction , Retrospective Studies , Stents , Superior Vena Cava Syndrome , General Surgery , ThrombosisABSTRACT
Objective To evaluate the efficacy of hypofractionated 3DCRT for primary liver cancer(PLC) with portal vein tumor thrombosis(PVTT).Methods Between April 1999 and August 2003,34 PLC patients with PVTT received hypofractionated 3DCRT.The severity of hepatic cirrhosis was 23 in Child-Pugh gradeA and 11 gradeB.The median value of GTV was 773?cm~3(105-2097?cm~3).The radiotherapy regimen consisted of 38-63?Gy in 7-15 fractions with 4-8?Gy per fraction(median value 5?Gy),the treatment was delivered 3 times per week during every other day.Results Having response rate(CR+PR) of 76%(26/34),the overall 1-,2-,and 3-year survival rate at was 36%,19% and 13%,respectively.Conclusion Hypofractionated three-dimensional conformal radiotherapy is effective for primary liver cancer with portal vein tumor thrombosis.
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Purpose:To investigate the toxicities and res po nse of liver cancers to 3-dimensional conformal radiation therapy (3-DCRT) com bined with Trancatheter arterial chemoembolization (TACE) Methods :The histopathological confirmed liver cancer patients were treated by 3-DCRT co mbined with TACE, all patients received TACE before 3-DCRT The total irradiati on dose is 50 Gy to 58 Gy in daily fractions of 2 Gy Each planning target volu me (PTV) received a minimum of 90% of the prescribed dose Each mean liver dose not reached 30 Gy, V 30 Gy (the percentage of normal liver volume with ra diation dose≥30 Gy) less than 33% Results:Thirty patients were included in this study including 2 1 hepatocellular carcinoma Survivals at 1 year after 3-DCRT were 76%, with a median survival time of 8 months 2 patients developed Grade 1 acute liver toxi city and one patient experienced Grade 2 gastrointestinal complications No pat ient developed Grade 2 or greater liver toxicity Conclusions:The use of 3-DCRT technique for liver cancer is a safe and efficient method O ur experience indicated the total irradiation dose above 58 Gy is feasible in da ily fractions of 2 Gy, if the mean liver dose did not reach 30 Gy and V 30 G y