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Objective To determine the value of lymph node ratio (LNR) in prognosis of patients with intrahepatic cholangiocarcinoma (ICC).Methods The pathological and survival data of ICC patients were extracted from the Surveillance Epidemiology and End Result Database (SEER).The value of LNR in prognosis of patients with intrahepatic cholangiocarcinoma was evaluated by the Kaplan-Meier and Cox proportional hazard models.Results A total of 357 pathologically confirmed ICC patients were included in this study (158 males,199 females).The results showed that patients with lymph node metastasis had significantly shorter survival time than patients without metastasis [(41.6 ± 1.8) vs.(23.2 ± 2.2) months,P＜ 0.05].Multivariate analysis on survival showed that the status of lymph node metastasis was independent prognostic factor of survival,after adjusting for age,gender and tumor stage.Only a LNR ≥ 20％ was an independent risk factor of prognosis (HR=2.3,95％CI:1.4～3.8,P＜0.05).Conclusion A positive lymph node ratio was superior to lymph node metastasis in predicting survival in patients with intrahepatic cholangiocarcinoma.
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Objective@#To explore the prognosis of patients with T1b stage gallbladder carcinoma underwent different surgical procedure.@*Methods@#The clinicopathological data of 97 patients with T1b stage gallbladder carcinoma came from 8 clinical centers from January 2010 to December 2016 and 794 patients who were admitted to the SEER database of USA from January 1973 to December 2014 were analyzed.There were 891 patients including 254 males and 637 females (1.0∶2.5) with age of (69.5±12.0)years. There were 380 patients who were less than 70 years old, 511 patients who were more than 70 years old. And there were 213 patients with the diameter of tumor less than 20 mm, 270 patients with the diameter of tumor more than 20 mm, 408 patients were unclear. There were 196 patients with well differentiation, 407 patients with moderately differentiation, 173 patients with poorly differentiation, 8 patients with undifferentiated, 107 patients were unclear. In the 891 patients with T1b stage gallbladder carcinoma, there were 562 cases accepted the simple cholecystectomy, 231 cases with simple cholecystectomy plus lymphadenectomy, and 98 cases with radical cholecystectomy. The time of follow-up were until June 2017. χ2 test was used to analyze the enumeration data, rank-sum test was used to analyze the measurement data, the analyses of prognostic factors were used Cox proportional hazards model, the survival analysis was performed using Kaplan-Meier method.@*Results@#The results of Cox proportional hazards model indicated, age, differentiation, surgical procedure were the risk factors of prognostic(1.929(1.594-2.336), P<0.01; 1.842(1.404-2.416), P<0.01; 1.216(0.962-1.538), P<0.01). The results of Kaplan Meier test indicated, the overall survival of T1b stage gallbladder carcinoma were (85.5±3.8)months, the overall survival of patients with simple cholecystectomy were (71.3±4.4)months, the overall survival of patients with cholecystectomy plus lymphadenectomy were(87.6±5.8)months, and the overall survival of patients with radical cholecystectomy were(101.7±9.3)months. The overall survival of patients with cholecystectomy plus lymphadenectomy and radical cholecystectomy were more than simple cholecystectomy(P<0.05). There were 329 patients with Lymph nodes examined in and after operations(231 patients with cholecystectomy plus lymphadenectomy, 98 patients with radical cholecystectomy). There were 265 patients with negative lymph node metastasis, the overall survival were(98.3±4.2)months. There were 64 patients with positive lymph node metastasis, the overall survival were(75.5±3.1)months. The overall survival of 38 patients with cholecystectomy plus lymphadenectomy were(62.7±2.6) months, and 26 patients with radical cholecystectomy were (82.2±3.7)months. The overall survival of patients with radical cholecystectomy were more than cholecystectomy plus lymphadenectomy(P<0.05).@*Conclusions@#The T1b stage gallbladder carcinoma patients with cholecystectomy plus lymphadenectomy or radical cholecystectomy has improved the prognosis comparing with simple cholecystectomy, significantly. When lymph node metastasis occurs, radical cholecystectomy has improved the prognosis comparing with cholecystectomy plus lymphadenectomy.
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Objective To analyze the pathological results and current treatment situation of patients with unexpected gallbladder carcinoma from multi-centers in China,and explore the diagnosis and treatment of unexpected gallbladder carcinoma.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 223 patients with unexpected gallbladder carcinoma who were admitted to the 8 clinical centers from January 2010 to December 2016 were collected,including 86 in the First Affiliated Hospital of Xi'an Jiaotong University,41 in the First Affiliated Hospital of Zhengzhou University,30 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University,27 in the Xinhua Hospital of Shanghai Jiaotong University,13 in the First Affiliated Hospital of Dalian Medical University,11 in the Tianjin Medical University Cancer Institute & Hospital,9 in the First Affiliated Hospital of Army Medical University (Third Military Medical University) and 6 in the Affiliated Hospital of North Sichuan Medical College.Treatment of patients with unexpected gallbladder carcinoma who were diagnosed by intraoperative frozen section biopsy and postoperative pathological examination followed guideline for the diagnosis and treatment of gallbladder carcinoma (2015 edition).According to tumor staging and patients' decision,postoperative adjuvant treatment was selectively performed.Observation indicators:(1) diagnosis and treatment of unexpected gallbladder carcinoma;(2) followup and survival.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to June 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).The survival time was calculated using the Kaplan-Meier method.Results (1) Diagnosis and treatment of unexpected gallbladder carcinoma:of 223 patients with unexpected gallbladder carcinoma,80 were initially diagnosed using intraoperative frozen section biopsy [20 received T stage results (intraoperative T stage of 14 patients had not matched postoperative results),and 60 didn't receive T stage results],and 143 were initially diagnosed using postoperative pathological examination (13 were initially diagnosed with gallbladder benign disease by intraoperative frozen section biopsy and 130 didn't intraoperatively receive frozen section biopsy).Of 223 patients,209,10,3 and 1 were respectively confirmed as adenocarcinoma,adenoma canceration,neuroendocrine tumor and squamous cell carcinoma;6,16,32,73,75,12 and 9 were respectively detected in Tis,T1a,T1b,T2,T3 and T4 stages and undefined stage;140 underwent reoperations,including 106 with radical resection of gallbladder carcinoma and 34 with extended radical resection of gallbladder carcinoma;operation of 126 patients reached the standard and operation of 97 patients didn't reach the standard.Of 27 patients with postoperative complications,12 with postoperative hemorrhage received successful hemostasis by reoperations (7 with cystic artery hemorrhage and 5 with blood oozing from gallbladder bed);8 with suppurative cholangitis received endoscopic retrograde cholangiopancreatography and choledochotomy with drainage,including 2 deaths and 6 with improvement;2 with common bile duct injury were improved by reoperation of choledochojejunostomy + T tube drainage;2 were complicated with bile leakage induced to peritonitis and underwent bile duct repair with drainage,including 1 death and 1 with improvement;2 with hepatic failure died of treatment failure;1 with colonic injury was improved by reoperation of anastomosis.Of 223 patients,207 didn't receive postoperative adjuvant treatment and 16 received postoperative adjuvant treatment,including 8 with chemotherapy,4 with radiotherapy,2 with immunologic therapy and 2 with Chinese medicine treatment.(2) Follow-up and survival:of 223 patients,193 were followed up for 6-90 months,with a median time of 33 months.Of 193 patients with follow-up:① The operation of 2 patients in stage Tis reached the standard,including 1 with cholecystectomy and 1 with radical resection of gallbladder carcinoma,and the postoperative survival time of them were respectively 28 months and 52 months.② The operation of 14 patients in stage T1a reached the standard,including 8 with cholecystectomy and 6 with radical resection of gallbladder carcinoma,and the postoperative survival time of them were respectively (74±5)months and (79±6)months.③ Of 26 patients in stage T1b,13 and 13 received respectively cholecystectomy and radical resection of gallbladder carcinoma (reaching the standard),and postoperative survival time of them were respectively (66±4)months and (76±8)months.④ Of 68 patients in stage T2,25,37,4 and 2 patients received respectively cholecystectomy,radical resection of gallbladder carcinoma (reaching the standard),extended radical resection of gallbladder carcinoma (reaching the standard) and palliative resection,and postoperative survival time of them were respectively (42±7) months,(66±6) months,(42±3) months and (26±3) months.⑤ Of 71 patients in stage T3,20,48 and 3 patients received respectively cholecystectomy,radical resection of gallbladder carcinoma (reaching the standard) and extended radical resection of gallbladder carcinoma (reaching the standard),and postoperative survival time of them were respectively (39±8) months,(48± 11) months and (10±6) months.⑥ Of 12 patients in stage T4,3,1,5 and 3 patients received respectively cholecystectomy,radical resection of gallbladder carcinoma (reaching the standard),extended radical resection of gallbladder carcinoma (reaching the standard) and palliative resection,and postoperative survival time of them were respectively (10±4) months,12 months,(9± 5) months and (11±3) months.Conclusions The intraoperative frozen section biopsy and pathological results are the key points for diagnosis and treatment of unexpected gallbladder carcinoma.Patients in stage Tis and T1a should undergo cholecystectomy,while patients in stage T1b and above should undergo radical resection of gallbladder carcinoma or extended radical resection of gallbladder carcinoma.
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Objective To systematically evaluate the clinical effect of surgery combined with adjuvant therapy (postoperative chemoradiotherapy or chemotherapy) and single surgery for resectable pancreatic cancers.Methods Literatures were researched using PubMed,Embase,Science Citation Index Expanded,Cochrane Central Register of Controlled Trials and China Biology Medicine disc with the key words including "pancreatic cancer,adjuvant therapy,chemoradiotherapy,radiochemotherapy,chemotherapy,radiotherapy,胰腺癌,辅助治疗,化学治疗and放射治疗”from the time of database building to October 2016.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients undergoing surgery combined with adjuvant chemoradiotherapy,surgery combined with adjuvant chemotherapy and single surgery were respectively allocated into the first treatment group,second treatment group and control group.The inverse variance was used for mergering hazard ratio (HR) and related statistic data.HR and 95％ confidence interval (CI) were used for assessing the overall survival time and disease-free survival time.The median survival time and 1-,2-,5-year survival rates were evaluated by the relative risk (RR) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Eleven randomized controlled trials (RCTs) of 9 literatures were retrieved,and the total sample size was 1 482 patients,including 238 patients in the first treatment group,545 in the second treatment group and 699 in the control group.Results of Meta analysis:① overall survival time:there was no significant difference in overall survival time between the first treatment group and control group (HR =0.87,95％ CI:0.56-1.17,P＞ 0.05).There was a significant difference in overall survival time between the second treatment group and control group (HR =0.68,95 ％ CI:0.55-0.80,P＜ 0.05).② Disease-free survival time:there was no significant difference in disease-free survival time between the first treatment group and control group (HR=0.78,95％CI:0.53-1.03,P＞0.05).There was a significant difference in disease-free survival time between the second treatment group and control group (HR=0.56,95％CI:0.45-0.67,P＜0.05).③ Median survival time:there were significant differences in median survival time between the first treatment group and control group (RR=1.82,95％CI:1.35-2.45,P＜0.05) between the second group and control group (RR=1.32,95％CI:1.07-1.62,P＜0.05).④ One-,2-,5-year survival rates:there was no significant difference in 1-,2-,5-year survival rates between the first treatment group and control group (RR=1.24,2.47,1.15,95％ CI:0.72-2.12,0.82-7.41,0.71-1.84,P＞0.05).One-year survival rate in the second treatment group was compared with that in the control group,with no significant difference (RR=1.15,95％CI:0.99-1.34,P＞0.05).There were significant differences in 2-and 5-year survival rates between the second treatment group and control group (RR=1.24,1.73,95％CI:1.01-1.50,1.32-2.27,P＜0.05).Conclusions Compared with single surgery,surgery combined with postoperative chemoradiotherapy cannot significantly improve the overall survival time and disease-free survival time of patients.However,surgery combined with adjuvant chemotherapy can prolong the overall survival time and disease-free survival time of patients.
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Liver cancer is the common malignant tumors of threat to human health and life,which makes the high mortality rate of patients with liver cancer.Mesenchymal stem cells can differentiate in the liver microenvironment of new liver cells,and promote tissue repair by secreting neurotrophic factors involved in immune regulation,anti-fibrosis and inhibition of hepatic stellate cells and liver progenitor cells activity and other characteristics of treatment of liver cancer has broad prospects.In this paper,mesenchymal stem cell research progress of the influence of primary liver cancer were reviewed.
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Objective To analyze retrospectively the factors related with lymph node metastasis in thyroid microcarcinoma.Methods One hundred and eieghty-seven cases of thyroid microcarcinoma were collected from the First Affiliated Hospital of Dalian Medical University from January 2007 to December 2011,who were operated at the first time and confirmed by pathology.According to the occurrence of lymph node metastasis,they were divided into metastasis group and non-metastasis group.The factors related were analyzed retrospectively.Results The total metastasis rate was 26.7％ (50/187),the metastasis rate of central lymph node was 22.9％ (43/187),and the metastasis rate of lateral lymph node was 11.8％ (22/187).Tumor's diameter more than 5 mm,multiple foci and extrathyroidal extension were related to neck lymph node metastasis of thyroid microcarcinoma (P ＜ 0.05).Conclusions Neck lymph node metastasis was seen most common in central lymph nodes.Tumor size,multiple foci and extrathyroidal extension were related to neck lymph node metastasis of thyroid microcarcinoma,operation therapy should be routinely performed.
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Objectives: To study the effect of early enteral nutrition using Fresubin after gastrointestinal operation. Methods:78 postoprative patients were divided into two groups. The jejunostic tube group(A group, n=50) received the enteral nutrition(Fresubin) 6h after operation, and the control group(B group, n=28)received the intravenous infusion and then the oral liquid diet after the bowel movement recovery.The clinical findings,operative complications,blood glucose,the function of liver and kidney,electrolytes and nutritional status were observed. Results:The recovery of bowel movement in group A was much earlier than that in group B(P