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Objective: To prove the effect and decrease toxicity in the treatment of lung cancer with bone metastasis of Traditional Chinese medicine and provide service for clinical by comparing the efficacy of traditional Chinese medicine combined with zoledronic acid with pure zoledronic acid in the treatment of lung cancer with bone metastasis. Methods: A retrieval was made for randomized controlled trials of traditional Chinese medicine combined with zoledronic acid in the treatment of lung cancer with bone metastasis which have been included in CNKI, VIP, Wanfang, PubMed, EMbase and CMB to March, 2018, and meta-analysis was performed according to Cochran systematic evaluation method and Revman 5.0. Results: A total of 14 RCTs and 847 patients were included. Compared with control group, ache in the Traditional Chinese medicine combined with zoledronic acid group remarkably decreased (RR =1.50, 95％CI =1.35-1.68, P ＜ 0.000 01), while the living quality remarkably increased (RR =1.47, 95％CI =1.27-1.70, P ＜ 0.000 01), and there were significant role and advantages in improving TCM syndromes of patients (RR =5.69, 95％CI =2.26-14.34, P =0.000 2), prolonging TTP (MD =1.16, 95％CI =0.74-1.58, P ＜ 0.000 01), decreasing serum calcium (MD =-0.32, 95％CI =-0.46——0.17, P ＜ 0.000 1) and reducing adverse reactions (RR =0.51, 95％CI =0.32-0.81, P =0.005). Conclusion: Traditional Chinese medicine combined with zoledronic acid has remarkable curative efficacy and safety in the treatment of lung cancer with bone metastasis, and it may be widely used in clinical practice.
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Objective:To determine the effect of apatinib combined with Xiaoyan decoction for the treatment of non-squamous non-small cell lung cancer. Methods:Thirty-eight patients with non-squamous non-small cell lung cancer were randomly categorized into apatinib group (group A, 18 cases) and apatinib combined with Xiaoyan decoction group (group B, 20 cases). All patients did not under-go surgical treatment, radiotherapy, or chemotherapy during the study. Results:The median progression free survival (mPFS) of ad-vanced non-squamous non-small cell lung cancer patients reached up to 3 months. The mPFS, objective response rate, and disease control rate of the apatinib combined with Xiaoyan decoction group showed no significant difference and statistical significance (P>0.05). The apatinib combined with Xiaoyan decoction group was superior to the apatinib group with regard to alleviating clinical symp-toms and adverse reactions (P<0.05). Conclusion:Xiaoyan decoction combined with apatinib can improve the clinical symptoms of pa-tients and reduce the incidence of adverse reactions in the treatment of advanced non-squamous non-small cell lung cancer.
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<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognosis of familial gastric cancer(FGC) and to provide clinical evidence for rational treatment program.</p><p><b>METHODS</b>Clinicopathological data of 91 patients with FGC and 293 patients with sporadic gastric cancer(SGC) in our department from March 2003 to October 2007 were retrospectively analyzed and compared between the two groups.</p><p><b>RESULTS</b>Tumors with a diameter of less than or equal to 5 cm were more common in FGC patients than SGC patients [65.9%(60/91) vs. 52.6%(154/293), P=0.025]. Proportion of FGC patients with poor differentiation was significantly higher as compared to SGC patients [68.1%(62/91) vs. 55.6%(163/293), P=0.034]. The 5-year overall survival rate in FGC patients was significantly lower than that in SGC patients(25.6% vs. 38.9%, P=0.001). Further stratified analysis revealed that the 5-year survival rates of T4 FGC and T4 SGC patients were 14.5% and 30.5% respectively, the 5-year survival rates of N3 FGC and N3 SGC patients were 10.4% and 17.3% respectively, and the differences were statistically significant(all P<0.05), while other T stage and N stage between the two groups were not significantly different(all P>0.05). Univarite analysis showed that tumor size, tumor location, pathological type, operation method, infiltration depth and lymph node metastasis were influencing factors of prognosis of FGC. Multivariate analysis showed that tumor size(HR=2.271), pathology types(HR=1.449), lymph node metastasis(HR=1.748) and the infiltration depth(HR=1.487) were independent risk factors affecting the prognosis of patients with FGC.</p><p><b>CONCLUSION</b>Compared with SGC, FGC is associated with poor differentiation and poor prognosis.</p>
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Humans , Lymphatic Metastasis , Multivariate Analysis , Prognosis , Retrospective Studies , Risk Factors , Stomach Neoplasms , Pathology , Survival RateABSTRACT
Objective To investigate the prognostic factors of low-and undifferentiated gastric cancer with negative metastasis of lymph nodes.Methods The clinicopathological data of 270 patients with low-and undifferentiated gastric cancer and negative metastasis of lymph nodes who were admitted to the Tianjin Cancer Hospital from January 2002 to December 2007 were retrospectively analyzed.All the patients received radical gastrectomy.One hundred and sixty-one patients had the number of lymph nodes dissected under 15,53 patients had 15-20 lymph nodes dissected,33 had 21-30 lymph nodes dissected and 23 patients with the number of lymph nodes dissected more than 30.Patients were followed up via out-patient examination,phone call and mail till October 2013.The prognosis analysis was done by COX step-wise regression.The survival curve was drawn by KaplanMeier method,and the survival was analyzed using the Log-rank test.Results All the patients were followed up for a median time of 63 months (range,2-103 months).The median survival time was 63 months (range,2-103 months),and the 1-,3-,5-year overall survival rates were 93.0％,69.5％ and 58.5％,respectively.The median survival time of the 161 patients with the number of lymph nodes dissected under 15 was 58 months (range,2-103 months),and the 1-,3-,5-year survival rates were 91.4％,59.3％ and 48.8％,respectively.The median survival time of the 53 patients with the number of lymph nodes dissected between 15 and 20 was 68 months (range,4-95 months),and the 1-,3-,5-year survival rates were 94.3％,84.9％ and 71.7％,respectively.The median survival time of the 33 patients with the number of lymph nodes dissected between 21 and 30 was 68 months (range,34-94 months),and the 1-,3-,5-year survival rates were 100.0％,97.0％ and 87.9％,respectively.The median survival time of the 23 patients with the number of lymph nodes dissected more than 30 was 60 months (range,2-84 months),and the 1-,3-,5-year survival rates were 87.5％,62.5％ and 54.2％,respectively.There was significant difference in the prognosis between the 4 groups (x2 =25.077,P ＜ 0.05).There was significant difference in the prognosis between patients who had 21-30 lymph nodes resected and those had 15-20 lymph nodes resected (x2=3.924,P ＜0.05).Significant difference was also observed in the prognosis between patients who had 15-20 lymph nodes resected and those had more than 30 lymph nodes resected (x2=4.454,P ＜ 0.05),while no significant difference was observed in the prognosis between patients who had lymph nodes resected more than 30 and those had lymph nodes resected less than 15 (x2=0.450,P ＞0.05).The results of univariate analysis showed that gender,age,location and diameter of the tumor,serosal invasion,Borrmann classification,range of gastric resection and the number of lymph nodes dissected were factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes (x2 =4.143,12.607,23.665,11.549,26.350,8.059,5.222,25.077,P ＜0.05).The results of multivariate analysis showed that the tumor diameter longer than 5 cm and serosal invasion were the independent factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes (HR =1.842,3.084,95％ confidence interval:1.286-2.638,1.956-4.861,P ＜ 0.05).Lymph nodes dissected for 21-30 was the protective factor of prognosis (HR =1.533,95％ confidence interval:1.229-2.248,P ＜ 0.05).Conclusions Lymph nodes dissected for 21-30 during radical gastrectomy may improve the long-term survival of patients.The tumor diameter longer than 5 cm,serosal invasion and the number of lymph nodes dissected (less than 15,15-20 and more than 30) were the independent factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes.
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Objective To evaluate negative lymph node count (NLNC) in prediction of prognosis of T3 gastric cancer after radical resection.Method 214 T3 patients of radical gastrectomy with complete clinical and follow-up data between Jan 2003 to Dec 2007 were enrolled.Survival was determined by the Kaplan-Metier method and univariate analysis was done by Log-rank test,Multivariate analysis was performed using the COX proportional hazard regression model.-2loglikelihood value and the hazard ratio (HR) value were used to compared the value of number of lymph node-negative (NLNC) staging and pN staging and lymph node metastasis rate (MLR) in gastric cancer prognosis evaluation.Results Univariate analysis showed that,pN stage (x2 =31.664),MLR stage (x2 =34.123),tumor size (x2 =5.025),type of differentiation (x2 =5.993),Borrmann classification (x2 =5.401),NLNC stage (x2 =37.256) were related to survival (P ＜ 0.05).COX multivariate analysis showed that-2loglikelihood of pN staging is 1 336.761,HR value is 1.464,-2loglikelihood value of MRL staging is 1 335.821,HR value is 1.441.-2loglikelihood value of NLNC staging is 1 326.902,HR value is 1.725.The N0 and N1 staging prognosis in different NLNC staging was significant (P =0.008,P =0.014).Conclusions Sufficient number of negative lymph node prolongs survival and reduces the risk of early recurrence in advanced gastric cancer.
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Objective To investigate the risk factors for group 14v lymph node metastasis in advanced gastric cancer.Methods The clinical data of 170 patients with advanced gastric cancer who were admitted to the Tianjin Cancer Hospital from January 2007 to December 2011 were retrospectively analyzed.All the patients received D2 gastrectomy + group 14v lymph node dissection.All the patients were with gastric adenocarcinoma.The general information of the patients,and the number of lymph node dissected and lymph node with positive expression were recorded.Univariate and multivariate analysis of clinicopathological factors influencing the group 14v lymph node metastasis were done using bivariate Logistic regression model.The correlation between the group 14v lymph node metastasis and regional lymph node metastasis was analyzed using the bivariate Logistic regression analysis.Results Of the 170 patients,459 group 14v lymph nodes were dissected,and 2.7 lymph nodes for each patient (range,1-17 lymph nodes) ; 55 positive lymph nodes were detected in patients with group 14v lymph node metastasis,and 1.7 lymph nodes for each patient (range,1-3 lymph nodes).The results of univariate analysis showed that group 14v lymph node metastasis was correlated with the degree of radical dissection of tumor,diameter of the tumor,lymph node metastasis (N stage) and distal metastasis (M stage).Compared with patients with advanced gastric cancer and with R0 resection of tumor,tumor diameter≤4 cm,N0 stages,and M0 stages,patients with R1 or R2 resection,tumor diameter ＞4 cm,N2 stages,N3 stages,and M1 stages had higher risk of group 14v lymph node metastasis (OR =3.899,2.646,19.231,33.929,5.000,95％ confidence interval:1.11113.677,1.075-6.516,2.333-158.548,4.310-267.112,1.617-15.464,P ＜ 0.05).The resnlts of multivariate analysis showed that N stage was the independent risk factor influencing the group 14v lymph node metastasis.Compared with patients in N0 stage,patients in N2 or N3 stage had higher risk of group 14v lymph node metastasis (OR =15.248,26.287,95％ confidence interval:1.811-128.386,3.244-213.034,P ＜ 0.05).Group 4sb,4d,5,6,7,8a,9,11p,12a and 16 lymph node mnetastasis were coxelated with group 14v lymph node metastasis (OR =3.923,3.335,2.693,5.641,3.100,4.203,3.655,3.660,3.838,17.400,95％ confidence interval:1.264-12.177,1.425-7.807,1.149-6.312,2.126-14.965,1.311-7.330,1.735-10.185,1.395-9.582,1.331-10.666,1.086-13.571,2.707-111.837,P ＜0.05).Conclusion N stage is an independent risk factor of group 14v lymph node metastasis,and the status of group 6 lymph node is the best indicator for group 14v lymph node metastasis.
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Objective To compare the clinicopathological features of Borrmann type Ⅳ gastric cancer with other gastric cancer and explore prognostic factors of the patients with Borrmann type Ⅳ cancer.Methods We retrospectively reviewed the clinical data of 671 advanced gastric cancer patients.They were divided into 2 groups:Borrmann type Ⅳ (64 cases) and other macroscopic Borrmann types of cancer (607 cases).Their clinicopathologic characteristics and overall survival data were analyzed.Results Age,sex,tumor size,tumor location,lymph node metastasis,distant metastasis,TNM classification were discrepant between Borrmann type Ⅳ and other macroscopic Borrmann types of cancer.The 5-year survival rate of Borrmann type Ⅳ cancer patients was 20.1％,while it was 40.3％ for other types of cancer (P ＜ 0.05).The 5-year survival rate for Borrmann type Ⅳ gastric cancer and the other type gastric cancer was 50.0％ and 72.0％ at stage Ⅰ,30.0％ and 57.9％ at stage Ⅱ,18.0％ and 28.4％ at stage Ⅲ,and 16.4％ and 20.0％ at stage Ⅳ (all P ＜ 0.05),respectively.Multivariate analyses revealed age,histology differentiation type,tumor size,the Borrmann type carcinoma and tumor stage to be independent prognostic factors for survival.Conclusions Borrmann type carcinoma has unique clinicopathological features compared with other types of gastric carcinoma and is an important independent prognostic factor.
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Objective To evaluate the risk factors for recurrence of node-negative advanced gastric cancer(N0-AGC) after radical resection.Methods Data of 270 N0-AGC cases after curative intent resection were collected from 2001 to 2008 in Tianjin Cancer Hospital.There were 45 cases with postoperative recurrence.Univariate and multivariate analysis were applied to investigate risk factors for postoperative recurrence.Results The recurrence time was 2-68 months,the survival time was 5-87 months.Univariate analysis showed that tumor size,depth of tumor invasion,number of negative lymph nodes were associated with recurrence of N0-AGC.Multivariate analysis identified tumor size,depth of tumor invasion,number of negative lymph nodes as independent recurrence factors for entire cohort,depth of tumor invasion,number of negative lymph nodes were risk factors for locoregional recurrence.Tumor size,adjuvant chemotherapy for hematogenous metastasis.Conclusions For T4 stage,tumor diameter ＞4 cm advanced node-negative gastric cancer patients,extended lymphadenectomy was recommended to decrease locoregional recurrence,and adjuvant chemotherapy to reduce hematogenous spread.