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Objective To investigate the prognostic value of different stages of TNM in patients with appendiceal neuroendocrine tumors (NETs). Methods The clinical data of 40 cases of NETs were analyzed, and follow-up data were staged by the ENETS and AJCC TNM staging system. Kaplan-Miere survival curves were used to compare survival differences in patients with different stages of TNM. Results Of the 40 patients, no one was diagnosed as appendiceal NETs before surgery. Twenty-one patients were diagnosed as acute appendicitis, 16 were diagnosed as chronic appendicitis and 3 were suspected as appendiceal tumors due to thickening of the lumen before surgery. No clinical manifestations were found in 40 patients before surgery including diarrhea, abdominal pain, facial flushing, asthma-like seizures and other carcinoid syndrome performance. All patients underwent appendectomy, and appendix NETs were diagnosed by pathology after surgery. In 40 appendical NETs patients, 15 cases were classified as stageⅠ(37.5%), 10 cases were classified as stageⅡA (25%), 2 cases were classified as stageⅢA (5%), 13 cases were classified at stageⅢB (32.5%), and no patients were classified as stageⅣ. The median survival times (months) were 27, 22, 21 and 18 for patients with different stages, and there were no significant differences in survival times between four stages (χ2=0.8988,P>0.05). Conclusion The clinical features of appendical NETs are nonspecific. The diagnosis of appendical NETs is based on pathological examination and immunohistochemistry. There are no correlation between different TNM stages and prognosis of patients.
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Objective To investigate the prognostic value of different stages of TNM in patients with appendiceal neuroendocrine tumors (NETs). Methods The clinical data of 40 cases of NETs were analyzed, and follow-up data were staged by the ENETS and AJCC TNM staging system. Kaplan-Miere survival curves were used to compare survival differences in patients with different stages of TNM. Results Of the 40 patients, no one was diagnosed as appendiceal NETs before surgery. Twenty-one patients were diagnosed as acute appendicitis, 16 were diagnosed as chronic appendicitis and 3 were suspected as appendiceal tumors due to thickening of the lumen before surgery. No clinical manifestations were found in 40 patients before surgery including diarrhea, abdominal pain, facial flushing, asthma-like seizures and other carcinoid syndrome performance. All patients underwent appendectomy, and appendix NETs were diagnosed by pathology after surgery. In 40 appendical NETs patients, 15 cases were classified as stageⅠ(37.5%), 10 cases were classified as stageⅡA (25%), 2 cases were classified as stageⅢA (5%), 13 cases were classified at stageⅢB (32.5%), and no patients were classified as stageⅣ. The median survival times (months) were 27, 22, 21 and 18 for patients with different stages, and there were no significant differences in survival times between four stages (χ2=0.8988,P>0.05). Conclusion The clinical features of appendical NETs are nonspecific. The diagnosis of appendical NETs is based on pathological examination and immunohistochemistry. There are no correlation between different TNM stages and prognosis of patients.
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Objective To investigate the expression levels and clinical significance of programmed cell death 1 ligand (PD-L1) and programmed cell death factor-1 (PD-1) in peripheral T-cell lymphoma (PTCL). Methods Immunohistochem?istry was used to detect expression levels of PD-L1 and PD-1 in PTCL (test group, n=51) and benign proliferative lesions of lymph node tissues (control group, n=20). The correlations of PD-L1 and PD-1 expressions with clinical pathological param?eters and prognosis were analyzed between two groups. Results The expression level of PD-L1 was significantly higher in PTCL group than that in control group (74.51%vs 35.00%,χ2=9.662, P<0.05). The positive expression of PD-1 was signifi?cantly higher in PTCL group than that in control group (66.67%vs 25.00%,χ2=10.074, P<0.05). There were significant dif?ferences in PD-L1 and PD-1 expressions between different peripheral lactate dehydrogenase (LDH) levels of PTCL group (P<0.05). After two cycles of CHOP or ECHOP treatments, the response rate (RR) was higher in PD-L1 negative group than that in positive group (84.6%vs 47.4%,χ2=5.478, P<0.05), and RR was higher in PD-1 negative group than that in positive group(82.4%vs 44.1%,χ2=6.755, P<0.05). The median overall survival (OS) time was higher in PD-L1 negative group than that in positive group (29.8 months vs 17.6 months,χ2=4.413, P<0.05) and the median OS time was higher in PD-1 negative group than that in positive group (29.8 months vs 17.6 months,χ2=8.293, P<0.05). Conclusion There are high expression levels of PD-L1 and PD-1 in peripheral T-cell lymphoma, which is closely related with the elevated LDH in peripheral blood, poor response rate and shorter OS. Therefore, the expression levels of PD-L1 and PD-1 can be used as factors of worse effect of chemotherapy and poor prognosis.
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Objective To explore the efficiency of postoperative individualized chemotherapy based on genetic testing results for non-small cell lung cancer (NSCLC). Methods Fifty-six NSCLC patients at stageⅡorⅢA who accepted video-assisted thoracic operation were divided into two groups:the individualized chemotherapy group (n=26) and non individual?ized chemotherapy group (n=30). The fresh lung tumor tissue of individualized chemotherapy group was tested target gene,in?cluding excision repair cross complementing 1 (ERCC1),ribonucleotide reductase subunit M1 (RRM1),β-tubulinⅢ,thymi?dylate synthase(TS),epidermal growth factor receptor (EGFR) and breast cancer gene 1 (BRCA1). The theraputic plan was based on genetic testing results in individualized chemotherapy group, and the non individualized chemotherapy group re?ceiving gemcitabine plus cisplatin. The 1-year disease free survival (DFS), 2-year disease free survival (DFS), the progres?sion-free survival (PFS) and the overall survival (OS) were compared between two groups. Results The 2-year DFS (57.69%), PFS (22.1 ± 5.0 months) and OS (24.1 ± 3.2 months) were significantly higher in the individualized chemotherapy group than those of non individualized chemotherapy group (respectively 30.00%, 18.9 ± 6.2 months, 21.9 ± 4.3 months, P<0.05). There was no significant difference in 1-year DFS between two groups (88.46%vs 83.33%, P<0.05). Conclusion The individualized chemotherapy based on genetic testing results can enhance the 2-year DFS, PFS, OS and the efficiency of postoperative adjuvant chemotherapy for NSCLC.
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Objective To investigate the expressions of RhoB and E-cadherin in non-small-cell lung cancer (NSCLC), and their clinical significances thereof. Methods Immunohistochemical staining was applied to detect expres-sions of RhoB and E-cadherin in 116 samples of NSCLC (NSCLC group) and 116 samples of normal lung tissues (control group). Correlations of expressions of RhoB and E-cadherin to clinical pathological parameters and prognosis were analyzed in two groups. Results The expression intensities of RhoB and E-cadherin were significantly lower in NSCLC group than those in control group (57.76%vs 87.07%,54.31%vs 85.34%,P＜0.01). There were significant differences in the expres-sion of RhoB between different pathological types, differentiation and lymph node metastasis in NSCLC group. There were significant differences in the expression of E-cadherin between different TNM stages, differentiation and lymph node metas-tasis in NSCLC group. The expression of RhoB was positively correlated with the expression of E-cadherin ( r=0.503,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of RhoB (83.93%) than those in pa-tients with low expression of RhoB (40.00%, Log-rank χ2=18.992,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of E-cadherin (85.11%) than those in patients with low expression of E-cadherin (44.93%, Log-rankχ2=16.680,P＜0.01). Further multivariate analysis suggested that both lower expressions of RhoB and E-cadherin and lymph node metastasis were prognostic indicators for NSCLC (P＜0.001). Conclusion The expressions of RhoB and E-cadherin showed a good correlation in NSCLC. Detecting the expression of RhoB combined with E-cadherin may give a clue on clinicopathological features and prognosis in patients with NSCLC.
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Objective To investigate the expression and prognostic significance of inhibitor of growth 4 (ING4) and tail-type homeobox transcription factor 2 (CDX2) in colorectal cancer. Methods The expressions of ING4 and CDX2 pro-teins were detected by immunohistochemistry in 99 tissue samples of colorectal cancer and 30 corresponding para-cancer-ous normal tissue samples. The data of clinic outcomes were collected. The correlations between the expressions of ING 4 and CDX2 and clinicopathological parameters were also analyzed. Results The positive expression rates of ING4 and CDX2 were 68.8%and 72.7%in colorectal cancer tissues, which were significantly lower than those of corresponding normal tissue samples (93.3% and 96.7%, P<0.05). There were significant differences in the differentiation, depth of invasion, lymph node metastasis and tumor stage between expressions of ING4 and CDX2 (P<0.05). The 5-year survival rate was significant-ly lower in ING4 negative group (35.5%) compared with that of ING4 positive group (77.9%). The 5-year survival rate was significantly lower in CDX2 negative group (48.1%) than that of CDX2 positive group (70.8%, P<0.05). The expression of ING4 was positively correlated with the expression of CDX2 in colorectal cancer. Conclusion The expressions of ING4 and CDX2 are strongly associated with the carcinogenesis, development and prognosis of the colorectal cancer,which suggests that ING4 and CDX2 might be used as prognostic markers for the colorectal cancer.
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Objective:To describe the clinical characteristics , overall survival as well as to evaluate the prognostic factors in Chinese diffuse large B cell lymphoma ( DLBCL) patients.Methods: DLBCL pa-tients who were initially diagnosed and treated in Peking University Cancer Hospital from January 1995 to December 2008 were identified and analyzed ,retrospectively .The 5-year OS rates were estimated with Ka-plan-Meier.Log-rank test was used to compare the survival curves of the different groups .The multivari-ate analysis of prognostic factors was conducted with Cox regression model , which included all statistically significant prognostic factors in the univariate analyses .Results:A total of 525 DLBCL patients were in-cluded in this retrospective analysis , of whom , 294 were male and 231 female ( male∶female=1 .27∶1 ) . The median age at the initial diagnosis was 55 (range 16-90) years, and 37.0% (n=194) were 60 years and above .Regarding the clinical staging at the initial diagnosis , 54 patients (10.3%) were diag-nosed as Stage Ⅰ of the disease, 152 (28.9%) as Stage Ⅱ, 117 (22.3%) as Stage Ⅲ and 202 (38.5%) as Stage Ⅳ.The ‘B symptoms’ and increased serum LDH were presented in 206 (39.2%) and 192 (36.6%) patients, respectively.A total of 197 (37.5%) patients were treated with rituximab (R).The survival follow-up continued till 31 January 2014 with a median follow-up time of 77.5 ( range:0-205) months.A total of 267 patients (50.9%) died during the follow-up period.The medi-al overall survival ( OS) time was 84 months, and 5-year OS rate was 52.3%.There were six statistically significant prognostic factors that were identified in both univariate and multivariate analyses : gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .The relative risk ( RR) of these prognostic factors in the multivariate analyses were: age >60 years /≤60 years=1.380 (95%CI 1.078 -1.765), male /female =1.315 (95%CI 1.025 -1.687), stage Ⅲ/stageⅠ=3.034(95%CI 1.667-5.522), stage Ⅳ/Ⅰ=3.748(95%CI 2.102 -6.681), with B symp-toms/without B symptoms=1.278(95%CI 0.999-1.636),serum LDH increased/LDH not increased=1.351(95%CI 1.057 -1.726), without R treatment /with R treatment =1.543(95%CI 1.182 -2 .015 ) .Compared with the IPI , age >50 years/≤50 years was a statistically significant factor in both univariate and multivariate analyses RR =1.478 (95%CI 1.148-1.902), P=0.002.Conclusion:Six factors were related to DLBCL survival:gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .Compared with the IPI , several specific factors may predict a poor prognosis in Chinese DLBCL patients:male , age>50 years and the presence of ‘B symptoms ’ .But this result is not conclusive until these factors are further tested .
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Objective To assess the factors affecting survival of malignant pheochromocytoma/malignant paraganglioma.Methods The clinical data of 85 malignant pheochromocytoma/malignant paraganglioma patients were analyzed retrospectively.All the patients were followed up,the duration from 2 months to 283 months,the median time was 48 months.The overall survivals of 5 years and 10 years were calculated.The possible affecting factors,such as gender,age,tumor function,metastatic sites,metastatic fields,incipience or recurrence,the time to recur,were analyzed.Survival differences between groups were compared with the log rank test.Multivariate analysis was performed by using Cox regression analysis to detect variables independently associated with survival.All P values were 2 tailed with P ＜ 0.05 considered statistically significant.All statistical analysis was done by SPSS 17.0 software package.Results The overall median survival time was 62 months,5-year survival rate was 44.7％,10-year survival rate was 11.8％.Gender (P =0.649),age (P =0.228),incipience or recurrence (P =0.217) had no significant effect on the survival time.Significance was found in tumor function (P =0.034),metastatic sites,metastatic fields (P =0.009),the time to recur (P =0.003).The median survival time of patients with nonfunctioning tumor and functioning tumor was 90 months and 37 months.The median survival time of patients with multiple system metastases and single system metastasis was 37 months and 117 months.For the patients with single system invaded,there were 15 cases (26.8％) of bone metastasis,10 cases (17.9％) of lymph node metastasis,8 (14.3％) of liver metastasis,7 (12.5％) of lung metastasis,6 (10.7％) of renal metastasis,6 (10.7％) of intestine metastasis and 4 (7.1％) of brain metastasis.The median survival time was 110,77,28,14,26,8 and 19 months.The median survival time of patients with lung,liver,intestine metastasis were shorter than the other patients (P ＜ 0.05).Fifty-five patients were found recurrence after operation,recurrent time was from 4 to 65 months,and the median time was 22 months.The survival time of patients with recurrence within 2 years was shorter than patients above 2 years (P =0.003).Conclusions The prognosis of malignant pheochromocytoma/malignant paraganglioma is poor.Gender,age,incipience or recurrence could not affect the overall survival time.The survival time has relationship with the function of tumor,metastatic field,metastatic sites and time to recurrence.The patients with nonfunctioning tumor have longer survival time than those with functioning tumors.The survival time of patients with single system invaded is longer than ones with multiple systems invaded.The common metastatic sites are bone,lymph node,liver,lung,kidney,intestine and brain.Patients with intestine metastasis have worst prognosis.The patients with only bone and lymph node metastasis have best prognosis.Patients with recurrence above 2 years have a better prognosis than those within 2 years.
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Objective: To retrospectively investigate the relationship between plasma concentration of fluorouracil and its therapeutic efficacy as well as adverse reactions in 70 patients with locally advanced or metastatic gastric cancer, and to determine the role of pharmacokinetic monitoring of fluorouracil in improvement of efficacy and reduction of adverse reactions of fluorouracil-based chemotherapy. Methods: Seventy patients with unresectable locally advanced or metastatic gastric cancer were randomly assigned into group A [treated with DCF regimen (docetaxol+cisplatin+fluorouracil), repeated every three weeksfor at least four cycles] and group B [treated with DOF regimen (docetaxol+oxaliplatin+fluorouracil), repeated every three weeks for at least four cycles]. The plasma concentration of fluorouracil was detected by high performance liquid chromatography (HPLC) (time for detection: 4-6 AM) after continuous infusion of fluorouracil over 12 h in each cycle. The average value of plasma concentrations in each cycle was calculated, and the factors related to plasma concentration of fluorouracil were screened by stepwise regression. Then all patients were divided into three groups (group 1, group 2 and group 3) according to the predictive confidence interval of plasma fluorouracil concentration, and the average values of plasma fluorouracil concentration in each cycle of these three groups were less than or equal to 25.5 mg/L25.6-37.4 mg/L, and more than 37.4 mg/L, respectively. The relationship between plasma concentration of fluorouracil and its therapeutic efficacy as well as adverse reactions was retrospectively analyzed. Results: Stepwise regression analysis showed that the plasma concentration of fluorouracil was associated with myelosuppression, mucositis, progression-free survival (PFS) and overall survival (OS). The average plasma concentrations of fluorouracil in group 1, group 2 and group 3 were (20.73±3.80) mg/L, (31.98±3.10) mg/L and (40.32±3.45) mg/L, respectively (χ2=66.24, P <0.001). As for efficacy, the medianPFS and OS of group 2 and group 3 were both significantly higher than those of group 1 [PFS: (6.00±0.32), (7.50±0.75) and (4.50±0.19) months, χ2=2.09, P <0.001; O S: (13.00±1.58), (12.50±2.66) and (8.50±1.00) months, χ2=32.32, P <0.001]. In terms of adverse reactions, the incidence rates of bone marrow suppression and mucositis of group 3 were both higher than those of group 1 and group 2 (P =0.04 and P =0.03). Conclusion: The patients with advanced gastric cancer receiving fluorouracil-based chemotherapy with an average plasma concentration of fluorouracil maintained within the range of 25.6-37.4 mg/L can obtain better survival and tolerance as well as lower incidence rates of adverse reactions such as myelosuppression (especially III/IV), mucositis, etc. Copyright© 2011 by TUMOR.
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To investigate association between prognosis of patients of peritoneal dialysis with their initial high peritoneal solute transport and complications. Two hundred and two patients with end-stage renal disease who began peritoneal dialysis during September 1,2006 to September 1, 2008 at Peking University Third Hospital, Beijing were recruited in the study. They were undergone peritoneal equilibration test within six weeks after initiating peritoneal dialysis, and their types of peritoneal solute transport, complications,nutrition status and outcomes were all recorded until August 31,2010. Their survival rate was estimated by Kaplan-Meier method. Compare to those with other types of solute transport, patients with high peritoneal solute transport showed higher proportion of complications ( P < 0. 05 ) during dialysis, but less ultrafiltration function ( P < 0. 05 ), worse nutrition status ( P < 0. 05 ) and lower cumulative survival rate ( P < 0. 01 ).Among patients with high peritoneal solute transport, cumulative survival rate in those with complication was lower than those without it ( P = 0. 031 ). Prognosis of patients with high peritoneal solute transport possibly varies with their complications in dialysis.
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ObjectiveTo evaluate prognosis and its clinical factors in patients with primary pontine hemorrhage. Methods Patients with primary pontine hemorrhage who were hospitalized in the First Affiliated Hospital of Wenzhou Medical College within 24 hours after stroke onset between April 2007 and April 2009 were registered conscutively. The patients were followed up for one year. Kaplan-Meier methods were used to analyze survival rate. Cox proportional hazards model was used to study risk factors for 1-year mortality. ResultsA total of 41 patients with primary pontine hemorrhage were studied. Their mean age was (63.5 ± 10. 1 ) years.The overall 1-year mortality rate was 61.0％, the median survival time was (80. 0 ±54.4) days (95％ CI 0-186. 64). After one-year follow-up, the mortality rate in patients with primary dorsal pontine hemorrhage( 18.2％ ) was significantly lower than that in patients with primary ventral pontine hemorrhage(72. 7％ ; x2 = 8. 800, P = 0. 003 ). Patients with massive primary pontine hemorrhage had significantly higher mortality rate than patients with dorsal primary pontine hemorrhage( x2 = 8. 927, P =0. 003). The average hematoma volume of the survivor group and mortality group was (3. 043 ± 1. 718) ml and (5. 984 ± 2. 707) ml, respectively, showing statistical significance (t = 3. 661, P = 0. 001 ). Analysis with Cox proportional hazards model showed that the risk factors associated with mortality were hematoma location ( RR = 2. 428, 95 ％ CI 1. 055-5. 587 ), hematoma volume ( RR = 1. 283, 95 ％ CI 1. 044-1. 577 ),GCS score on admission(RR =3. 389, 95％ CI 1. 177-9. 756). Patients with pontine hematomas in dorsal had a significantly better outcome than in other locations.Conclusions The survival and prognosis in primary dorsal pontine hemorrhage are better than with hemorrhaging in other parts of pontine. A significant correlation was observed between poor prognosis and hematoma volume, hematoma location and GCS score on admission.
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Objective To study clinical manifestations, diagnosis, treatment, as well as effect of surgical operation, of primary mediastinal large B-cell lymphoma (PMBCL).Methods Data of 19 patients of PMBCL with complete clinical and pathological records hospitalized at Peking Union Medical College Hospital during 1998 to 2008 were retrospectively reviewed and analyzed.Kaplan-Meier method was used to estimate their survival time and survival rate in comparison of efficacy in those with surgical operation to those without it.Results Overall three-year survival rate was 54% for all the 19 patients, 55% for those with surgical operation and 54% without it, respectively, with an average survival time of 44 months, 44 months for those with surgical operation and 42 months without it, respectively, but not reaching at statistical significance.Symptoms of superior vena cava syndrome in five cases at admission relieved immediately after surgical operation, but symptoms of superior vena cava syndrome in three of nine cases in non-surgical group relieved gradually one to three weeks after chemotherapy.Conclusions Surgical operation has no significant effect on survival in patients with PMBCL, but it can relieve syndrome of superior vena cava syndrome and provide accurate pathological diagnosis.