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Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.
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BACKGROUND: Chemotherapy, local radiotherapy, autologous peripheral blood stem cell transplantation and cellular immunotherapy are the treatment options for lymphoma. High-dose chemotherapy combined with autologous hematopoietic stem cell transplantation can significantly prolong the survival time and improve the prognosis of patients. It is recommended as the first-line treatment for relapsed refractory and (or) highly invasive lymphoma. OBJECTIVE: To explore the influencing factors of high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation in lymphoma. METHODS: The clinical records of 74 lymphoma patients after high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation in Transplantation Ward, Department of Hematology, West District of The First Affiliated Hospital of University of Science and Technology of China from October 2015 to March 2020 were collected and analyzed retrospectively to evaluate efficacy and prognostic factors of autologous hematopoietic stem cell transplantation for lymphoma. RESULTS AND CONCLUSION: (1) The follow-up period was up to May 15, 2020. The median time from diagnosis to transplantation was 8(3-83) months, and the median follow-up time was 17(2-59) months. (2) All patients obtained hematopoietic reconstruction after transplantation. The median time for granulocyte implantation was +10(+8-+17) days, and the median time for platelet implantation was +12(+9-+22) days. (3) There were 60 cases of progression-free survival after transplantation, 13 cases of recurrence, 11 of the relapsed patients died, and 1 died of lung infection 11 months after transplantation. (4) All four patients with progression disease before transplantation died within 7 months after transplantation due to the progression of the primary disease. (5) The 2-year overall survival rate after receiving autologous hematopoietic stem cell transplantation was 78.5%; the 2-year progression-free survival rate was 75.8%. Patients with international prognostic index ≤ 2 points before transplantation and international prognostic index > 2 points had 93.9% and 66.4% overall survival at 2 years after transplantation (P=0.003); progression-free survival rates at 2 years were 85.6% and 65.5% (P=0.017), respectively. (6) The two-year overall survival rates of patients with bone marrow invasion and no bone marrow invasion before transplantation were 55.5% and 91.9% (P=0.001) respectively. The 2-year progression-free survival rates were 53.1% and 88.7% (P < 0.001), respectively. (7) The 2-year overall survival rate of patients in clinical staging (stages I and II) was better than that in clinical staging (stages III and IV) (100% vs. 82.5%, P=0.026). The 2-year progression-free survival rate of first-line consolidation patients was better than that of rescue group (84% vs. 48.9%, P=0.01). There was no statistically significant difference in the effects of patient age and degree of remission before transplantation on progression-free survival and overall survival. (8) Results found that high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation could significantly improve the survival and prognosis of patients with lymphoma, and had high safety. It can be used as a safe and effective treatment for lymphoma. International prognostic index score, the presence or absence of bone marrow invasion, the timing of transplantation, and the stage of primary disease are relative to the prognosis of involved patients.
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Objective To investingate the effect of SGK1 expression level on the prognosis of patients with NSCLC,and provide new biological predictors for the prognosis assessment of patients with NSCLS.Methods One hundred and twenty patients with NSCLC received radical resection in Hanzhong 3201 hospital from Jan 2011 to Dec 2013 were selected.There were 75 males and 45 females,age (63.15 ± 16.44) years,age range 45-80 years.According to the results of immunohistochemical staining,the SGK1 cut-off value determined by the integral was determined,and NSCLC patients were divided into SGK1 high expression group (n =70) and SGK1 low expression group(n =50).The relationship between the expression of SGK1 and clinicopathological features (age,sex,smoking history,alcoholism history,BMI,tissue type,tumor diameter,T stage,N stage,TNM stage,differentiation degree) in NSCLC were analyzed,and the overall survival rate in NSCLC were also analyzed.Followup was carried out by telephone or patient admission.The follow-up period was up to June 1,2018.Chest X-ray and ultrasonography were reviewed every 3 to 6 months after operation,and enhanced CT or MRI were performed if the results were abnormal.The measurement data conforming to normal distribution were expressed by t test and showed by (Mean ± SD);the counting data were tested by x2 test;the 5-year overall survival rate was used as the endpoint event for univariate analysis,and the significant variables for univariate analysis were analyzed by COX risk ratio model for multivariate analysis.The cumulative survival curve was drawn by Kaplan-Meier method,and the difference was tested by Log-rank method.Results The expression level of SGK1 in tissues was not related to age,sex,smoking history,alcoholism,BMI,tissue type and tumor diameter (P ＞ 0.05),but it was related to T stage,N stage,TNM stage and differentiation degree (P ＜ 0.05).The univariate and multivariate COX risk ratio model showed that TNM stage and SGK1 expression were independent factors affecting the 5-year overall survival rate of NSCLC patients (P ＜ 0.05).The results of Kaplan-Meier survival curve showed that the 5-year overall survival rate in NSCLC with low expression of SGK1 was significantly higher than that in NSCLC with high expression of SGK1 (P ＜ 0.05).Conclusions The expression of SGK1 in tissues is closely related to the prognosis of patients with NSCLC.The high expression of SGK1 in tissues is not conducive to the prognosis of patients with NSCLC.
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Objective To compare the clinical features and surgical outcomes of hepatocellular carcinoma (HCC) combined with portal venous tumor thrombus (PVTT) and hepatic venous tumor thrombus (HVTT) or bile duct tumor thrombi (BDTT),and analyze the effects of different tumor thrombus (TT) types and different surgical methods for TT on prognosis.Methods The retrospective cross-sectional study was conducted.The clinical data of 220 HCC patients with lymphovascular invasion (LVI) who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University between January 2004 and December 2014 were collected.Of 220 patients,140 were combined with PVTT,36 with HVTT and 44 with BDTT.According to patients' conditions,they underwent tumor and TT resection,and tumor resection + TT removal or single TT removal.Observation indicators:(1) comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT;(2) surgical and postoperative situations;(3) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2015.Measurement data with normal distribution were represented as (x)±s.Comparisons among 3 indicators were analyzed using the one-way ANOVA,and comparisons between 2 indicators were analyzed using the t test.Comparisons of count data were analyzed using the chi-square test.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Results (1) Comparisons of clinical features of HCC patients with PVTT or HVTT or BDTT:number of patients with Child-pugh A,Child-pugh B and peritoneal effusion,tumor diameter and cases with tumor capsule were respectively detected in 133,7,23,(10±4)cm,91 in HCC patients with PVTT and 35,1,4,(9±4)cm,27 in HCC patients with HVTT and 35,9,16,(6±4)cm,15 in HCC patients with BDTT,with statistically significant differences (x2 =12.693,10.408,F=11.300,x2 =17.188,P＜ 0.05).(2) Surgical and postoperative situations:of 140 HCC patients with PVTT,51 underwent tumor and PVTT resection,89 underwent tumor resection + PVTT removal through incising portal vein;68 received postoperative transcatheter arterial chemoembolization (TACE).Thirty-six HCC patients with HVTT underwent tumor and HVTT resection;24 received postoperative TACE.Of 44 HCC patients with BDTT,23 underwent tumor and BDTT resection,21 underwent tumor resection + BDTT removal through incising common bile duct;29 received postoperative TACE.(3) Follow-up and survival:① 220 patients were followed up for 1-73 months,with a median time of 12 months.The median survival time,1-,3-and 5-year survival rates were respectively 12 months,48.2％,25.0％,15.4％ in 140 HCC patients with PVTT and 28 months,77.1％,45.6％,24.5％ in 36 HCC patients with HVTT and 36 months,88.6％,48.3％,24.6％ in 44 HCC patients with BDTT,with a statistically significant difference in survival (x2 =13.316,P＜0.05).② Of 140 HCC patients with PVTT,49 were in type Ⅰ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 20 months,60.3％,32.6％ and 17.1％;70 were in type Ⅱ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 13 months,51.4％,26.0％ and 17.3％;21 were in type Ⅲ PVTT,and median survival time,1-,3-and 5-year survival rates were respectively 7 months,9.5％,4.8％ and 0,showing a statistically significant difference in survival (x2=18.102,P＜0.05).The median survival time,1-,3-and 5-year survival rates were respectively 21 months,72.5％,42.5％,26.2％ in 51 patients undergoing tumor and TT resection and 9 months,40％,14.4％,0 in 89 patients undergoing tumor resection + PVTT removal through incising portal vein,showing a statistically significant difference in survival (x2=24.098,P＜0.05).③ Of 36 HCC patients with HVTT,17 were detected in right HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 14 months,64.7％,20.2％ and 0;10 were detected in left HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 53 months,80.0％,70.0％ and 38.9％;9 were detected in middle HVTT,and median survival time,1-,3-and 5-year survival rates were respectively 40 months,88.9％,61.0％ and 30.5％;showing no statistically significant difference in survival (x2 =5.951,P＞0.05).④ Of 44 HCC patients with BDTT,24,6 and 14 were respectively detected in type Ⅰ,Ⅱ and Ⅲ BDTTs,and median survival time,1-,3-and 5-year survival rates were respectively 38 months,87.5％,60.4％,34.9％ in type Ⅰ BDTT patients and 26 months,83.3％,16.7％,0 in type Ⅱ BDTT patients and 35 months,78.6％,50.0％,21.4％ in type Ⅲ BDTT patients,showing no statistically significant difference in survival (x2 =5.312,P＞0.05).Of 44 patients,median survival time,1-,3-and 5-year survival rates were respectively 38 months,91.3％,59.5％,34.3％ in 23 patients undergoing tumor and TT resection and 26 months,85.7％,35.7％,15.3％ in 21 patients undergoing tumor resection + TT removal through incising common bile duct,showing no statistically significant difference in survival (x2 =2.071,P＞0.05).Conclusions HCC patients with PVTT have larger tumor diameter and worse liver dysfunction,and are prone to peritoneal effusion.HCC patients with different LVI undergo surgery.There is better prognosis in HCC patients with BDTT,and good prognosis in patients with HVTT,while poorer prognosis in patients with PVTT.The postoperative survival of HCC patients with PVTT is associated with TT type,and patients will have better prognosis after tumor resection + TT removal if TT type is confirmed earlier.The postoperative survival of HCC patients with BDTT is not associated with TT type,tumor resection + TT removal maybe prolong postoperative survival time.
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Objective To study the clinical features and prognostic analysis of 36 children with relapsed acute lymphoblastic leukemia(ALL)treated with the ALL 2006 protocol.Methods The data of 308 children who were new-ly diagnosed as ALL at the Department of Pediatric Hematology,Tongji Hospital,Tongji Medical College,Huazhong Uni-versity of Science Technology treated with the ALL 2006 protocol between January 2007 and December 2012 were col-lected,and the clinical features and prognosis of 36 children with relapsed ALL were retrospectively analyzed.The date included initial treatment time,age,gender,immunophenotyping,the white blood cell count,the risk classification,the chromosome,the fusion gene(29 kinds of fusion genes including MLL rearrangement,BCR/ABL,E2A/PBX1,TEL/AML1)in relapsed patients with ALL on the initial diagnosis and recurrence time,recurrence site,as well as whether to get second complete remission(CR2),follow-up time,follow-up deadline condition.Results After treatment with ALL 2006 protocol,the recurrence rate was 11.7%(36/308 cases);the 3 years overall survival rate was(38.0 ± 9.0)%.The recurrence happened almost in the very early stage,about 75.0%(27/36 cases),and the recurrence rate of the early stage and the late stage patients was 16.7%(16/36 cases)and 8.3%(3/36 cases),respectively.The re-lapsed sites were mainly in the bone marrow alone(66.7%,24/36 cases),and the extramedullary recurrence and the combination of bone marrow with extramedullary recurrence was 16.7%(6/36 cases).The 3-year OS was(16.4 ± 8.0)% and(80.0 ± 18.0)% for those relapsed in the very early stage and early stage,respectively(P=0.002).The 3-year OS of the high-risk,medium-risk relapsed patients were(21.0 ± 11.0)%,(51.9 ± 16.0)% and(64.3 ± 21.0)%(P=0.022).Conclusions After the treatment with ALL 2006 protocol,the patients with recurrence were almost at the very early stage.The relapsed sites were mainly in bone marrow alone.The factor associated with survival time of children with relapsed ALL is the relapse at the very early stage.
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Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute & Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors (age,gender) and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup (≤ 1 risk factor) and high-risk subgroup (≥ 2 risk factors).In low-risk subgroup,1,3 and 5-year overall survival (OS) rates were 91.6％,65.5％,61.9％ respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4％,25.6％,10.8％ respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2％,54.9％,48.0％ respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.
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Objective To explore the clinical treatment of patients with stage Ⅲ carcinoma of colon and rectum by tegafur chemotherapeutic drugs combined with standardized adjuvant therapy. Methods The data of 60 cases of carcinoma of colon and rectum treated in Wenzhou Central hospital from January 2013 to December 2015 were collected. The patients were divided into three groups, non standardized adjuvant treatment group of 18 cases, standardized adjuvant treatment group of 15 cases and tegafur drug combined with standardized treatment group of 27 cases. Recorded and compared the survival rate of the three groups within three years, the statistics of each group of disease-free survival (DFS) and overall survival rate (OS). According to the duration of treatment group, the use of oxaliplatin combined with 5-fluorouracil and leucovorin (FOLFOX) treatment, analyzed and recorded OS and DFS. Follow-up examinations were performed in patients who did not receive adjuvant therapy. Recorded and compared the OS and DFS of each group. Results Tegafur drug combined with standardized treatment group DFS and OS were significantly higher than the other two groups, the difference was statistically significant (P<0.05). In addition, when treated with FOLFOX regimen, the DFS and OS of group Ⅲ were significantly higher than those of groupⅠand groupⅡ, the difference was statistically significant (P<0.05). In the follow-up survey of three groups, the rates of recurrence and death in patients treated with tegafur drug combined with standardized treatment group were significantly lower than those in the non standardized adjuvant treatment group and the standardized adjuvant treatment group. Conclusion Tegafur combined with adjuvant therapy can significantly improve the standardization of the rate of carcinoma of colon and rectum and the rate of disease-free survival, it is suggested that doctors use chemotherapy combined with auxiliary standardized therapy, can significantly improve the survival of patients, and reduce the risk of disease recurrence rate.
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Reports of BRCA2 genetic mutations on the prognosis of familial breast cancer (BC) patients have been contradictory. True difference in survival, if it exists, would have important implications for genetic counseling and in treatment of hereditary BC. The purpose of this study was to compare overall survival rate (OSR) among BRCA2 mutation carriers, non-carriers and sporadic BC patients. We searched the PUBMED and EMBASE databases and retrieved 4529 articles using keywords that included breast cancer, BRCA, prognosis and survival. Nine articles were selected for systematic review and among them 6 were included in our meta-analysis. We used the fixed and random effect models to calculate the summary odds ratio (OR) and corresponding 95% confidence interval (CI). BRCA2 mutation carriers had significantly higher long-term OSR than non-carriers (OR=0.69 [95% CI=0.5-0.95]), while both short-term and long-term OSR of BRCA2 mutation carriers did not differ from those of patients with sporadic disease (OR=1.11 [95% CI=0.74-1.65]; 0.85 [95% CI=0.38-1.94], respectively). For BC-specific survival rate (BCSSR), BRCA2 mutation carriers had a similar BCSSR to the non-carriers (OR=0.61 [95% CI=0.28-1.34]). There was no significant difference in disease-free survival (DFS) between BRCA2 mutation carriers and patients with sporadic disease. Our results suggest that BRCA2 mutation increases long-term OSR in hereditary BC, which reminds us a new prospect of management of the disease.
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Female , Humans , BRCA2 Protein , Genetics , Breast Neoplasms , Genetics , Mortality , Pathology , Gene Expression , Genetic Counseling , Genetic Predisposition to Disease , Mutation , Odds Ratio , Prognosis , Survival AnalysisABSTRACT
Objective To assess the efficacy of postoperative adjuvant interferon (IFN) therapy on patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC).Methods An electronic search for articles published from January 2000 to January 2013 was conducted to identify English language comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.Results A total of five trials consisting of 694 patients were included in the Meta-analysis.The estimated odds ratios (OR) for the 1-,2-,3-,and 5-year overall survival rates of HBV-related HCC were 3.37 (95％CI:1.18-6.27,P=0.000),2.36 (95％ CI:1.45-3.83,P=0.001),1.81 (95％ CI:1.21-2.72,P=0.004),and 1.93 (95％ CI:1.35-2.75,P=0.000),respectively.The OR for the 1-,2-,3-,and 5-year recurrence rates were 0.63 (95％ CI:0.44-0.91,P=0.014),0.84 (95％ CI:0.60-1.18,P=0.322),0.88 (95％ CI:0.63-1.22,P=0.431),and 0.78 (95％ CI:0.56-1.07,P=0.120),respectively.Conclusion This Meta-analysis shows that IFN therapy had a significant clinical effect in improving overall survival rates but not in decreasing recurrence rates of HBV infected HCC patients postoperatively.
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Objective: The effect of thymosin alpha 1 (Tα1) on patients with hepatocellular carcinoma (HCC) after radical hepatectomy was assessed. Methods: A total of 558 HCC patients treated by radical hepatectomy were retrospectively collected. Patients in the treatment group (n=146) received postoperative Tα1 therapy, whereas patients in the control group (n=412) did not. Propensity scale matching was conducted to improve the balance between the two groups. Changes in liver function, recurrence-free survival rates, and overall survival rates were compared between the two groups. Results: Postoperative liver function (i.e., TBIL, ALB, ALT, and PT) in the treatment group was significantly better than that in the control group (P<0.05). The one-, two-, and three-year recurrence-free survival rates and overall survival rates in the treatment group were significantly higher than those in the control group (P=0.019 and P=0.011, respectively). Conclusion:Postoperative Tα1 therapy can improve postoperative liver function, thus significantly prolonging recurrence-free survival and overall survival.
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PURPOSE: CD34 antigen is an early marker of hematopoietic progenitors. CD34 expression on leukemic cells might define peculiar characteristics of immaturity. The prognostic significance of CD34 antigen expression in acute lymphoblastic leukemias (ALL), especially in children, is still not well established. To evaluate the prognostic value of CD34 expression in childhood ALL, we compared the clinical features, laboratory findings and survival rates according to the presence of CD34 antigen in patients with ALL. METHODS: We conducted retrospective reviews in 38 children with ALL who were admitted to the Department of Pediatrics in Pusan National University Hospital between July 1994 and December 1999. We analyzed and compared the clinical features, laboratory findings and survival rates of CD34 ALL with those of CD34-ALL. RESULTS: CD34 antigen was expressed more on B-lineage ALL (71.9%) than T-lineage ALL (16.7%). There was no statistical differences in age, sex, clinical manifestations (eg, hepatomegaly, splenomegaly, CNS involvement) and initial laboratory findings. In B- lineage ALL, CD34 positive group had higher complete remission rate. CD34 antigen positive group had better overall survival rate than that of CD34 negative group both in ALL and B-lineage ALL, but there was no difference in disease free survival rate between two groups. CONCLUSION: It suggests that CD34 positivity in acute lymphoblastic leukemia could be prognostic value by demonstrating higher overall survival rate than that of CD34 negative group.