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Objective To investigate the value of different immune and inflammatory indices in predicting the survival outcome of patients with intrahepatic cholangiocarcinoma (ICC) after curative-intent resection. Methods A retrospective analysis was performed for the case data of 122 patients with ICC who underwent curative-intent resection in Affiliated Hospital of Weifang Medical University and Tianjin Medical University Cancer Institute and Hospital from January 2012 to December 2017 to analyze the correlation of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic inflammation index (PII), inflammation score (IS), and systemic inflammation score (SIS) with the disease-free survival (DFS) and overall survival of ICC patients after surgery, and the value of the above indices in predicting prognosis was evaluated. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison between groups; the Cox regression model was used for univariate and multivariate analyses, and hazard ratio ( HR ) and 95% confidence interval [ CI ] were calculated. Results The univariate survival analysis showed that NLR ( HR =2.212, P =0.004), LMR ( HR =0.403, P =0.012), PII ( HR =3.013, P < 0.001), prognostic nutritional index (PNI) ( HR =0.530, P =0.019), IS ( HR =1.809, P =0.001), SII ( HR =2.107, P =0.002), and SIS ( HR =2.225, P < 0.001) were predictive factors for postoperative DFS of patients with ICC, and NLR ( HR =2.416, P =0.009), LMR ( HR =0.297, P =0.008), PII ( HR =3.288, P < 0.001), PNI ( HR =0.292, P =0.003), IS ( HR =2.048, P =0.002), SII ( HR =1.839, P =0.049), and SIS ( HR =2.335, P < 0.001) were predictive factors for postoperative OS of patients with ICC. The multivariate survival analysis showed that high levels of PII ( HR =2.146, P =0.035) and SIS ( HR =2.511, P < 0.001) were independent influencing factors for postoperative DFS of ICC patients, and high levels of PII ( HR =2.981, P =0.009), PNI ( HR =0.261, P =0.002), and SIS ( HR =2.294, P =0.010) were independent influencing factors for postoperative OS. The patients with a high level of PII tended to have advanced tumor T stage ( χ 2 =8.777, P =0.003) and M stage ( P =0.029), and the patients with high-grade SIS tended to have advanced N stage ( χ 2 =9.985, P =0.030) and M stage ( χ 2 =8.574, P =0.012). Conclusion Among the various inflammation indices, PII and SIS are recommended for preoperative stratification and prediction of the outcome of ICC patients after curative-intent resection.
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Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius ( AO types B and C ) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67. 9 ± 10. 7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66. 2 ± 11. 5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complica-tions. Results There was no significant difference between the 2 groups in follow-up time ( P > 0. 05 ) . Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85. 0％ while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57. 7％. A significant difference was shown between the 2 groups ( P <0. 05 ) . At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score ( 2. 16 ± 1. 82 ) and complication rate ( 30. 0％, 6/20 ) than the nonoperative group [ 6. 62 ± 3. 78 and 53. 8％( 14/26 ) , respectively ] ( P <0. 05 ) . Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoper-ative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen.