RESUMO
Objective: To evaluate the impact of perineural invasion (PNI) on the overall survival (OS) of patients with gastric cancer. Methods: A total of 1,007 patients with gastric cancer who underwent curative resection between January 2011 and December 2012 at the Cancer Institute and Hospital of Tianjin Medical University were enrolled. All the patients were categorized into the following two groups according to the status of PNI: positive group, presence of PNI; and negative group, absence of PNI. Potential prognostic factors and clinical pathological variables correlated with the presence of PNI were analyzed. Results: One hundred and twenty (11.9%) patients had PNI. Multivariate analysis revealed that histology, depth of invasion, and lymphovascular invasion were indepen-dently associated with the presence of PNI. Univariate survival analysis revealed that age, tumor location, Borrmann type, tumor size, curability, TNM stage, type of gastrectomy, tumor deposit, lymphovascular invasion, PNI, preoperative CA19-9 levels, and CEA levels were significant prognostic factors. Gastric cancer patients with PNI had a significantly lower 5-year OS rate than those without PNI (5-year OS: 38.3% versus 66.6%, P<0.001). In the multivariate analysis, age, Borrmann typeⅣ, TNM stage, curability, tumor deposit, and PNI were independent prognostic factors for this population cohort. The strata analysis revealed that PNI merely had a significant im-pact on OS in patients at stagesⅠ,Ⅱ, andⅢa. Conclusions: PNI is an independent prognostic factor in patients with gastric cancer and can be used as a prognostic indicator for gastric cancer patients at stagesⅠ,Ⅱ, andⅢa.
RESUMO
Objective@#To study the long-term prognosis of the convalescent patients with hepatitis B virus (HBV) associated acute-on-chronic liver failure (HBV-ACLF).@*Methods@#A 72-month follow-up study of HBV-ACLF recovery patients recruited between January 2005 and December 2009 was performed in our hospital. According to the results of imaging examination at the first visit, the enrolled patients were divided into two groups, the liver cirrhosis ACLF (Lc-ACLF) group and chronic hepatitis B related ACLF (CHB-ACLF) group. In both groups, the occurrence of cirrhosis, decompensated cirrhosis or ACLF and hepatocellular carcinoma (HCC) were observed.@*Results@#The media time of cirrhosis formation, decompensated cirrhosis and HCC occurrence in CHB-ACLF group were 12.5, 23 and 43 months, respectively. However, the median time of LC-ACLF patients developing to decompensated cirrhosis and HCC were 7 and 14 months, which was significantly shorter than that in CHB-ACLF group (P=0.009, 0.040, with statistical significance). Furthermore, the blood chemical parameters including serum albumin (ALB), cholinesterase (CHE) and total cholesterol (TC), triglyceride (TG), as well as platelet count (PLT), the anti-viral treatment compliance and the virus mutation were significantly related to the clinical endpoint events, respectively (P<0.05). Moreover, results from the logistic regression model demonstrated that the patient age, with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance were the independent risk factors for the long-term prognosis of patients with hepatitis B associated liver failure (OR=1.035, 0.510, 2.462, respectively. P< 0.05). The cumulative risk of Lc-ACLF patients progressed to decompensate cirrhosis, acute-on-chronic liver failure or HCC was significantly higher than that of CHB-ACLF patients (χ2=21.603, 4.423, P=0.000, 0.035, respectively).@*Conclusions@#Considering the importance of patients with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance in the long-term prognosis of HBV-ACLF patients, it is necessary and important to monitor the virus mutation and anti-viral treatment compliance of HBV- ACLF patients during antiviral therapy and those processes would benefit the improvement of long term prognosis of the patients with ACLF.