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Thyroidectomy as Treatment of Choice for Differentiated Thyroid Cancer 甲状腺切除术作为分化型甲状腺癌的治疗选择
IF 1.5 Q2 Medicine Pub Date : 2019-10-13 DOI: 10.1155/2019/2715260
D. Giuffrida, R. Giuffrida, I. Puliafito, V. Vella, L. Memeo, C. Puglisi, C. Regalbuto, G. Pellegriti, S. Forte, A. Belfiore
Background Despite a large amount of data, the optimal surgical management of differentiated thyroid cancer remains controversial. Current guidelines recommend total thyroidectomy if primary thyroid cancer is >4 cm, while for tumors that are between 1 and 4 cm in size, either a bilateral or a unilateral thyroidectomy may be appropriate as surgical treatment. In general, total thyroidectomy would seem to be preferable because subtotal resection can be correlated with a higher risk of local recurrences and cervical lymph node metastases; on the other hand, total thyroidectomy is associated with more complications. Methods This is a retrospective study conducted on 359 patients with differentiated thyroid cancer, subjected to total thyroidectomy. Our aim was to correlate clinical and pathological features (extrathyroid tumor growth, bilaterality, nodal and distant metastasis) with patient (gender and age) and tumor (size and histotype) characteristics. Moreover, we recorded postoperative complications, including hypoparathyroidism and laryngeal nerve damage. Results In our study, we found a high occurrence of pathological features indicating cancer aggressiveness (bilaterality, nodal metastases, and extrathyroid invasion). On the other hand, total thyroidectomy was associated with relatively low postsurgical complication rates. Conclusions Our data support the view that total thyroidectomy remains the first choice for the routine treatment of differentiated thyroid cancer.
背景尽管有大量的数据,分化型甲状腺癌的最佳手术治疗仍然存在争议。目前的指南建议,如果原发性甲状腺癌的大小为4cm,则应进行全甲状腺切除术,而对于大小在1 - 4cm之间的肿瘤,则可采用双侧或单侧甲状腺切除术作为手术治疗。总的来说,甲状腺全切除术似乎更可取,因为次全切除术可能与局部复发和颈部淋巴结转移的高风险相关;另一方面,全甲状腺切除术的并发症较多。方法对359例行甲状腺全切除术的分化型甲状腺癌患者进行回顾性研究。我们的目的是将临床和病理特征(甲状腺外肿瘤生长、双侧、淋巴结和远处转移)与患者(性别和年龄)和肿瘤(大小和组织型)特征联系起来。此外,我们还记录了术后并发症,包括甲状旁腺功能减退和喉神经损伤。结果在我们的研究中,我们发现高发生率的病理特征表明癌症的侵袭性(双侧,淋巴结转移和甲状腺外浸润)。另一方面,甲状腺全切除术的术后并发症发生率相对较低。结论甲状腺全切除术仍是分化型甲状腺癌常规治疗的首选。
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引用次数: 5
Postsurgical Ultrasound Evaluation of Patients with Prosthesis in Acellular Dermal Matrix: Results from Monocentric Experience 脱细胞真皮基质假体术后超声评价:单中心经验的结果
IF 1.5 Q2 Medicine Pub Date : 2019-06-16 DOI: 10.1155/2019/7437324
Ballesio Laura, Casinelli Alice, Gigli Silvia, Boldrini Cristiana, Di Taranto Giuseppe, Albano Antonio, Onesti Maria Giuseppina
Mastectomy and breast prosthetic reconstruction is the most common surgical treatment for women diagnosed with breast cancer. In the last few years, breast prosthetic augmentation in acellular dermal matrix (ADM) has been introduced. The aim of this study is to present our single-center experience in evaluating the outcome of patients who underwent breast reconstruction in ADM, using ultrasound (US) examination. US follow-up allows evaluating both normal postoperative findings and changes and potential local complications, demonstrating that ADM is a safe option for women candidates for mastectomy.
乳房切除术和乳房假体重建是诊断为乳腺癌的妇女最常见的手术治疗。在过去的几年里,在脱细胞真皮基质(ADM)隆胸假体已经被介绍。本研究的目的是通过超声(US)检查来评估ADM患者行乳房重建术的结果。美国随访可以评估正常的术后发现和变化以及潜在的局部并发症,证明ADM是女性乳房切除术候选人的安全选择。
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引用次数: 7
Prognostic Factors and Survival Time in Patients with Small Bowel Tumors: A Retrospective Observational Study. 小肠肿瘤患者的预后因素和生存时间:回顾性观察研究
IF 1.6 Q4 ONCOLOGY Pub Date : 2019-05-02 eCollection Date: 2019-01-01 DOI: 10.1155/2019/2912361
Shokouh Taghipour Zahir, Zahra Heidarymeybodi, Sogol AleSaeidi

This study examines survival time in patients with small bowel tumors and determines its contributing factors. In this retrospective analytical study, the medical records of 106 patients with small bowel cancer (from 2006 to 2011) were investigated. The patients' data were extracted, including age, gender, clinical presentation, location of tumor, histological type, grade of tumor, site of metastasis, and type of treatment. The Kaplan-Meier test was used to estimate the overall survival time and the Log-rank test to compare the survival curves. The Cox regression was also used to evaluate the effect of the confounding variables on survival time. This study was conducted on 106 patients with a median age of 60 years (Min: 7, Max: 87). The tumor types included adenocarcinoma (n=78, 73.6%), MALToma (n=22, 20.8%), neuroendocrine tumors (n=4, 3.8%), and sarcoma (n=2. 1.8%). Grade 3 adenocarcinomas had a significantly lower survival time (HR: 1.48, 95% CI: 0.46-2.86; P=.001). Combined therapy (chemotherapy and surgery) vs. single-therapy (only surgery) had no significant effects on the survival of the patients with MALToma (5 vs. 3 months, 95% CI: 1.89-5.26; P=.06). There were no significant differences between the survival time in adenocarcinoma and MALToma (12 vs. 20 months, 95% CI: 6.24-24.76; P=.49). Tumor grade was the only independent prognostic factor that affected survival in adenocarcinoma. The patients diagnosed with MALToma in the study also had a poor prognosis, and the type of treatment had no significant effect on their survival.

本研究探讨了小肠肿瘤患者的生存时间,并确定了其诱因。在这项回顾性分析研究中,研究人员调查了 106 名小肠癌患者(2006 年至 2011 年)的病历。研究提取了患者的数据,包括年龄、性别、临床表现、肿瘤位置、组织学类型、肿瘤分级、转移部位和治疗类型。用 Kaplan-Meier 检验估计总生存时间,用 Log-rank 检验比较生存曲线。此外,还使用 Cox 回归评估混杂变量对生存时间的影响。这项研究的对象为 106 名患者,中位年龄为 60 岁(最小:7 岁,最大:87 岁)。肿瘤类型包括腺癌(78 例,占 73.6%)、MALToma(22 例,占 20.8%)、神经内分泌肿瘤(4 例,占 3.8%)和肉瘤(2 例,占 1.8%)。3级腺癌的生存时间明显更短(HR:1.48,95% CI:0.46-2.86;P=.001)。联合疗法(化疗和手术)与单一疗法(仅手术)对MALToma患者的生存期没有显著影响(5个月与3个月,95% CI:1.89-5.26;P=.06)。腺癌和MALToma的生存期没有明显差异(12个月对20个月,95% CI:6.24-24.76;P=.49)。肿瘤分级是影响腺癌生存期的唯一独立预后因素。研究中被诊断为MALToma的患者预后也很差,治疗类型对其生存期没有显著影响。
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引用次数: 0
A Concise Review of Pelvic Radiation Therapy (RT) for Rectal Cancer with Synchronous Liver Metastases. 盆腔放疗(RT)治疗直肠癌伴同步肝转移的简要综述。
IF 1.5 Q2 Medicine Pub Date : 2019-04-21 eCollection Date: 2019-01-01 DOI: 10.1155/2019/5239042
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Bahar Dirican, Murat Beyzadeoglu

Background and objective: Colorectal cancer is a major health concern as a very common cancer and a leading cause of cancer-related mortality worldwide. The liver is a very common site of metastatic spread for colorectal cancers, and, while nearly half of the patients develop metastases during the course of their disease, synchronous liver metastases are detected in 15% to 25% of cases. There is no standardized treatment in this setting and no consensus exists on optimal sequencing of multimodality management for rectal cancer with synchronous liver metastases.

Methods: Herein, we review the use of pelvic radiation therapy (RT) as part of potentially curative or palliative management of rectal cancer with synchronous liver metastases.

Results: There is accumulating evidence on the utility of pelvic RT for facilitating subsequent surgery, improving local tumor control, and achieving palliation of symptoms in patients with stage IV rectal cancer. Introduction of superior imaging capabilities and contemporary RT approaches such as Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) offer improved precision and toxicity profile of radiation delivery in the modern era.

Conclusion: Even in the setting of stage IV rectal cancer with synchronous liver metastases, there may be potential for extended survival and cure by aggressive management of primary tumor and metastases in selected patients. Despite lack of consensus on sequencing of treatment modalities, pelvic RT may serve as a critical component of multidisciplinary management. Resectability of primary rectal tumor and liver metastases, patient preferences, comorbidities, symptomatology, and logistical issues should be thoroughly considered in decision making for optimal management of patients.

背景和目的:结直肠癌是一种非常常见的癌症,是全球癌症相关死亡率的主要原因,是一个主要的健康问题。肝脏是结直肠癌转移扩散的一个非常常见的部位,虽然近一半的患者在其疾病过程中发生转移,但在15%至25%的病例中检测到同步肝转移。在这种情况下,没有标准化的治疗方法,对于同步肝转移的直肠癌的多模式治疗的最佳顺序也没有共识。方法:在此,我们回顾盆腔放射治疗(RT)作为直肠癌同步肝转移的潜在治愈或姑息性治疗的一部分。结果:越来越多的证据表明盆腔放疗有助于IV期直肠癌患者的后续手术,改善局部肿瘤控制,实现症状缓解。引入卓越的成像能力和现代放射治疗方法,如强度调制放射治疗(IMRT)和图像引导放射治疗(IGRT),在现代提供了更高的辐射传递精度和毒性谱。结论:即使在伴有同步肝转移的IV期直肠癌中,通过积极治疗原发肿瘤和转移的患者,也有可能延长生存期和治愈。尽管在治疗方式的顺序上缺乏共识,盆腔RT可以作为多学科管理的关键组成部分。原发性直肠肿瘤和肝转移的可切除性、患者偏好、合并症、症状学和后勤问题应在制定最佳患者管理决策时充分考虑。
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引用次数: 9
Oral Submucous Fibrosis in Pediatric Patients: A Systematic Review and Protocol for Management. 儿科患者口腔黏膜下纤维化:系统综述与管理方案
IF 1.6 Q4 ONCOLOGY Pub Date : 2019-04-01 eCollection Date: 2019-01-01 DOI: 10.1155/2019/3497136
Anuj Jain, Saumya Taneja

Aim: To conduct a systematic review evaluating the cases of oral submucous fibrosis in pediatric patients.

Material and method: Systematic review was conducted using PRISMA guidelines. The article focused on oral submucous fibrosis in pediatric patients were included. A total of five manuscripts were included in our systematic review. The prevalence of OSMF in pediatric patients, gender distribution, causes, and clinical presentation were reviewed.

Results: On systematically reviewing, a total of 10 cases of OSMF in pediatric patients were found. The youngest patient reported to be diagnosed with OSMF was of 2.5 years of age. Female preponderance was noticed. All the patients had the habit of areca nut chewing which subsequently led to fibrosis.

Conclusion: Such a rapid increase in the rate of OSMF among pediatric population is a potential danger to the society. The habit of areca nut chewing is the major cause for this dreadful condition. Lack of health consciousness and low level of education are the major factors for initiation of this habit among children. Therefore it is imperative for the parents and school as well as government authorities to take serious actions.

目的:对儿科患者口腔黏膜下纤维化病例进行系统性回顾评估:采用PRISMA指南进行系统回顾。纳入了关注儿童患者口腔黏膜下纤维化的文章。共有五篇手稿被纳入我们的系统综述。回顾了儿童患者口腔黏膜下纤维化的发病率、性别分布、病因和临床表现:结果:经过系统回顾,我们共发现了 10 例儿童 OSMF 病例。据报告,被诊断为OSMF的最小患者只有2.5岁。女性患者居多。所有患者都有咀嚼槟榔的习惯,随后导致纤维化:结论:儿童OSMF发病率的快速增长对社会构成了潜在的威胁。咀嚼山茶果的习惯是导致这种可怕疾病的主要原因。缺乏健康意识和教育水平低是导致儿童养成这种习惯的主要因素。因此,家长、学校和政府当局必须采取严肃的行动。
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引用次数: 0
Soft Tissue Sarcomas of the Thoracic Wall: More Prone to Higher Mortality, and Local Recurrence-A Single Institution Long-Term Follow-up Study. 胸壁软组织肉瘤:更高的死亡率和局部复发——一项单机构长期随访研究
IF 1.5 Q2 Medicine Pub Date : 2019-03-04 eCollection Date: 2019-01-01 DOI: 10.1155/2019/2350157
Tine Rytter Soerensen, Mathias Raedkjaer, Peter Holmberg Jørgensen, Anette Hoejsgaard, Akmal Safwat, Thomas Baad-Hansen

Objectives: This study aims to assess the impact of surgical margin and malignancy grade on overall survival (OS) and local recurrence free rate (LRFR) for soft tissue sarcomas (STS) of the thoracic wall.

Methods: This retrospective cohort study identified 88 patients, diagnosed and treated surgically for a nonmetastatic STS located in the thoracic wall between 1995 and 2013, using the population based and validated Aarhus Sarcoma Registry and Danish Sarcoma Registry. The Kaplan-Meier method was used to estimate OS and LRFR. Multivariate Cox analyses were used to determine prognostic factors for OS and LRFR.

Results: The 5-year OS was 55% (95% confidence interval (CI): 0.44-0.65) and 5-year LRFR was 77% (95% CI: 0.67-0.85). High malignancy grade and intralesional/marginal resection were identified as negative predictors for OS. High grade was the only prognostic factor associated with a lower LRFR.

Conclusions: In this large, single institution, study tumor grade was the key predictor for OS and LRFR. Surgical margin only statistically significantly influenced mortality, not local recurrence.

目的:本研究旨在评估手术切缘和恶性肿瘤分级对胸壁软组织肉瘤(STS)总生存期(OS)和局部无复发率(LRFR)的影响。方法:这项回顾性队列研究确定了1995年至2013年间88例胸壁非转移性STS患者,使用基于人群并经过验证的奥胡斯肉瘤登记和丹麦肉瘤登记。采用Kaplan-Meier法估计OS和LRFR。多因素Cox分析用于确定OS和LRFR的预后因素。结果:5年OS为55%(95%可信区间(CI): 0.44-0.65), 5年LRFR为77% (95% CI: 0.67-0.85)。高恶性程度和瘤内/边缘切除被认为是OS的阴性预测因素。高分级是唯一与低LRFR相关的预后因素。结论:在这个大型的单一机构中,肿瘤分级是OS和LRFR的关键预测因子。手术切缘仅对死亡率有统计学意义,对局部复发率无统计学意义。
{"title":"Soft Tissue Sarcomas of the Thoracic Wall: More Prone to Higher Mortality, and Local Recurrence-A Single Institution Long-Term Follow-up Study.","authors":"Tine Rytter Soerensen,&nbsp;Mathias Raedkjaer,&nbsp;Peter Holmberg Jørgensen,&nbsp;Anette Hoejsgaard,&nbsp;Akmal Safwat,&nbsp;Thomas Baad-Hansen","doi":"10.1155/2019/2350157","DOIUrl":"https://doi.org/10.1155/2019/2350157","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess the impact of surgical margin and malignancy grade on overall survival (OS) and local recurrence free rate (LRFR) for soft tissue sarcomas (STS) of the thoracic wall.</p><p><strong>Methods: </strong>This retrospective cohort study identified 88 patients, diagnosed and treated surgically for a nonmetastatic STS located in the thoracic wall between 1995 and 2013, using the population based and validated Aarhus Sarcoma Registry and Danish Sarcoma Registry. The Kaplan-Meier method was used to estimate OS and LRFR. Multivariate Cox analyses were used to determine prognostic factors for OS and LRFR.</p><p><strong>Results: </strong>The 5-year OS was 55% (95% confidence interval (CI): 0.44-0.65) and 5-year LRFR was 77% (95% CI: 0.67-0.85). High malignancy grade and intralesional/marginal resection were identified as negative predictors for OS. High grade was the only prognostic factor associated with a lower LRFR.</p><p><strong>Conclusions: </strong>In this large, single institution, study tumor grade was the key predictor for OS and LRFR. Surgical margin only statistically significantly influenced mortality, not local recurrence.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/2350157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37127618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Outcome of Cervical Lymph Nodes Dissection for Thyroid Cancer with Nodal Metastases: A Southeast Asian 3-Year Experience. 伴有淋巴结转移的甲状腺癌颈部淋巴结清扫的结果:东南亚3年的经验。
IF 1.5 Q2 Medicine Pub Date : 2019-02-28 eCollection Date: 2019-01-01 DOI: 10.1155/2019/6109643
Raymond Z M Lim, Juin Y Ooi, Jih H Tan, Henry C L Tan, Seniyah M Sikin

Introduction: Therapeutic nodal dissection is still the mainstay of treatment for patients with lymph node metastases in many centres. The local data, however, on the outcome of therapeutic LND remains limited. Hence, this study aims to inform practice by presenting the outcomes of LND for thyroid cancer patients and our experience in a tertiary referral centre.

Methods: This is a single-centre retrospective observational study in a Malaysian tertiary endocrine surgery referral centre. Patients who underwent total thyroidectomy with lymph node dissection between years 2013 and 2015 were included and electronic medical records over a 3-year follow-up period were reviewed. The outcomes of different lymph node dissection (LND), including central neck dissection, lateral neck dissection, or both, were compared.

Results: Of the 43 subjects included, 28 (65.1%) had Stage IV cancer. Among the 43 subjects included, 8 underwent central LND, and 15 had lateral LND while the remaining 20 had dissection of both lateral and central lymph nodes. Locoregional recurrence was found in 16 (37.2%) of our subjects included, with no statistical difference between the central (2/8), lateral (7/15), and both (7/20). Postoperative hypocalcaemia occurred in 7 (16.3%) patients, and vocal cord palsy occurred in 5 (11.6%), whereas 9 patients (20.9%) required reoperation. Death occurred in 4 of our patients.

Conclusion: High recurrence and reoperative rates were observed in our centre. While the routine prophylactic LND remains controversial, high risk patients may be considered for prophylactic LND. The long-term risk and benefit of prophylactic LND with individualised patient selection in the local setting deserve further studies.

在许多中心,治疗性淋巴结清扫仍然是治疗淋巴结转移患者的主要方法。然而,当地关于治疗性LND结果的数据仍然有限。因此,本研究旨在通过介绍LND治疗甲状腺癌患者的结果和我们在三级转诊中心的经验,为实践提供信息。方法:这是一项在马来西亚三级内分泌外科转诊中心进行的单中心回顾性观察研究。纳入2013年至2015年期间接受甲状腺全切除术并淋巴结清扫的患者,并回顾了3年随访期间的电子病历。比较不同淋巴结清扫(LND)的结果,包括中央颈清扫、侧颈清扫或两者兼而有之。结果:在纳入的43例受试者中,28例(65.1%)为IV期癌症。在纳入的43例受试者中,8例为中央淋巴结清扫,15例为外侧淋巴结清扫,其余20例为外侧和中央淋巴结清扫。16例(37.2%)患者出现局部复发,中央(2/8)、外侧(7/15)和两侧(7/20)之间无统计学差异。术后低钙7例(16.3%),声带麻痹5例(11.6%),需再手术9例(20.9%)。4名患者死亡结论:本院肿瘤复发率和再手术率高。虽然常规预防性LND仍有争议,但高风险患者可考虑预防性LND。在当地进行个体化患者选择的预防性LND的长期风险和益处值得进一步研究。
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引用次数: 2
Comparison of Survival in Patients with Isolated Peritoneal Carcinomatosis from Colorectal Cancer Treated with Cytoreduction and Melphalan or Mitomycin-C as Hyperthermic Intraperitoneal Chemotherapy Agent. 细胞减量与美法兰或丝裂霉素c腹腔高温化疗对结直肠癌腹膜分离性癌患者生存的影响。
IF 1.5 Q2 Medicine Pub Date : 2018-12-13 eCollection Date: 2018-01-01 DOI: 10.1155/2018/1920276
Arkadii Sipok, Armando Sardi, Carol Nieroda, Mary Caitlin King, Michelle Sittig, Vadim Gushchin

Background: The role of hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is debated. Melphalan as a perfusion agent has also demonstrated survival benefit in other recurrent and chemoresistant malignancies. Thus, we hypothesize that melphalan as a HIPEC agent may improve overall survival (OS) and progression-free survival (PFS) in patients with PC from CRC.

Methods: A retrospective review of a prospective database of 48 patients who underwent optimal CRS (CC-0/1) and HIPEC from 2001-2016 was performed. Nineteen had CRS/HIPEC with melphalan (group I) and 29 with mitomycin-C (group II). Survival was estimated using the Kaplan-Meier method. Cox regression was used for multivariate analysis. Perioperative variables were compared.

Results: Mean age at CRS/HIPEC was 53±10 years. Median peritoneal cancer index (PCI) was 17 vs 13 in groups I and II, respectively (p=0.86). PCI≥20 occurred in 9 (47%) and 13 (45%) patients in groups I and II, respectively. Positive lymph nodes were identified in 8/19 (42%) vs 12/29 (41%) in groups I and II, respectively (p=0.73). Multivariate analysis identified PCI≥20 as a predictive factor of survival (HR: 7.5). Median OS in groups I and II was 36 and 28 months, respectively (p=0.54). Median PFS in groups I and II was 10 and 20 months, respectively (p=0.05).

Conclusions: CRS/HIPEC with MMC had longer median PFS in PC from CRC. PCI≥20 was the only independent predictive factor for survival. Until longer follow-up is available, we recommend using MMC in CRS/HIPEC for PC from CRC. Further prospective randomized studies are necessary.

背景:热腹腔化疗(HIPEC)在结直肠癌(CRC)腹膜癌病(PC)中的作用一直存在争议。美法兰作为灌注剂在其他复发性和化疗耐药恶性肿瘤中也显示出生存益处。因此,我们假设melphalan作为HIPEC药物可以改善CRC PC患者的总生存期(OS)和无进展生存期(PFS)。方法:对2001-2016年48例接受最佳CRS (CC-0/1)和HIPEC的前瞻性数据库进行回顾性分析。19例患者使用美法兰(I组),29例使用丝裂霉素- c (II组)进行CRS/HIPEC治疗。使用Kaplan-Meier法估计生存率。多因素分析采用Cox回归。比较围手术期变量。结果:CRS/HIPEC患者平均年龄为53±10岁。I组和II组中位腹膜癌指数(PCI)分别为17和13 (p=0.86)。PCI≥20的患者I组9例(47%),II组13例(45%)。ⅰ组和ⅱ组淋巴结阳性率分别为8/19(42%)和12/29(41%),差异有统计学意义(p=0.73)。多因素分析发现PCI≥20是生存的预测因素(HR: 7.5)。I组和II组的中位OS分别为36个月和28个月(p=0.54)。I组和II组的中位PFS分别为10个月和20个月(p=0.05)。结论:CRS/HIPEC合并MMC在大肠癌中有更长的中位PFS。PCI≥20是生存的唯一独立预测因素。在有更长的随访之前,我们建议在CRS/HIPEC中使用MMC治疗CRC的PC。进一步的前瞻性随机研究是必要的。
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引用次数: 13
Hepatic marker combination provides relevant score to predict severe morbidity after colorectal metastases-related major hepatectomy 肝标志物联合应用可为预测结直肠癌转移相关大肝切除术后的严重发病率提供相关评分
IF 1.5 Q2 Medicine Pub Date : 2018-11-26 DOI: 10.31487/j.JSO.2018.01.004
A. Pontallier, C. Laurent, E. Buscail, F. Muscari, J. Adam, L. Chiche, S. Dabernat, V. Vendrely
Background and objectives: After hepatic resection, liver failure is not diagnosed until the postoperative day-5. The aim was to identify a biomarker predictive of severe morbidity, the day after major hepatectomy. Methods: This retrospective study included patients undergoing major hepatectomy for colorectal metastases, plasma hepatic marker concentrations being determined at postoperative day-one. Outcomes were 30-day severe morbidity (Dindo III to V) and grade C post-hepatectomy liver failure. Results: A total of 433 patients were included. Thirty-day severe morbidity, 90-day mortality and grade-C post-hepatectomy liver failure rates were 15.5%, 2.5% and 2.5% respectively. Using cut-offs determined by receiver operating characteristic curves the association of serum bilirubin ? 2.1 mg/dL (? 2 N) and aspartate-amino-transferase ? 450 IU/L (? 10 N) was selected for the best biochemical predictors of severe morbidity (sensitivity 38%, specificity 94%) and post-hepatectomy failure (sensitivity 100%, specificity 91%). In multivariate analysis, this score was independently associated with severe morbidity (HR = 5.98, 95% IC 2.65-13.89; P < 0.0001) Conclusions: The association of plasma bilirubin ? 2.1 mg/dL and aspartate-amino-transferase ? 450 IU/L is identified as a relevant predictor of severe morbidity and post-hepatectomy failure as early as the first postoperative day after major hepatectomy for colorectal metastases.
背景和目的:肝切除术后,直到术后第5天才诊断出肝功能衰竭。目的是确定一种生物标志物,预测主要肝切除术后一天的严重发病率。方法:这项回顾性研究纳入了因结肠直肠癌转移而接受大肝切除术的患者,在术后第一天测定血浆肝脏标志物浓度。结果是30天严重发病率(Dindo III至V)和肝切除术后C级肝衰竭。结果:共纳入433例患者。术后30天严重发病率、90天死亡率和c级肝衰竭发生率分别为15.5%、2.5%和2.5%。使用由受者工作特征曲线确定的截止值,血清胆红素?2.1 mg/dL (?2 N)和天冬氨酸氨基转移酶?450 iu / l (?选择10 N)作为严重发病率(敏感性38%,特异性94%)和肝切除术后失败(敏感性100%,特异性91%)的最佳生化预测指标。在多变量分析中,该评分与严重发病率独立相关(HR = 5.98, 95% IC 2.65-13.89;P < 0.0001)结论:血浆胆红素?2.1 mg/dL和天冬氨酸氨基转移酶?450iu /L被确定为严重发病率和肝切除术后失败的相关预测因子,早在结直肠癌大肝切除术后第一天。
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引用次数: 0
Early Cervical Cancer: Predictive Relevance of Preoperative 3-Tesla Multiparametric Magnetic Resonance Imaging. 早期宫颈癌:术前3-特斯拉多参数磁共振成像的预测相关性。
IF 1.5 Q2 Medicine Pub Date : 2018-08-01 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9120753
Hyun Jin Roh, Kyung Bin Kim, Jong Hwa Lee, Hwa Jung Kim, Yong-Soon Kwon, Sang Hun Lee

Objective: We assess the predictive significance of preoperative 3-Tesla multiparametric MRI findings.

Methods: A total of 260 patients with FIGO IA2-IIA cervical cancer underwent primary surgical treatment between 2007 and 2016. Univariable and multivariable logistic regression analyses were used to assess the incremental prognostic significance.

Results: The clinical predictive factors associated with pT2b disease were MRI parametrial invasion (PMI) (adjusted odds ratio (AOR) 3.77, 95% confidence interval(CI) 1.62-8.79; P=0.02) and MRI uterine corpus invasion (UCI) (AOR 9.99, 95% CI 4.11-24.32; P<0.0001). In multivariable analysis, for underdiagnoses, histologically squamous carcinoma versus adenocarcinoma and adenosquamous carcinoma (AOR 2.07, 95% CI 1.06-4.07; P=0.034) and MRI tumor size (AOR 0.76, 95% CI 0.63-0.92; P=0.005) were significant predictors; for overdiagnoses, these results were MRI tumor size (AOR 1.51, 95% CI 1.06-2.16; P=0.023), MRI PMI (AOR 71.73, 95% CI 8.89-611.38; P<0.0001) and MRI UCI (AOR 0.19, 95% CI 0.01-1.01; P=0.051).

Conclusion: PMI and UCI on T2-weighted images through preoperative 3T MRI are useful coefficients for accurate prediction of the pT2b stage; however, careful surveillance is required. Therefore, preoperative decision-making for early cervical cancer patients based on MRI diagnosis should be considered carefully, particularly in the presence of factors that are known to increase the likelihood of misdiagnosis.

目的:探讨术前3-特斯拉多参数MRI表现的预测意义。方法:2007年至2016年,260例FIGO IA2-IIA宫颈癌患者接受了初级手术治疗。采用单变量和多变量logistic回归分析评估增量预后的意义。结果:pT2b疾病的临床预测因素为MRI参数侵犯(PMI)(调整优势比(AOR) 3.77, 95%可信区间(CI) 1.62 ~ 8.79;P=0.02)和MRI子宫体侵犯(UCI) (AOR 9.99, 95% CI 4.11 ~ 24.32;结论:术前3T MRI t2加权图像的PMI和UCI是准确预测pT2b分期的有用系数;然而,仔细的监督是必要的。因此,早期宫颈癌患者基于MRI诊断的术前决策应慎重考虑,特别是在已知存在增加误诊可能性因素的情况下。
{"title":"Early Cervical Cancer: Predictive Relevance of Preoperative 3-Tesla Multiparametric Magnetic Resonance Imaging.","authors":"Hyun Jin Roh,&nbsp;Kyung Bin Kim,&nbsp;Jong Hwa Lee,&nbsp;Hwa Jung Kim,&nbsp;Yong-Soon Kwon,&nbsp;Sang Hun Lee","doi":"10.1155/2018/9120753","DOIUrl":"https://doi.org/10.1155/2018/9120753","url":null,"abstract":"<p><strong>Objective: </strong>We assess the predictive significance of preoperative 3-Tesla multiparametric MRI findings.</p><p><strong>Methods: </strong>A total of 260 patients with FIGO IA2-IIA cervical cancer underwent primary surgical treatment between 2007 and 2016. Univariable and multivariable logistic regression analyses were used to assess the incremental prognostic significance.</p><p><strong>Results: </strong>The clinical predictive factors associated with pT2b disease were MRI parametrial invasion (PMI) (adjusted odds ratio (AOR) 3.77, 95% confidence interval(CI) 1.62-8.79; P=0.02) and MRI uterine corpus invasion (UCI) (AOR 9.99, 95% CI 4.11-24.32; P<0.0001). In multivariable analysis, for underdiagnoses, histologically squamous carcinoma versus adenocarcinoma and adenosquamous carcinoma (AOR 2.07, 95% CI 1.06-4.07; P=0.034) and MRI tumor size (AOR 0.76, 95% CI 0.63-0.92; P=0.005) were significant predictors; for overdiagnoses, these results were MRI tumor size (AOR 1.51, 95% CI 1.06-2.16; P=0.023), MRI PMI (AOR 71.73, 95% CI 8.89-611.38; P<0.0001) and MRI UCI (AOR 0.19, 95% CI 0.01-1.01; P=0.051).</p><p><strong>Conclusion: </strong>PMI and UCI on T2-weighted images through preoperative 3T MRI are useful coefficients for accurate prediction of the pT2b stage; however, careful surveillance is required. Therefore, preoperative decision-making for early cervical cancer patients based on MRI diagnosis should be considered carefully, particularly in the presence of factors that are known to increase the likelihood of misdiagnosis.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9120753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36438440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
期刊
International Journal of Surgical Oncology
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