颈段食管鳞癌根治性同期放化疗的临床疗效分析

摘 要：［目的］分析颈段食管鳞癌根治性同期放化疗的临床疗效及失败模式,并探讨临床相关因素对其预后的影响。［方法］回顾性分析2002年至2014年接受根治性放化疗的颈段食管鳞癌患者100例。放疗中位剂量为60 Gy（50～70Gy）,常规分割,其中54例（54.0%）采用三维适形放射治疗（three-dimensional conformal radiotherapy,3DCRT）,46例（46.0%）采用调强放射治疗（intensity-modulated radiotherapy,IMRT）;化疗采用以铂类为基础的化疗方案。采用Kaplan-Meier法进行生存分析,Log-rank检验进行组内分析,Cox回归模型进行多因素分析。［结果］全组中位随访时间47.0个月（3.8～128.0个月）,5年总生存率(overall survival,OS)、无进展生存率（progression-free survival,PFS）、无局部区域复发生存率（locoregional failure-free survival,LRFFS）分别为33.2%、31.5%、32.1%。截至末次随访日期,共31例（31.0%）患者出现局部复发,25例（25.0%）出现区域复发,41例（41.0%）发生远处转移。多因素分析显示,性别、声嘶是影响OS（HR=2.015,P=0.01;HR=3.736,P<0.001）和PFS（HR=2.064,P=0.007;HR=3.583,P= 0.001）的独立预后因素,而声嘶是影响LRFFS的唯一的不良预后因素（HR=2.884,P=0.002）。［结论］颈段食管癌根治性放化疗后可获得较高的局部区域控制率,远处转移为其主要失败模式。声嘶是颈段食管鳞癌不良预后因素。     

243例ⅡB期宫颈癌术前同期放化疗加根治术与根治性放疗同期化疗预后比较

目的 比较宫颈癌术前同期放化疗加根治术与根治性放疗同期化疗的临床疗效及远期不良反应。方法 回顾分析2004—2011年收治的243例Ⅱ_B期宫颈癌患者,121例术前同期放化疗加根治术(放化疗手术组),122例根治性放疗同期化疗(放化疗组),化疗方案为顺铂40 mg/m²·周。Kaplan-Meier法计算生存率等并Logrank法检验,Cox法多因素预后分析。结果 放化疗手术组、放化疗组随访率均为100%,随访时间满3年样本数分别为34、33例。放化疗手术组与放化疗组3年无进展生存率(PFS)为91.5%与82.0%(P=0.013),总生存率(OS)为95.5%与89.2%(P=0.085),局控率为96.7%与93.4%(P=0.375)。肿瘤直径(≥6 cm)、年龄(≤35岁)为放化疗手术组PFS预后因素(P=0.033、0.037)。病理类型(非鳞癌)、肿瘤直径(≥6 cm)为放化疗组PFS预后因素(P=0.013、0.002),其中肿瘤直径(≥6 cm)也是OS预后因素(P=0.007)。放化疗手术组下肢水肿发生率较高(P=0.000),放化疗组放射性肠炎发生率较高(P=0.000)。结论 初步结果表明术前同期放化疗加根治术能获得较好预后,肿瘤直径为两个组共同的PFS预后因素。     

中性粒细胞/淋巴细胞比值评估老年食管癌放疗预后的价值

目的 评价放疗前外周血中性粒细胞与淋巴细胞比值（NLR）评价老年食管鳞癌患者放疗疗效和预后的价值。方法 回顾性分析128例初治的老年食管鳞癌患者,行单纯放疗或同步放化疗。分析放疗前外周血NLR水平与食管鳞癌临床病理特征和预后的关系;采用Cox比例风险回归模型分析影响患者总生存（OS）的因素。结果 受试者工作特征曲线（ROC）显示,放疗前NLR的最佳截断值为3.13。根据3.13将128例患者分为低NLR组（n=75）和高NLR组（n=53）。放疗前NLR水平与年龄、性别、TNM分期和治疗方式均无关（P＞0.05）。低NLR组放疗有效率为96.0％,高NLR组有效率为69.8％,差异有统计学意义（P＜0.05）。单因素分析显示,NLR、N分期、TNM分期是影响老年食管鳞癌患者OS的因素。多因素分析显示,NLR、N分期影响老年食管鳞癌患者OS的独立因素。结论  高NLR水平提示老年食管鳞癌患者放疗疗效、预后均较差。     

治疗前白蛋白与纤维蛋白原比值对根治性放化疗宫颈癌患者预后的价值

目的：探讨治疗前白蛋白与纤维蛋白原比值（albumin-to-fibrinogen ratio,AFR）在根治性放化疗宫颈癌患者预后中的价值。方法：收集2011年1月至2018年12月于四川省肿瘤医院行根治性放化疗的241名宫颈鳞癌患者的资料,评估AFR在不同FIGO分期和生存状态组别的差异,根据受试者ROC曲线确定AFR最佳截断值,根据最佳截断值将患者分为高AFR组和低AFR组,比较两组间总生存期（overall survival,OS）和无进展生存期（progression-free survival,PFS）。结果：AFR的水平在不同的FIGO分期存在显著差异,其水平随FIGO分期的增加而下降。高AFR组患者具有更长的PFS和OS(P <0.05)。在单个指标OS诊断ROC曲线中,血小板淋巴细胞比值（platelet-to-lymphocyte ratio,PLR）的AUC最大,为0.894。单个指标PFS诊断ROC曲线中,中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio,NLR）的AUC最大,为0.867,AFR的AUC分别为0.78...     

NLR和LMR对EGFR-TKIs治疗EGFR突变阳性非小细胞肺癌预后的预测价值

目的:探讨治疗前血清中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和淋巴细胞与单核细胞比值（lympho cyte to monocyte ratio,LMR）对表皮生长因子受体-酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs）治疗EGFR突变阳性非小细胞肺癌（non-small cell lung cancer,NSCLC)患者预后的预测价值。方法:回顾性分析112例EGFR突变阳性并接受了EGFR-TKIs治疗的Ⅳ期NSCLC患者的临床资料,根据接受者操作特征曲线（ROC）分析确定的NLR和LMR的最佳分界值,将患者分为高、低水平两组,比较不同分组之间的无进展生存时间（progression free survival,PFS）和总生存时间（overall survival,OS）,通过Cox比例风险模型分析影响PFS和OS的独立预后因素。结果:根据ROC曲线,NLR=2.92,LMR=3.81作为评价的分界值。低NLR组和高NLR组的PFS分别为15.6个月和10.5个月（P＜0.001）,OS分别为26.9个月和19.3个月（P=0.003）;高LMR组和低LMR组的PFS分别为13.4个月和11.5个月（P=0.024）,OS分别为26.2个月和21.8个月（P=0.020）。通过多因素分析发现,ECOG评分和NLR是影响患者PFS和OS的独立预后因素。结论:治疗前血清NLR水平可作为预测EGFR-TKIs治疗EGFR突变阳性Ⅳ期NSCLC患者的预后因子。     

中性粒细胞/淋巴细胞比值对舌鳞状细胞癌患者预后的预测价值

目的 舌鳞状细胞癌(tongue squamous cell carcinoma,TSCC)是最常见的头颈部肿瘤之一,其生长较局限,早期易发生淋巴结转移.本研究探讨术前外周血中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对TSCC患者预后的评估价值.方法 回顾性分析广州医科大学附属肿瘤医院2011-01-01-2014-12-31行根治性手术治疗的56例TSCC患者临床资料,根据患者术前外周血NLR分为低NLR组(NLR≤1.94,28例)和高NLR组(NLR＞1.94,28例),分析两组患者NLR与临床病理因素之间的关系,比较两组患者的总生存率(overall survival,OS)和无瘤生存率(disease-free survival,DFS).结果 NLR升高与患者年龄、性别、不良嗜好、肿瘤生长部位、临床分期、复发无显著相关(P＞0.05),而与肿瘤分化程度(P=0.003)、淋巴结转移(P=0.035)密切相关;低NLR组患者的1、3、5年OS分别为96.4％、85.7％和85.7％,高NLR组分别为78.6％、57.1％和53.6％;两组5年DFS分别为82.1％和39.3％,差异有统计学意义,P＜0.05.单因素回归分析显示,肿瘤中低分化、肿瘤临床分期(Ⅲ～Ⅳ期)、复发和术前NLR(NLR＞1.94)与患者OS、DFS相关,是患者预后不良的影响因素;多因素Cox回归分析显示,肿瘤中低分化、肿瘤临床分期(Ⅲ～Ⅳ期)、复发术前NLR(NLR＞ 1.94)是影响患者总生存期的独立预后因素.结论 术前高NLR(NLR＞ 1.94)是影响TSCC患者预后的独立危险因素,术前NLR升高提示TSCC患者预后不良.     

LSD1和EZH2蛋白表达与食管鳞癌术后预后相关性分析

目的 表现遗传学是当前肿瘤生物学研究的热点,本研究探讨食管鳞状细胞癌癌组织中组蛋白赖氨酸特异性脱甲基酶1 (lysine specific demethylase 1,LSD1)和Zeste基因增强子(enhancer of zeste homolog 2,EZH2)的蛋白表达与术后预后的相关性.方法 收集2008-05-07-2009-8-20在安阳市肿瘤医院胸外科行食管癌根治术的食管鳞癌患者85例.选取食管鳞癌组织85例,淋巴结转移癌组织30例,癌旁组织30例.免疫组织化学法检测食管鳞癌组织、淋巴结转移癌组织、癌旁组织中LSD1和EZH2蛋白表达.采用x2检验分析LSD1和EZH2蛋白表达与临床病理特征的关系;Spearman法分析LSD1和EZH2两者的相关性;Kaplan-meier法和Logrank-test检验分析LSD1和EZH2蛋白表达与术后总生存期(overall survival,OS)和无进展生存期(progression free survival,PFS)的关系,Cox模型多因素预后分析.结果 LSD1在食管鳞癌组织和淋巴结转移癌组织中的高表达率分别为64.7％ (55/85)和70.0％(21/30);癌旁组织均为少量阳性表达(低表达),主要位于增殖较旺盛的鳞状上皮基底部;LSD1在食管鳞癌组织、淋巴结转移癌组织的表达均高于癌旁组织(P＜0.001,P=0.001),食管鳞癌组织与淋巴结转移癌组织中的表达差异无统计学意义,P=0.598.EZH2在食管鳞癌组织、淋巴结转移癌组织和癌旁组织中的高表达率分别为62.3％(53/85)、76.7％ (23/30)和20.0％ (6/30);EZH2在食管鳞癌组织、淋巴结转移癌组织的表达均高于癌旁组织(P＜0.001,P=0.001),食管鳞癌组织与淋巴结转移癌组织中的表达差异无统计学意义,P=0.155.Spearman相关分析显示,LSD1和EZH2蛋白表达存在正相关,r=0.239,P=0.028.LSD1蛋白表达水平与pT分期(P=0.007)和分化程度(P=0.021)相关.EZH2蛋白表达水平与pT分期(P=0.022)、pN分期(P=0.046)和分化程度(P=0.018)相关.单因素分析显示,LSD1高表达患者的mOS和mPFS均低于低表达患者,均P＜0.001.EZH2高表达患者的mOS和mPFS均低于低表达患者,均P＜0.001.亚组分析LSD1和EZH2同时高表达患者的中位总生存期(median overall survival,mOS)和中位无进展生存期(median progress free survival,mPFS)均低于非LSD1和EZH2同时高表达患者,均P＜0.001.多因素分析显示,LSD1表达为独立的PFS预后指标,P=0.005;EZH2表达为独立的OS和PFS预后因素(P=0.003,0.014).结论 LSD1和EZH2在食管鳞癌组织和淋巴结转移癌组织中表达上调,高表达的患者与术后不良预后有关.     

营养风险筛查工具(NRS-2002)对不可手术的食管鳞癌患者同步放化疗疗效和不良反应的相关性分析

目的 研究营养风险筛查工具(NRS-2002)对不可切除的局部晚期食管鳞癌(LAESCC)患者接受同步放化疗治疗的疗效及生存结果影响。 方法 回顾性分析2013-2015年浙江省人民医院放疗科行根治性同步放化疗治疗的LAESCC患者 105例,营养状况的筛查使用营养风险筛查工具NRS-2002量表,率间比较采用χ²检验,Kaplan-Meier法计算生存率,Logrank法检验,Cox回归模型预后因素分析。 结果 37.1%的患者在同步放化疗前就存在营养风险,NRS-2002评分≥3分的患者≥3级不良反应发生率显著高于评分为 1~2分者(P=0.007),所有患者的中位生存(OS)和无进展生存(PFS)分别为17.0个月和11.8个月,NRS-2002评分≥3分组的患者OS和PFS均显著低于评分为 1~2分者(均 P=0.000),进一步行多因素分析发现,评分≥3分是OS (P=0.000)和PFS (P=0.001)降低的独立预后因素。 结论 NRS-2002工具表明食管癌患者存在较高营养风险,而治疗前评分≥3分提示与不良反应增加及生存降低显著相关,值得进一步研究和应用。     

中性粒细胞/淋巴细胞比值与小细胞肺癌放疗患者预后的关系

目的:分析外周血中性粒细胞/淋巴细胞比值（NLR）与小细胞肺癌（SCLC）放疗患者预后的关系。方法:回顾性分析2014年1月至2018年12月的91例SCLC患者临床资料,通过受试者工作特征（ROC）曲线获得最佳截断值,将患者分为低NLR组和高NLR组,χ2检验或Fisher's精确概率法检验评估NLR与临床特征的关系,利用Kaplan-Meier法绘制生存曲线,Log-rank法进行单因素预后分析,Cox比例风险回归模型多因素分析NLR值是否为总生存期（OS）和无进展生存期（PFS）的独立预后因素。结果:全组患者1、3年OS率分别为72.5%、39.1%,1、3年PFS率分别为42.9%、19.8%。放疗中和放疗后NLR值对患者预后有诊断价值。放疗中低NLR组的疾病控制率（DCR）显著高于高NLR组（P=0.042）。放疗中和放疗后高NLR组均与较差的OS（P=0.001,0.003）相关,放疗中高NLR组与较差的PFS（P=0.034）相关。放疗中和放疗后NLR是OS的独立预后因素,放疗中NLR是PFS的独立预后因素。结论:放疗中和放疗后NLR是小细胞肺癌患者的预后影响因素,放疗中NLR≥4.425,放疗后NLR≥4.155提示预后不良。     

治疗前PLR和NLR对鼻咽癌患者预后的影响北大核心CSCD

目的探讨鼻咽癌患者治疗前外周血中血小板与淋巴细胞比(platelet-lymphocyte ratio,PLR)、中性粒细胞与淋巴细胞比(neutrophil-lymphocyte ratio,NLR)与总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)的相关性。方法回顾性分析西安交通大学第一附属医院和陕西省人民医院2009年1月至2013年9月期间初治的91例鼻咽癌患者临床资料,根据ROC曲线选取PLR和NLR的截断值,将患者根据截断值分组,采用Kaplan-Meier法和Log rank检验比较不同组患者的总生存率和无进展生存率,应用Cox比例风险模型进行单因素和多因素分析。结果当PLR=143.3、NLR=2.6时,对患者的预后预测价值最高。Cox多因素分析发现PLR≥143.3(RR=2.491,95%CI=1.139~5.451,P=0.022)、NLR≥2.6(RR=2.186,95%CI=1.021~4.682,P=0.044)时,患者的OS较短,而PLR≥143.3(RR=2.461,95%CI=1.242~4.874,P=0.01)时,患者的PFS较差。结论治疗前PLR和NLR可能是影响鼻咽癌患者预后的独立危险因素。     

胸段食管鳞癌诱导化疗联合同期放化疗对比同期放化疗的配对分析

目的 比较不能手术胸段食管鳞癌诱导化疗联合同期放化疗对比同期放化疗的疗效差异。方法 回顾性分析2002-2015年接受根治性放化疗的胸段食管鳞癌患者 267例,化疗均采用多西他赛联合顺铂方案。以年龄、性别、PS评分、肿瘤部位、肿瘤长度、TNM分期作为配对因素,将 85例接受诱导化疗联合同期放化疗的患者作为研究组与接受单纯同期放化疗的患者1∶1配对,比较两组的临床疗效和毒性差异。采用Kaplan-Meier法进行生存分析,Logrank检验进行组内分析,Cox回归模型进行多因素分析。结果 170例患者的中位随访时间为18(3~72)个月。放化疗后诱导组、同期组的客观缓解率分别为74.1%、58.8%(P=0.035),3年总生存率分别为44.2%、 29.7%(P=0.028),3年无进展生存率分别为34.8%、 15.4%(P=0.015)。亚组分析显示诱导化疗有效组总生存率、无进展生存率和无局部区域复发生存率高于诱导化疗无效组(P=0.002、0.001、0.002),两组无远处转移生存率相近(P=0.116)。诱导组≥3级白细胞下降的发生率显著高于同期组(38.8%∶24.7%,P=0.048)。多因素分析显示年龄、是否采用诱导化疗是影响总生存的因素(P=0.003、0.016)。结论 与同期放化疗相比,诱导化疗联合同期放化疗可获得较好的近期疗效并可延长食管鳞癌患者的生存。诱导组血液学毒性的发生率较高但可耐受,值得进一步开展前瞻性对照研究以确证其有效性。     

Dynamics of neutrophil-to-lymphocyte ratio predict outcomes of metastatic colorectal carcinoma patients treated by FOLFOX

BackgroundPeripheral blood cell count is the most common clinical laboratory test. Neutrophil-to-lymphocyte ratio (NLR) as an economic marker has been reported in various cancer types. It is believed that NLR is associated with the prognosis and treatment outcomes of some cancers. Low baseline NLR has been reported as associated with better overall survival (OS) in advanced cancer patients. In this study, we aimed to determine whether the changes of NLR may predict the outcome of metastatic colorectal carcinoma (mCRC) patients treated with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) combined with bevacizumab/cetuximab.MethodsThe clinical data obtained from 128 mCRC patients between January 2014 and December 2018 were retrospectively analyzed. The NLR values of patients were calculated after 4 cycles of treatments. Kaplan-Meier analysis and Cox regression modeling were performed to assess the impact of NLR dynamics on OS and progression-free survival (PFS).ResultsAmong the 128 participants, the optimum pre-treatment NLR cutoff value was 3. A total of 70 (54.7%) participants had a pre-treatment of NLR lower than 3. The median of PFS was 9.1 months for NLR <3 compared with 6.1 months for pre-treatment NLR >3. A lower pre-treatment NLR was significantly associated with better PFS (P<0.001), but not associated with OS (P=0.064). A total of 94 (73.4%) participants had a post-treatment NLR <3, which was associated with better PFS and OS (P=0.007). However, changes in NLR significantly affected PFS and OS. Decrease in post-treatment NLR was associated with longer PFS and OS. Patients with changes from low pre-treatment NLR to high post-treatment NLR had worse OS and PFS than that of NLR changes from high to low.ConclusionsIt is not the NLR but the changes of NLR that may predict the efficacy of FOLFOX treatment in mCRC patients.     

Prognostic Significance of Preoperative Lymphocyte-Monocyte Ratio in Patients with Resectable Esophageal Squamous Cell Carcinoma

Background: The interaction between tumor cells and inflammatory cells has not been systematicallyinvestigated in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to evaluatewhether preoperative the lymphocyte-monocyte ratio (LMR), the neutrophil-lymphocyte ratio (NLR), andthe platelet-lymphocyte ratio (PLR) could predict the prognosis of ESCC patients undergoing esophagectomy.Materials and Methods: Records from 218 patients with histologically diagnosed ESCC who underwent attemptedcurative surgery from January 2007 to December 2008 were retrospectively reviewed. Besides clinicopathologicalprognostic factors, we evaluated the prognostic value of the LMR, the NLR, and the PLR using Kaplan-Meiercurves and Cox regression models. Results: The median follow-up was 38.6 months (range 3-71 months). Thecut-off values of 2.57 for the LMR, 2.60 for the NLR and 244 for the PLR were chosen as optimal to discriminatebetween survival and death by applying receiver operating curve (ROC) analysis. Kaplan-Meier survivalanalysis of patients with low preoperative LMR demonstrated a significant worse prognosis for DFS (p=0.004)and OS (p=0.002) than those with high preoperative LMR. The high NLR cohort had lower DFS (p=0.004)and OS (p=0.011). Marginally reduced DFS (p=0.068) and lower OS (p=0.039) were found in the high PLRcohort. On multivariate analysis, only preoperative LMR was an independent prognostic factor for both DFS(p=0.009, HR=1.639, 95% CI 1.129-2.381) and OS (p=0.004, HR=1.759, 95% CI 1.201-2.576) in ESCC patients.Conclusions: Preoperative LMR better predicts cancer survival compared with the cellular components ofsystemic inflammation in patients with ESCC undergoing esophagectomy.     

Prognostic value of inflammation-based markers in patients with pancreatic cancer administered gemcitabine and erlotinib

AIM: To evaluate the value of systemic inflammation-based markers as prognostic factors for advanced pancreatic cancer (PC). METHODS: Data from 82 patients who underwent combination chemotherapy with gemcitabine and erlotinib for PC from 2011 to 2014 were collected retrospectively. Data that included the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio, and the C-reactive protein (CRP)-to-albumin (CRP/Alb) ratio were analyzed. Kaplan-Meier curves, and univariate and multivariate Cox proportional hazards regression analyses were used to identify the prognostic factors associated with progression-free survival (PFS) and overall survival (OS). RESULTS: The univariate analysis demonstrated the prognostic value of the NLR (P = 0.049) and the CRP/Alb ratio (P = 0.047) in relation to PFS, and a positive relationship between an increase in inflammation-based markers and a poor prognosis in relation to OS. The multivariate analysis determined that an increased NLR (hazard ratio = 2.76, 95%CI: 1.33-5.75, P = 0.007) is an independent prognostic factor for poor OS. There was no association between the PLR and the patients’ prognoses in those who had received chemotherapy that comprised gemcitabine and erlotinib in combination. The Kaplan-Meier method and the log-rank test determined significantly worse outcomes in relation to PFS and OS in patients with an NLR > 5 or a CRP/Alb ratio > 5. CONCLUSION: Systemic inflammation-based markers, including increases in the NLR and the CRP/Alb ratio, may be useful for predicting PC prognoses.     

The Role of Haematological Parameters in Predicting the Response To Radical Chemoradiotherapy in Patients with Anal Squamous Cell Cancer

BackgroundHistorically, the treatment of choice for anal cancer had been abdominoperineal resection (APR). Radical radiotherapy with concurrent 5-fluorouracil plus mitomycin C chemotherapy was later established as standard therapy, although with a failure rate of 20–30%. The aim of this study was to evaluate the outcomes after radical chemoradiotherapy (CRT), prognostic and predictive factors and patterns of failure.Patients and methodsThis study included 47 patients treated with radical CRT for patohistologicaly confirmed anal squamous cell carcinoma. Analysed haematological parameters included: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and haemoglobin level. The final logistic regression model included treatment break period. Tumour response was assessed at 24 weeks from CRT completion. Follow-up was performed every 3 months during the first two years, and every 6 months thereafter.ResultsA complete clinical response (CR) was detected in 30 patients (63.8%). Patients who did not achieve a 6-months CR and those who had a CR after 6 months but then relapsed were referred to surgical treatment. With combined CRT and surgical salvage treatment the CR rate was 80.9%. Patients with CR after 6 months had significantly longer disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). A significant effect on the 6-month response was confirmed for PLR (p = 0.03).ConclusionsImportant prognostic factors associated with CR were baseline haemoglobin level and period of treatment interruptions. Potential haematological prognostic factors could be PLR and NLR, which can be routinely determined by low-cost and minimally invasive methods.Key words: anal cancer, chemoradiotherapy, haematological parameters     

SALL4高表达在食管鳞癌临床病理及预后判定中的意义

目的 分析食管鳞癌(Esophageal squamous cell carcinoma,ESCC)中SALL4的表达与临床病理及生存预后的关系,探讨SALL4在食管鳞癌诊断和治疗中的作用。方法 收集2010年7月—2011年11月哈尔滨医科大学附属肿瘤医院90例食管鳞癌患者的癌组织及相应的癌旁组织,采用免疫组织化学的方法检测SALL4的表达情况,比较癌组织与癌旁组织间SALL4的表达差异,并分析其与食管鳞癌患者临床特征、总生存(Overall survival,OS)及无进展生存(Progression free survival,PFS)的关系。结果 食管鳞癌组织中SALL4的表达水平明显高于癌旁组织(P＜0.05),SALL4高表达与术中肿瘤部位(P=0.038)、G分级(P=0.036)和AJCC分期(P=0.015)密切关联。生存分析及Cox风险回归分析表明,SALL4高表达组的食管鳞癌患者OS和PFS均低于SALL4低表达组(P＜0.05)。结论 SALL4高表达可以作为食管鳞癌一个独立的预后判定因子,在临床工作中,可以帮助判断食管鳞癌患者的生存预后。     

非手术食管鳞癌病变长度对临床分期影响——Ⅱ/Ⅲ期根治性放疗患者多中心回顾性分析(3JECROG R-01D)

目的 回顾性分析接受根治性放疗Ⅱ、Ⅲ期食管鳞癌患者病变长度对预后的影响和在临床分期中的作用。方法 回顾分析2002-2016年全国10所医疗中心(泛京津冀食管癌协作组)符合纳入标准的2086例不宜手术或拒绝手术而接受根治性放疗的Ⅱ、Ⅲ期食管鳞癌患者的临床及随访资料。分析中位病变长度与总生存、无进展生存的关系,进一步分层分析病变长度对临床分期的影响。结果 全组中位生存时间和中位无进展生存时间分别为25.6个月和18.2个月。Cox多因素生存分析显示治疗方式、年龄、临床分期、病变长度为预后影响因素。≤5 cm组中位生存时间28.9个月,1、3、5年生存率为77.3%、45.0%、36.3%。全组>5 cm组中位生存时间21.9个月,1、3、5年生存率为69.9%、37.9%、28.1%(P<0.05)。Ⅱ期患者≤5 cm组和>5 cm组中位生存时间分别为42.1个月和38.9个月(P=0.303),Ⅲ期患者的分别为23.9个月和19.3个月(P<0.001),N1期患者的分别为24.1个月和18.4个月(P<0.001)。结论 Ⅱ、Ⅲ期食管癌患者病变长度与放疗预后相关,可能对目前临床分期具有补充作用,≤5 cm长度对Ⅲ期、N1期患者能更好的预测生存。