Objective To investigate the clinical characteristics, short-term therapy outcome and survival in patients of lung cancer with different smoking status. Methods 3751 cases were enrolled and the differences in age, sex, pathological type, stage, treatment modality, efficiency and survival were compared according patients′smoking status. Results 1206 ( 32. 2% ) patients were never smokers and 2545 ( 67. 8% ) were smokers. 80. 3% male patients and 10. 5% female patients were smokers. Among never smoking lung cancer patients, proportion of female gender, adenocarcinoma, second primary neoplasm,advanced stages and non-operative treatment were high. In the smokers, much more COPD and pulmonary tuberculosis, squamous cancer and operative treatmentwere found. No statistical differences were detected in overall outcome and survival. Conclusions The clinical characters and treatmentmodalities of patients with lung cancer of different smoking status were significant different, but had the same survival. Patients’smoking status should be accountted into the diagnosis and treatment of lung cancer.
Objective To investigate the expression of Jumonji domain-containing protein 3 ( JMJD3) in lung cancer tissue. Methods The cancer tissue slides from 53 lung cancer patients with different TNMstages were immunostained with JMJD3 antibody. The relationship between the expression of JMJD3 and type of pathology, TNM stage, survival time was analyzed. Results 94. 3% lung cancer tissue expressed JMJD3 protein. The expression of JMJD3 was negatively correlated with TNMstage( r = - 0. 347,P =0. 002) . The patients with decreased JMJD3 expression had shorter survival time than the patients with high JMJD3 expression ( X2 = 17. 83, P = 0. 001) . Conclusion Decreased expression of JMJD3 may promote the lung cancer progression.
Objective To investigate the prognostic factors of severe chronic obstructive pulmonary disease ( COPD) in elderly patients, and to guide the clinical assessment and appropriate interventions. Methods A prospective cohort study was carried out from May 1993 to December 2010. A total of 178 elderly patients with severe COPD were recruited for baseline survey, and followed up for the living conditions, whether used non-invasive ventilation, and causes of death. A survival analysis was performed on all patients stratified by lung function. The significant factors on survival rate were analyzed. Results In this cohort the survival rates were 49% and 12% in five and ten years, respectively. The important factors for prognosis were age [ relative risk( RR) = 1. 043, 95% confidence intervals( 95% CI = 1. 010-1. 050] , forced expired volume in one second ( FEV1 , RR = 0. 019, 95% CI = 0. 007-0. 052) , FEV1% pred ( RR = 1. 045, 95% CI = 1. 012-1. 079) , lung function grade ( RR = 2. 542, 95% CI = 1. 310-4. 931) , body mass index ( BMI, RR= 0. 945, 95% CI = 0. 895-0. 952) , and pulmonary heart disease ( RR = 1. 872, 95% CI = 1. 188- 2. 959) . In severe COPD, non-invasive ventilation ( NIV, RR = 1. 167, 95% CI = 0. 041-1. 674) , pulmonary heart disease ( RR = 3. 805, 95% CI = 1. 336-10. 836) , FEV1 ( RR = 0. 081, 95% CI = 1. 001-1. 168) , and arterial partial of oxygen ( PaO2 , RR=0. 956, 95% CI =0. 920-0. 993) were the independent predictors.The patients using NIV had longer survival than those without NIV. The 5 and 10 years survival rate in the patients with NIV were 78% and 50% , much higher than those without ventilation which were 30% and 25% , respectively. In extremely severe COPD, FEV1 ( RR=1. 059, 95% CI =1. 015-1. 105) , arterial partial of carbon dioxide ( PaCO2 , RR=1. 037, 95% CI = 1. 001-1. 074) , age ( RR= 1. 054, 95% CI = 1. 013-1. 096) and pulmonary heart disease ( RR = 1. 892, 95% CI = 1. 125-3. 181) were the independent predictors. Conclusions Age, BMI, FEV1 , PaO2 , PaCO2 , pulmonary heart disease, and NIV were prognostic factors in elderly patients with severe COPD. The prognostic factors between severe and extremely severe COPD were not identical. Patients with severe COPD should be given early intervention, including progressive nutritional support, and long-term home oxygen therapy combining with NIV.
Abstract： Objective To evaluate surgical outcomes of patients with Marfan syndrome （MFS） complicated by type A aortic dissection （AAD） during follow-up. Methods We retrospectively reviewed clinical data of 44 patients with MFS complicated by AAD who were admitted to Wuhan Asia Heart Hospital from January 2006 to January 2012. There were 31 male patients and 13 female patients with their age of 12-54 （33.0±9.8） years. Twenty-three patients underwent Bentall procedure at different time after the onset of AAD， while the other 21 patients received conservative treatment in stead of surgery because of economical or other reasons. COX regression with time-varying covariates was performed to analyze related factors， using primary end point， primary end point＋secondary end point as the outcome variables respectively， to compare postoperative outcomes and quality of life between the surgical treatment patients and conservative treatment patients. Results Postoperatively 1 patient died of multiple organ failure， and the other 22 patients survived the surgery. All the 43 patients were followed up from 1 to 75 months. The 3-year survival rate of the 22 surgical treatment patients was 95.7%， and they all had a good quality of life during follow-up. The survival condition and quality of life of the 21 conservative treatment patients was poor， and 13 patients （61.9%） died with the 3-year survival rate of only 31.7%. The main causes of their death included acute cardiac tamponade， aortic dissection rupture， acute myocardial infarction andcardiogenic shock. COX regression with time-varying covariates showed that the treatment outcomes of the surgical treatment patients were statistically different from those of the conservative treatment patients after modifying the influence caused by different operating time （OR of T_COV_ =0.088， P=0.028） . The risk of death of surgical treatment was only 8.8% of that of conservative treatment. Conclusion The prognosis of patients with MFS complicated by AAD is very poor. Therefore， all these patient， both in acute stage and chronic stage， should undergo surgical treatment as early as possible. The short-term and follow-up outcomes of surgical treatment are satisfactory.
Objective To investigate surgical outcomes and prognostic factors for patients with coronary heart disease and low left ventricular ejection fraction （LVEF≤40%） undergoing off-pump coronary artery bypass grafting （OPCAB）. Methods We retrospectively analyzed clinical records of 63 discharged patients with coronary heart disease and low LVEF who underwent OPCAB in Peking University People’s Hospital from 2001 to 2004 year. There were 48 males and 15 females with mean age of 65.1±9.2 years and mean LVEF of 33.8%±5.0%. Regular follow-up evaluation was completed. We investigated risk factors for long-term survival of the patients by Kapalan-Meier survival curve, log-rank test and Cox regression model.?Results?Follow-up time was 3-107 （71.3±24.4） months, and six patients were lost during the follow-up. Nineteen patients （30.2%） died during follow-up including 10 patients （15.9%） who had cardiac-related death. The survival rate at 1, 3, 5 and 8 year was 96.7% （61）, 94.9% （60）, 85.9% （55）, 77.2% （53） respectively. Univariate analysis shows LVEF≤30% and acute myocardial infarction within 30 days are risk factors for long-term survival（P＜0.05）. Cox regression analysis showed that LVEF≤30%（RR=4.662, P＜0.05）and acute myocardial infarction within 30 days（RR=5.544, P＜0.05）were two independent risk factors for cardiac-related death after discharge. Conclusion Patients with coronary heart disease and low LVEF can have satisfactory surgical outcomes after OPCAB. LVEF≤30% and acute myocardial infarction within 30 days are the two independent risk factors for cardiac-related death after discharge.
Objective To improve esophageal lymph node staging and investgate an ideal esophageal lymph node metastasis staging method. Methods The clinical pathological data and followup data of the 236patients who had undergone thoracic esophagectomy with at least 6 lymph nodes (LN) removed from January 1985 to December 1989 were analyzed retrospectively. Cox proportional hazard model was used to screen risk factors, and Logrank test was applied to perform survival analysis according to lymph node metastasis staging (number, distance and extent). Results The 10-year follow-up rate was 92.3%（218/236）. The overall 1-year, 5-year and 10-year survival rates were 80.2%, 43.1% and 34.2% respectively. One hundred and twelve (47.4%) patients had LN metastasis, and their 5-year survival rates were lower than that of patients without LN metastasis (14.8% vs. 66.6%; χ2=77.18, P=0.000). Cox regression analysis showed that besides depth of invasion, differentiation grade and LN metastasis, the number, distance and extent of LN metastasis were the independent risk factors which could influence prognosis. A further analysis was given via univariate Logrank test. When grouped according to the number of LN metastasis, there were significant differences in overall survival rates (χ2=96.00,P=0.000), but no significant difference was found in survival rates between N2 and N3 group(Pgt;0.05). When grouped according to the distance of LN metastasis, there were significant differences in overall survival rates (χ2=79.29, P=0.000), but no significant difference was found in survival rates among S1, S2 and S3 group(Pgt;0.05). When grouped according to the extent of LN metastasis (0, 1, and ≥2 fields), there were significant differences in overall survival rates (χ2=87.47, P=0.000), and so were the survival rates among groups (χ2=5.14, P=0.023). Conclusion Revising the current Nclassification of TNM staging of esophageal cancer according to the extent of LN metastasis(0, 1, and ≥2 fields) is more reasonable, and can reflect the prognosis of patients with esophageal cancer after esophagectomy better.
目的 初步探讨影响男性乳腺癌患者预后的因素。 方法 收集2003年1月－2011年12月经病理确诊、接受治疗、临床资料较完整的36例男性乳腺癌患者的临床资料。采用对数秩检验和Cox回归分析影响男性乳腺癌患者预后的因素。 结果 36例患者无进展生存期（PFS）为3～95个月，中位PFS为45个月。单因素分析显示：肿瘤直径（P=0.001）、阳性淋巴结（P=0.001）、TNM分期（P＜0.001）、手术方式（P=0.001）是影响预后的因素。多因素分析显示：阳性淋巴结（P=0.024）和TNM分期（P=0.022）是影响预后的主要因素。 结论 阳性淋巴结和TNM分期是影响预后的主要因素，以手术为主的综合治疗模式是提高男性乳腺癌患者生存率的重要措施。
目的 探讨影响岩斜区脑膜瘤（PCM）预后的相关因素。 方法 回顾分析解放军452医院2005年9月－2009年6月及四川大学华西医院1999年9月－2009年2月110例患者的临床资料及随访结果，通过单因素生存分析及Cox比例风险模型分析探讨影响PCM预后的相关因素。 结果 单因素生存分析发现8种相关因素影响PCM患者的预后，但Cox多因素分析仅发现脑干T2像高信号（OR=5.54，P=0.012）、肿瘤侵入脑干（OR=5.10，P=0.034）、病理高级别（OR=4.03，P=0.011）这3种因素有统计学意义。 结论 脑干T2像高信号、肿瘤侵入脑干、病理高级别可影响岩斜区脑膜瘤患者的预后。
ObjectiveTo establish a predictive model for survival and study it’s clinical value by reviewing the information of patients with hilar cholangiocarcinoma. MethodsMedical record of 196 patients with hilar cholangiocarcinoma were analyzed retrospectively. Seventeen possible clinicopathologic factors were selected. Cox model was used for univariate and multivariate analysis. Prognostic index (PI) was calculated based on the results of multivariate analysis. Patients with different PI were divided into three different risk level groups in order to compare the survival rate. Individual expected survival rate was calculated based on the median PI. Log cumulative hazards function plot was used to test Cox model proportional hazards assumption (PH assumption). ResultsThe significant prognostic factors influencing the survival rate were surgical procedure, surgical margin, and preoperative total bilirubin level (Plt;0.05). The predictive formula was PI=0.815×preoperative total bilirubin level+0.580×surgical margin－0.713×surgical procedure. According to the value of PI, all patients were divided into 3 groups, low risk group (PI≤－0.642), middle risk group (－0.642lt;PIlt;1.364), high risk group (PI≥1.364), and survival rate declined between groups and in groups with statistically significant difference (Plt;0.05). ConclusionThis model for survival can predict the prognosis of patients with hilar cholangiocarcinoma individually and help to conduct individual clinical therapy.
ObjectiveTo explore the expression of chloride intracellular channel protein 1 (CLIC1) protein in the matched colorectal normal mucosa tissue, colorectal adenoma tissue， and colorectal cancer tissue, and its relationship with tumorigenesis, tumor progression， and prognosis of patients with colorectal cancer . MethodsThe expression of CLIC1 protein was detected in 150 cases of colorectal normal mucosa tissues, 62 cases of colorectal adenoma tissues, and 187 cases of colorectal cancer tissues by using immunohistochemistry tissue microarray, and the relationships between the expression of CLIC1 protein and clinicopathologic features, and the survival rate of patients with colorectal cancer were analyzed. ResultsThe positive rate of CLIC1 protein expression in normal mucosa tissues (26.00%, 39/150), colorectal adenoma tissues (66.13%, 41/62), and colorectal cancer tissues (82.89%, 187/155) increased in turn and the difference was statistically significant (Plt;0.001). The expression of CLIC1 protein was related to TNM staging (P=0.007), but it was not related to gender (P=0.553), age (P=0.206), tumor diameter (P=0.185), tumor differentiation (P=0.062), and tumor location (P=0.598). The median survival time after surgery in patients with CLIC1 protein positive expression was 80 months, and it was 111 months in patients with CLIC1 protein negative expression. The survival rate of patients with CLIC1 protein positive expression was lower than that with CLIC1 protein negative expression by log-rank test (66.40% vs. 80.00%, P=0.031). ConclusionsThe expression of CLIC1 protein is related to the tumorigenesis and progression of colorectal cancer as well as the survival of patients with colorectal cancer. CLIC1 is a potential tumor biomarker.