Objective To study the effect of HBeAg on recurrence and survival after radical resection of small (≤3 cm) hepatocellular carcinoma (HCC). Methods Two hundreds and twenty-three HCC patients undergone radical resection from 1999 to 2000 were divided into two groups according to serum HBeAg status， HBeAg positive group (n=73) and HBeAg negative group (n=150). The patients’ factors, operative factors and tumorous facors were studied retrospectively between the two groups. And risk factors of overall survival (OS) and disease-free survival (DFS) were analyzed. Results There were no significant differences in operative and tumorous factors between the two groups, but the HBeAg positive group were younger with more severe cirrhosis (P=0.004, P=0.008). The OS and DFS were significantly different between the HBeAg positive group and HBeAg negative group. The 1-, 3- and 5-year OS were 91.5%, 76.8%, 60.1% and 95.2%, 85.3%, 73.2%, respectively (P=0.053)； and the 1-, 3- and 5-year DFS were 73.3%, 53.7%, 40.3% and 86.6%, 65.5%, 54.5%, respectively (P=0.002). Multivariate analysis revealed that age ＞50 years, HBeAg positive and macronodular cirrhosis were significantly related to OS, and HBeAg positive, multiple tumor nodulars were significantly related to DFS. Positive serum HBeAg status was an independent risk factor for both OS and DFS. Conclusion Positive serum HBeAg is closely related to early recurrence and survival after radical resection of patients with small HCC.
ObjectiveTo assess the long-term effectiveness and safety of autologous bone marrow mononuclear cells (BM-MNC) transplantation in the treatment of critical diabetic lower arteriosclerosis obliterans (ASO). MethodsBetween January 2007 and January 2010, 61 patients with critical diabetic lower ASO were treated with standard medical therapies in 29 cases (control group) or with standard medical therapies and autologous BM-MNC transplantation in 32 cases (treatment group). There was no significant difference in gender, age, disease duration, Fontatine stage, glucose (GLU), triglyceride (TG), total cholesterol (CHOL), low-density lipoprotein-cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between 2 groups (P>0.05). The endpoints were overall survival (OS) and amputation-free survival (AFS). The risk indexes for ASO were observed and compared between 2 groups before and after treatments. ResultsThe patients were followed up 2-36 months, and no malignant tumor occurred. The OS rate, OS time, AFS rate, and AFS time were 82.76% (24/29), (32.31±9.08) months, 37.50% (9/24), and (21.28±13.35) months in the control group and were 78.13% (25/32), (32.47±6.96) months, 68.00% (17/25), and (28.38±9.48) months in the treatment group;all indexes showed no significant differences (P>0.05). OS rate, OS time, AFS rate, and AFS time showed no significant differences between 2 groups at the other time (P>0.05) except AFS time at 1 year, which was significantly short in the control group than the treatment group (t=2.806, P=0.007). At the endpoint of follow-up, the indexes of GLU, TG, CHOL, LDL-C, HbA1c, SBP, and DBP showed no significant differences between before and after treatments and between 2 groups (P>0.05) in 49 survival patients (24 in control group and 25 in treatment group). ConclusionAutologous BM-MNC transplantation is safe and effective in the treatment of critical diabetic lower ASO, which can significantly improve AFS rate and prolong AFS time with no risks.
Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.
ObjectiveTo explore the prognostic value of modified Glasgow Prognostic Score (mGPS) in lung cancer patients.MethodsThe clinical data and follow-up information of patients with lung cancer diagnosed for the first time in West China Hospital of Sichuan University from August 2008 to May 2013 were retrospectively analyzed. Overall survival (OS) of patients with different mGPS were compared by Kaplan-Meier test and log-rank test. Univariate and multivariate Cox proportional hazard analysis were performed, and hazard ratio (HR) and 95% confidence interval (CI) were counted to evaluate the predictive value of different prognostic factors in patients with lung cancer.ResultsA total of 289 patients were included. According to the mGPS score, 127 patients had 0 point, 90 patients had 1 point, and 72 patients had 2 points. The OS of lung cancer patients with mGPS=0 was better than that of patients with mGPS=1 and mGPS=2 (P<0.001). Cox proportional hazards of univariate analysis revealed that age< 65 (P=0.022), stage for Ⅰand Ⅱ (P<0.001), surgery (P<0.001), chemotherapy (P=0.018), and mGPS=0 (1 vs. 0, P=0.008; 2 vs. 0, P<0.001) were the protective factors for lung cancer patients (P<0.05). Multiple-factor analysis showed that age [HR=0.680, 95%CI (0.508, 0.911), P=0.010], stage [HR=0.580, 95%CI (0.359, 0.939), P=0.027], operation [HR=0.254, 95%CI (0.140, 0.459), P<0.001], chemotherapy [HR=0.624, 95%CI (0.435, 0.893), P=0.010], mGPS (1 vs. 0) [HR=1.548, 95%CI (1.101, 2.176), P=0.012] and mGPS (2 vs. 0) [HR=1.425, 95%CI (1.003, 2.024), P=0.048] were independent predictors of OS in patients with lung cancer.ConclusionmGPS could be considered as an independent prognostic factor in lung cancer.
Objective To investigate the relevance among sarcopenia, peripheral inflammatory, and nutritional factors, as well as the impact of sarcopenia on the prognosis of gastric cancer. Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included. The skeletal muscle index (SMI) of the third lumbar vertebra level was calculated using CT images, and male patients with SMI<52.4 cm2/m2 and female patients with SMI<38.5 cm2/m2 were considered sarcopenia. The key clinicopathological features of patients were collected for prognostic analysis. ResultsAmong the 174 patients with gastric cancer, 73 patients (41.95%) were diagnosed with sarcopenia. Compared with those of non-sarcopenia, the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index (BMI). In addition, males demonstrated a significantly higher rate of sarcopenia. Further, patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia. The two groups showed significant differences in type 2 diabetes, peripheral C-reaction protein (CRP), interleukin-6 (IL-6), albumin, prealbumin, and hemoglobin. Overall, the multivariate analysis and Kaplan-Meier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients. Conclusion Sarcopenia is closely related to higher levels of inflammation, malnutrition, and poor prognosis in patients with gastric cancer. Therefore, we should diagnose sarcopenia patients as early as possible, and give nutritional support to the patients.