AIM:The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of ...AIM:The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of node-negative EGC are much better than those of node-positive EGC. This study examined the factors related to lymph node metastasis in EGC to determine the appropriate treatment for EGC.METHODS: We investigated 748 patients with EGC who underwent surgery between January 1985 and December 1999 at the Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hospital. Several clinicopathologic factors were investigated to analyze their relationship to lymph node metastasis: age, sex, tumor location, tumor size, gross type, histologic type, depth of invasion, extent of lymph node dissection, type of operation,and DNA ploidy.RESULTS:Lymph node metastases were found in 75 patients (10.0%). Univariate analysis showed that male sex, tumor size larger than 2.0cm, submucosal invasion of tumor, histologic differentiation, and DNA ploidy pattern were risk factors for regional lymph node metastasis in EGC patients. However, a multivariate analysis showed that three risk factors were associated with lymph node metastasis:large tumor size, undifferentiated histologic type and submucosal invasion. No statistical relationship was found for age, sex, tumor location, gross type, or DNA ploidy in multivariate analysis. The 5-year survival rate was 94.2% for those without lymph node metastasis and 87.3% for those with lymph node metastasis, and the difference was significant (P<0.05).CONCLUSION: In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore,a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.展开更多
Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） ...Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods： Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1：1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase （KPC） gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results： The independent risk factors for CRKP infection were admission to Intensive Care Unit （odds ratio [OR]： 15.486, 95% confidence interval [CI]： 3.175-75.541, P 〈 0.001）; use of I3-1actams and [3-1actamase inhibitor combination （OR： 4.765, 95% CI： 1.508-15.055, P = 0.008）： use of cephalosporins （OR： 8.033, 95% CI： 1.623-39.763, P = P= 0.019）： and indwelling of urethral catheter （OR： 6.164, 95% CI： 1.847 0.011 ）; fluoroquinolones （OR： 6.090, 95% CI： 1.343-27.613, -20.578, P = 0.003）. However, older age （OR： 1.079, 95% CI： 1.005-1.158, P= 0.036）, Charlson comorbidity index （OR： 4.690, 95% CI：2.094-10.504, P= 0.000）, and aminoglycoside use （OR： 670.252, 95% CI： 6.577-68,307.730, P = 0.006） were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion： Implementation of infection control measures and protection of the immunefunction are crucial.展开更多
文摘AIM:The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of node-negative EGC are much better than those of node-positive EGC. This study examined the factors related to lymph node metastasis in EGC to determine the appropriate treatment for EGC.METHODS: We investigated 748 patients with EGC who underwent surgery between January 1985 and December 1999 at the Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hospital. Several clinicopathologic factors were investigated to analyze their relationship to lymph node metastasis: age, sex, tumor location, tumor size, gross type, histologic type, depth of invasion, extent of lymph node dissection, type of operation,and DNA ploidy.RESULTS:Lymph node metastases were found in 75 patients (10.0%). Univariate analysis showed that male sex, tumor size larger than 2.0cm, submucosal invasion of tumor, histologic differentiation, and DNA ploidy pattern were risk factors for regional lymph node metastasis in EGC patients. However, a multivariate analysis showed that three risk factors were associated with lymph node metastasis:large tumor size, undifferentiated histologic type and submucosal invasion. No statistical relationship was found for age, sex, tumor location, gross type, or DNA ploidy in multivariate analysis. The 5-year survival rate was 94.2% for those without lymph node metastasis and 87.3% for those with lymph node metastasis, and the difference was significant (P<0.05).CONCLUSION: In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore,a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.
基金This work was supported by the National Natural Science Foundation of China under Grant （No. 81201338）.
文摘Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods： Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1：1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase （KPC） gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results： The independent risk factors for CRKP infection were admission to Intensive Care Unit （odds ratio [OR]： 15.486, 95% confidence interval [CI]： 3.175-75.541, P 〈 0.001）; use of I3-1actams and [3-1actamase inhibitor combination （OR： 4.765, 95% CI： 1.508-15.055, P = 0.008）： use of cephalosporins （OR： 8.033, 95% CI： 1.623-39.763, P = P= 0.019）： and indwelling of urethral catheter （OR： 6.164, 95% CI： 1.847 0.011 ）; fluoroquinolones （OR： 6.090, 95% CI： 1.343-27.613, -20.578, P = 0.003）. However, older age （OR： 1.079, 95% CI： 1.005-1.158, P= 0.036）, Charlson comorbidity index （OR： 4.690, 95% CI：2.094-10.504, P= 0.000）, and aminoglycoside use （OR： 670.252, 95% CI： 6.577-68,307.730, P = 0.006） were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion： Implementation of infection control measures and protection of the immunefunction are crucial.
