BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and t...BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be defined.AIM To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres.Patient data were retrospectively collected from medical records.Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN.Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1.Kaplan-Meier analysis was applied to estimate survival outcomes.Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 years.Males:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases analysed.Most distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine component.Ninety-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of origin.Chemotherapy was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion.In localised cases,median recurrence free survival(RFS);14.0 months(95%CI:9.2-24.展开更多
目的探讨新辅助放化疗(nCRT)联合根治性手术治疗局部进展期直肠癌的安全性和疗效。方法回顾性分析首都医科大学附属北京朝阳医院普通外科2013年3月至2018年12月收治的208例局部进展期直肠癌病人的临床资料。分为nCRT组(97例)和直接手术...目的探讨新辅助放化疗(nCRT)联合根治性手术治疗局部进展期直肠癌的安全性和疗效。方法回顾性分析首都医科大学附属北京朝阳医院普通外科2013年3月至2018年12月收治的208例局部进展期直肠癌病人的临床资料。分为nCRT组(97例)和直接手术组(111例)。比较两组手术资料、围手术期并发症和局部复发率以及生存情况。结果nCRT组肿瘤下缘与肛缘距离显著低于直接手术组[(5.8±2.2)cm vs.(6.9±2.9)cm,P=0.003]。nCRT组的病理完全缓解率(pCR)为19.6%,淋巴结清扫数量[(12.0±4.7)枚vs.(16.6±6.7)枚,P<0.001]、脉管浸润率(16.5%vs.30.6%,P=0.017)和癌结节检出率(4.1%vs.11.7%,P=0.046)均显著低于直接手术组。与直接手术组相比,nCRT组手术时间明显延长[(251.9±70.6)min vs.(227.4±85.0)min,P=0.015]、术中失血量显著增加(165 mL vs.125 m L,P=0.041)、保护性造口率明显增加(85.1%vs.28.0%,P<0.001)。两组的保肛率、围手术期并发症总发生率、术后平均住院时间、造口还纳率等差异无统计学意义。随访时间34(6~83)个月,随访率91.4%。nCRT组的局部复发率明显降低(5.5%vs.15.2%,P=0.03),5年总体生存率(OS)(77.4%vs.59.5%,P=0.047)和无病生存率(DFS)(75.1%vs.61.6%,P=0.015)显著升高。nCRT组中pCR病人的5年OS显著高于非pCR病人(100.0%vs.69.3%,P=0.033)。结论虽然nCRT显著增加了直肠癌病人的保护性造口率、延长手术时间和增加术中出血量,但能够明显降低肿瘤的局部复发率,增加病人5年OS和DFS。展开更多
BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospect...BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.展开更多
Background： The effectiveness of neoadjuvant chemoradiotherapy （NCRT） treatment for patients with esophageal carcinoma （EC） remains controversial. The aim of this study was to compare the effect of NCRT followed ...Background： The effectiveness of neoadjuvant chemoradiotherapy （NCRT） treatment for patients with esophageal carcinoma （EC） remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery （NCRTS） with surgery alone （SA） for EC. Methods： The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio （RR） with 95% confidence intervals （CI s） as effective size was determined to assess the 1-, 3-, 5-year survival rates （SRs）, postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg＇s test and Egger＇s test were used for assessing any potential publication bias. Results： Of 1120 identified studies, 16 eligible studies were included in this analysis （involving 2549 patients）. Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year （RR： 1.07, 95% CI： 1.02–1.13）, 3-year （RR： 1.26, 95% CI： 1.14–1.39）, and 5-year （RR： 1.36, 95% CI： 1.18–1.56） SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity （RR： 0.93, 95% CI： 0.82–1.05） and postoperative mortality （RR： 1.17, 95% CI： 0.56–2.44）. Conclusions： Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.展开更多
Background： There has been no external validation of survival prediction models for severe adult respiratory distress syndrome （ARDS） with extracorporeal membrane oxygenation （ECMO） therapy in China. The aim of s...Background： There has been no external validation of survival prediction models for severe adult respiratory distress syndrome （ARDS） with extracorporeal membrane oxygenation （ECMO） therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data. Methods： A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE （Predicting death for severe ARDS on VV-ECMO）, ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction （RESP） score, a center-specific model developed lbr inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation （APACHE） II and Sequential Organ Failure Assessment （SOFA） were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve （AUC）. Results： The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 （95% confidence interval [CI], 0.659-1 .010, P = 0.007） and 0.762 （95% CI, 0.558-0.965, P = 0.035）, respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 （95% CI, 0.571-1.009, P = 0.038）. However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since Conclusions： The RESP, APCHAE 11, and SOFA scorings only one patient died six months postdischarge. syste展开更多
文摘BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be defined.AIM To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres.Patient data were retrospectively collected from medical records.Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN.Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1.Kaplan-Meier analysis was applied to estimate survival outcomes.Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 years.Males:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases analysed.Most distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine component.Ninety-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of origin.Chemotherapy was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion.In localised cases,median recurrence free survival(RFS);14.0 months(95%CI:9.2-24.
文摘目的探讨新辅助放化疗(nCRT)联合根治性手术治疗局部进展期直肠癌的安全性和疗效。方法回顾性分析首都医科大学附属北京朝阳医院普通外科2013年3月至2018年12月收治的208例局部进展期直肠癌病人的临床资料。分为nCRT组(97例)和直接手术组(111例)。比较两组手术资料、围手术期并发症和局部复发率以及生存情况。结果nCRT组肿瘤下缘与肛缘距离显著低于直接手术组[(5.8±2.2)cm vs.(6.9±2.9)cm,P=0.003]。nCRT组的病理完全缓解率(pCR)为19.6%,淋巴结清扫数量[(12.0±4.7)枚vs.(16.6±6.7)枚,P<0.001]、脉管浸润率(16.5%vs.30.6%,P=0.017)和癌结节检出率(4.1%vs.11.7%,P=0.046)均显著低于直接手术组。与直接手术组相比,nCRT组手术时间明显延长[(251.9±70.6)min vs.(227.4±85.0)min,P=0.015]、术中失血量显著增加(165 mL vs.125 m L,P=0.041)、保护性造口率明显增加(85.1%vs.28.0%,P<0.001)。两组的保肛率、围手术期并发症总发生率、术后平均住院时间、造口还纳率等差异无统计学意义。随访时间34(6~83)个月,随访率91.4%。nCRT组的局部复发率明显降低(5.5%vs.15.2%,P=0.03),5年总体生存率(OS)(77.4%vs.59.5%,P=0.047)和无病生存率(DFS)(75.1%vs.61.6%,P=0.015)显著升高。nCRT组中pCR病人的5年OS显著高于非pCR病人(100.0%vs.69.3%,P=0.033)。结论虽然nCRT显著增加了直肠癌病人的保护性造口率、延长手术时间和增加术中出血量,但能够明显降低肿瘤的局部复发率,增加病人5年OS和DFS。
文摘BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.
文摘Background： The effectiveness of neoadjuvant chemoradiotherapy （NCRT） treatment for patients with esophageal carcinoma （EC） remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery （NCRTS） with surgery alone （SA） for EC. Methods： The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio （RR） with 95% confidence intervals （CI s） as effective size was determined to assess the 1-, 3-, 5-year survival rates （SRs）, postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg＇s test and Egger＇s test were used for assessing any potential publication bias. Results： Of 1120 identified studies, 16 eligible studies were included in this analysis （involving 2549 patients）. Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year （RR： 1.07, 95% CI： 1.02–1.13）, 3-year （RR： 1.26, 95% CI： 1.14–1.39）, and 5-year （RR： 1.36, 95% CI： 1.18–1.56） SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity （RR： 0.93, 95% CI： 0.82–1.05） and postoperative mortality （RR： 1.17, 95% CI： 0.56–2.44）. Conclusions： Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.
文摘Background： There has been no external validation of survival prediction models for severe adult respiratory distress syndrome （ARDS） with extracorporeal membrane oxygenation （ECMO） therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data. Methods： A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE （Predicting death for severe ARDS on VV-ECMO）, ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction （RESP） score, a center-specific model developed lbr inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation （APACHE） II and Sequential Organ Failure Assessment （SOFA） were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve （AUC）. Results： The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 （95% confidence interval [CI], 0.659-1 .010, P = 0.007） and 0.762 （95% CI, 0.558-0.965, P = 0.035）, respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 （95% CI, 0.571-1.009, P = 0.038）. However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since Conclusions： The RESP, APCHAE 11, and SOFA scorings only one patient died six months postdischarge. syste
