Objective: To analyze the predictive value of neutrophil（NEU） count and lymphocyte（LYM） count ratio（NLR） in peripheral blood for predicting postoperative liver insufficiency（PLI） after hepatectomy for primary liver cancer. Methods: According to the inclusion and exclusion criteria, 204 patients with primary liver cancer performed with hepatectomy who were hospitalized in the Department of Hepatobiliary Surgery of Tumor Hospital Affiliated to Nantong University from January 2018 to December 2020 were selected. Patients with PLI were included in the observation group, and those without PLI were included in the control group. The clinical data of the two groups were collected, and preoperative NEU count, NLR value and indocyanine green clearance test 15-minute retention rate（ICG-R15） were compared between the two groups to analyze the application value of NLR in predicting PLI. Results: There were significant differences in preoperative NEU count, NLR and ICG-R15 between the two groups（all P＜0.05）. Univariate Logistic regression analysis showed that preoperative peripheral blood NEU, NLR and ICG-R15 were all influencing factors for the occurrence of PLI in patients with primary liver cancer after hepatectomy. ROC curve analysis showed that the AUC of NLR, ICG-R15 and their combination were 0.701, 0.603 and 0.622, respectively, and the AUC of NLR was the largest. Conclusion: Preoperative peripheral NEU count, NLR and ICG-R15 are all influencing factors of PLI in patients with primary liver cancer. NLR can effectively predict the occurrence of PLI in patients with primary liver cancer after hepatectomy, and the combination of NLR and ICG-R15 can improve the predictive value of ICG-R15 for PLI.

Objective: To investigate the influence factor of poor prognosis after hepatectomy for hepatitis B virus（HBV） related liver cancer and predictive value of γ-glutamyl transpeptidase and platelet ratio（GPR） and fibrinogen（FIB）. Method: The clinical data of 120 patients with HBV related liver cancer admitted to Cancer Hospital Affiliated to Nantong University from January 2019 to January 2020 were analyzed retrospectively. The patients were followed up and grouped. Serum GPR and FIB were detected in all patients before operation. The clinical data of all patients was collected. The grouping was counted, the GPR and FIB levels before operation were compared between the two groups. The predictive ability of GPR, FIB and combined detection on prognosis was analyzed. The influencing factors of poor prognosis in patients with HBV related liver cancer after hepatectomy were analyzed. Result: All 120 patients were followed up completely, and there were no lost patients. Sixty-nine patients（57.50%） of 120 patients had poor prognosis after operation, including 49 recurrences, 9 metastases（4 lymph node metastases, 3 intrahepatic metastases, 2 pulmonary metastases）, and 11 deaths, which were included in the poor prognosis group; 51 patients（42.50%） had no recurrence, metastasis or death and were included in the good prognosis group. The levels of GPR and FIB in poor prognosis group were significantly higher than those in good prognosis group（P＜0.05）. The results of ROC curve analysis showed that the AUC of preoperative GPR and FIB combined to predict the prognosis of patients was significantly higher than that of single prediction（P＜0.05）. The cut-off values of GPR and FIB for predicting the prognosis of patients were 0.39 and 4.32 g/L respectively. Univariate analysis showed that the proportions of vascular invasion, cirrhosis, preoperative GPR ≥0.39and preoperative FIB ≥4.32 g/L in the poor prognosis group were higher than those in the good prognosis group（P＜0.05）. Multivariate analysis showed that vascular invasion, preoperative GPR ≥0.39 and FIB level ≥4.32 g/L were independent influencing factors of poor prognosis in patients with HBV related liver cancer after hepatectomy（P＜0.05）. Conclusion: Vascular invasion, preoperative GPR ≥0.39 and FIB level ≥4.32 g/L are independent influencing factors of poor prognosis in patients with HBV related liver cancer after hepatectomy. The combined detection of preoperative GPR and FIB has a good predictive value for the prognosis of patients with HBV related liver cancer after hepatectomy.

目的 本研究旨在探讨白蛋白-胆红素(albumin-bilirubin,ALBI)分级在接受根治性手术切除的肝细胞癌患者中的预后意义.方法 回归性分析2015年01月至2018年12月间于我院收治并行手术治疗的126例肝细胞癌患者的临床病理资料、术前1周内的血清白蛋白与胆红素水平.根据白蛋白-胆红素分级,将病人分为ALBI 1级(n=69)和ALBI 2～3级(n=57).比较各项临床病理参数在两组患者中的差异,以明确白蛋白-胆红素分级与肝细胞癌患者的临床病理特征的关系.通过Kaplan-Meier生存曲线计算ALBI 1级与ALBI 2～3级患者的总体生存,组间差异比较采用log-rank检验.此外,通过Cox风险比例回归模型(LR向前法)确定白蛋白-胆红素分级在肝细胞癌患者中的独立预后价值.结果 术前高白蛋白-胆红素分级(ALBI 2～3级)与肿瘤大小(x2=7.092,P=0.008)、TNM分期(x2=11.838,P＜0.001)、肝癌BCLC临床分期(x2=6.925,P=0.031)、血管侵犯(x2=5.155,P=0.023)及PNI(x2=14.814,P＜0.001)显著相关.生存曲线表明高白蛋白-胆红素分级是肝细胞癌患者预后不佳的标志,ALBI 1级与ALBI 2～3级患者的3年总体OS分别为46.1％与15.1％,差异具有统计学意义(x2=20.738,P＜0.001).亚组分析进一步展示白蛋白-胆红素分级可以较好地区分不同TNM 分期(Ⅰ～Ⅱ期,3 年 OS:85.5％vs 33.3％,x2=6.080,P=0.014;Ⅲ 期,20.8％vs 12.3％,x2=5.929,P=0.015)或BCLC 分期(A-B 期,3 年 OS:55.0％vs 4.3％,x2=15.745,P＜0.001;C 期,23.5％vs 0％,x2=5.511,P=0.019)患者的预后结局.另外,多因素COX分析的结果揭示肿瘤直径≥5 cm(风险比HR:2.500,95％置信区间:1.109～5.635,P=0.027)、TNM Ⅲ 期(风险比 HR:3.989,95％置信区间:1.865～8.534,P＜0.001)、术前血清 AFP≥400 ng/mL(风险比 HR:1.779,95％置信区间:1.117～2.835,P=0.015)及 ALBI 2～3 级(风险比 HR:2.129,95％置信区间:1.305～3.471,P=0.002)是肝细胞癌患者的独立预后因素.结论 白蛋白-胆红素分级有助于区分接受根治性肝切除治疗的肝细胞癌患者的生存结局,是一项有价值的预后评价指标.

Objective:To compare the dose distribution of conventional radiotherapy (CRT) with that of the intensity modulation radiation therapy (IMRT) in breast cancer patients after breast-conserving surgery (BCR), and to provide evidence for the application of IMRT in the treatment of the patients. Methods: The 3-dimensional treatment planning system was used to design CRT and IMRT plans for 10 post-BCR patients, with the prescribed dosage as 50Gy/25f. CRT and IMRT were compared by evaluation of the dose volume, dose profile and dose distribution homogeneity indices. Results: The V95%, V105%, V110% and V115% of PTV for CRT were (98.3+1.9)%, (42.7+15.1)%, (8.2+8.7)% and (2.2+5.3)%, and those for IMRT were (98.5+1.0)%, (8.6+4.5)%, (0+0.4)% and 0, respectively. Statistically significant differences were observed in V105%and V110% (P 0.05) but not in V95% (P 0.05). Dose distribution homogeneity indices of CRT and IMRT were 1.30±0.14 and 1.12±0.03, respectively, with statistically significant differences (P 0.05). Comparing with CRT, IMRT reduced the V30 and V40 of the heart by 70.69% and 93.33%, and the V20 and V30 of the lungs by 22.27% and 40.35%, respectively, both with statistically significant differences (P 0.05). Conclusion: For PTV after breast-conserving surgery, both CRT and IMRT plans had a satisfactory coverage, but the latter was more conformal and had a more uniform dose distribution than the former, and it could effectively reduce the radiation dose for normal organs such as the heart and lungs.

Objective To study the effect of radiotherapy combined with Tetrandrine(Tet)in the treatment of locally advanced and recurrent rectal cancer.Methods The data of 33 cases of locally advanced and recurrent rectal cancer from 2000 to 2005 were analysed retrospectively,of which 15 patients received radiotherapy(radiotherapy group),18 cases received radiotherapy combined with Tet(Tet group).All patients were treated with conventional radiotherapy by 15MVX ray to a total dose of 60-66Gy in 6-7 weeks for the respectable disease.During radiotherapy of the Tet group,all the patients took Tet 40mg every time and three times per day.Results Local symptom remission rate was 100% for the two groups.Symptoms remission beginning time of the Tet group was shorter than the radiotherapy group,but had no statistical difference(P0.05).Hematochezia and pain relief sustained median time of the Tet group and the radiotherapy group were 15 months and 8 months,and there was a significant difference between the two groups(P0.05).Effective power of the Tet group and the radiotherapy group were 72.2% and 64.3%,there was no significant difference(P0.05).1,2,3-year survival rates of the Tet group and the radiotherapy group were 77.8%,44.4%,27.8% and 64.3%,33.3%,20.0%,there was no significant difference(P0.05).Conclusion Tet with radiotherapy can effectively extend locally symptom remission time for advanced and recurrent rectal cancer,and survival rate have a trend of improvement.Tet may be an ideal radiosensitizer.

Objective To observe the radiosensitizing effect and side-effects of tetrandrine in combination with radiotherapy in treatment of nasopharyngeal carcinoma(NPC).Methods 112 patients with NPC were randomly divided into the sensitization group and the control group.In the sensitization group,all patients were treated by conventional fractional radiotherapy with a total dose of 66-70 Gy/33-36 F/6-7 W by 6 MV-X-ray.During radiotherapy of the sensitization group,all the patients took tetrandrine 40 mg every time and three times per day.In the Control group,all patients were given to the same as the sensitization group in radiotherapy.Results The short-term overall response rate of the sensitization group(89.3%) was significantly higher than the control group(69.6%).There was not a significant difference between the 2 groups(P0.05)on side-effects.Conclusion Tetrandrine is an ideal radiosensitizer during NPC radiotherapy.