Background: Apatinib has a certain efficacy for advanced esophageal squamous cell carcinoma (ESCC). This study aimed to investigate the prognostic significance of platelet (PLT) and platelet to mean platelet volume (PLT/MPV) ratio for advanced ESCC patients with apatinib second-line or late-line treatment. Methods: A retrospective study included 80 patients with advanced ESCC who received Apatinib >= 2 lines targeted therapy. We collected baseline clinical characteristics and blood parameters from the patients. Kaplan-Meier plots and univariate and multivariate analysis were used to find the factors related to progression-free survival (PFS). Results: The optimal cut-off values of PLT and PLT/MPV ratio were determined by X-tile software. Kaplan-Meier analysis demonstrated that patients in the high PLT group had better PFS than those in the low PLT group (156 d vs 80 d, P <.001), and patients in the high PLT/MPV ratio group had better PFS than those in low PLT/MPV ratio group (157 d vs 85 d, P <.001). Univariate analysis revealed pretreatment PLT and PLT/MPV ratio were significantly correlated with PFS. Multivariate analysis revealed high levels of pretreatment PLT/MPV ratio was an independent predictor of longer PFS (HR: 0.257, 95% CI: 0.089-0.743, P = .012). Conclusion: High levels of baseline PLT and PLT/MPV may indicate a better prognosis in apatinib >= 2 lines treatment for advanced ESCC patients.

目的:研究基线外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)和全身免疫炎症指数(systemic inflammation index,SII)对转移性结直肠癌(metastatic colorectal cancer,mCRC)患者接受西妥昔单抗为基础一线治疗疗效的预测作用.方法:回顾性分析接受西妥昔单抗为基础一线治疗的mCRC患者123例.收集患者的基线临床特征和血液学参数.采用Kaplan-Meier分析和COX回归分析方法探讨与无进展生存(progression-free survival,PFS)相关的因素.结果:受试者工作特征(receiver operating characteristic,ROC)曲线分析确定基线NLR最佳截断点为2.25(敏感度为71.4％,特异度为74.6％),基线PLR最佳截断点为152.53(敏感度为64.3％,特异度为76.1％),基线SII最佳截断点为472.09(敏感度为73.2％,特异度为74.6％).Kaplan-Meier分析显示,基线高NLR组患者的PFS期较基线低NLR组更短(6.86vs 12.03个月,P＜0.001),基线高PLR组患者的PFS期较基线低PLR组的更短(6.88 vs 11.5个月,P＜0.001),基线高SII组患者的PFS期较基线低SII组的更短(6.83 vs 12.03个月,P＜0.001).单因素分析显示,体质指数、原发肿瘤是否切除、有无肝转移、首次疗效评估以及基线NLR、PLR和SII与PFS显著相关.多因素分析显示,基线NLR(风险比:1.981,95％置信区间:1.199～3.273,P=0.008)、PLR(风险比:1.926,95％置信区间:1.219～3.043,P=0.005)、SII(风险比为 1.965,95％置信区间:1.141～3.384,P=0.015)是PFS的独立影响因素.结论:基线外周血NLR、PLR和SII是mCRC患者接受西妥昔单抗为基础一线治疗的PFS的独立影响因素,高水平的基线外周血NLR、PLR和SII可能提示疗效较差.

Objectives This study aimed to create a nomogram for the risk prediction of neoadjuvant chemoradiotherapy (nCRT) resistance in locally advanced rectal cancer (LARC). Methods Clinical data in this retrospective study were collected from a total of 135 LARC patients admitted to our hospital from June 2016 to December 2020. After screening by inclusion and exclusion criteria, 62 patients were included in the study. Texture analysis (TA) was performed on T2WI and DWI images. Patients were divided into response group (CR+PR) and no-response group (SD+PD) according to efficacy assessment. Multivariate analysis was performed on clinicopathology, IVIM-DWI and texture parameters for screening of independent predictors. A nomogram was created and model fit and clinical net benefit were assessed. Results Multivariate analysis of clinicopathology parameters showed that the differentiation and T stage were independent predictors (OR values were 14.516 and 11.589, resp.; P<0.05). Multivariate analysis of IVIM-DWI and texture parameters showed that f value and Rads-score were independent predictors (OR values were 0.855, 2.790, resp.; P<0.05). In this study, clinicopathology together with IVIM-DWI and texture parameters showed the best predictive efficacy (AUC=0.979). The nomogram showed good predictive performance and stability in identifying high-risk LARC patients who are resistant to nCRT (C-index=0.979). Decision curve analyses showed that the nomogram had the best clinical net benefit. Ten-fold cross-validation results showed that the average AUC value was 0.967, and the average C-index was 0.966. Conclusions The nomogram combining the differentiation, T stage, f value and Rads-score can effectively estimate the risk of nCRT resistance in patients with LARC.

目的:探讨直肠癌肺转移患者的一般临床特征,分析患者术前外周血中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)对直肠癌肺转移患者预后的意义.方法:回顾性分析2016年1月—2018年12月在安徽医科大学附属省立医院就诊的104例直肠癌伴肺转移患者的临床病历资料,进行复发模式分析,并进一步对其中55例具有完整血液学参数的首诊直肠癌肺转移患者进行血液学分析.根据治疗前的血液学指标构建受试者工作特征(receiver operating characteristic,ROC)曲线以确定NLR、PLR、全身免疫炎症指数(systemic immune-inflammation index,SII)、平均血小板体积(mean platelet volume,MPV)、癌胚抗原(carcinoembryonic antigen,CEA)和糖类抗原199(carbohydrate antigen 19-9,CA19-9)水平预测直肠癌肺转移患者预后的最佳截断值.采用曲线下面积(area under the curve,AUC)评价其诊断价值.生存分析采用Kaplan-Meier法,差异分析采用log-rank检验,多因素分析采用COX回归分析.结果:直肠癌患者术后第1、2、3、4和5年的肺转移发生率分别为22.12％、28.85％、23.00％、10.58％和4.80％,提示肺转移主要发生在术后前3年.单因素分析显示,下段直肠癌(肿瘤下缘距离肛缘<7 cm)、低分化腺癌、远处淋巴结转移、T分期≥T3、N2患者的总生存(overall survival,OS)率曲线显著降低(P<0.05).多因素分析显示,下段直肠癌、低分化腺癌、术后T分期≥T3和N2是预后不良的独立影响因素(P<0.05),而下段直肠癌、术后T分期≥T3和低分化腺癌是至肺转移时间的独立影响因素(P<0.05).术前NLR升高、PLR升高以及高水平CEA和CA19-9患者的术后OS期和至肺转移时间均显著缩短(P<0.05),术前高水平MPV患者的术后OS期显著缩短(P<0.05).结论:直肠癌肺转移主要发生在术后3年内,原发肿瘤部位、肿瘤分化程度、术前NLR、PLR、CEA和CA19-9可能是直肠癌肺转移患者预后的独立影响因素.

目的 分析以肺转移为首发表现的结肠癌患者的预后的因素.方法 回顾性分析2011年10月～2020年4月安徽医科大学附属省立医院确诊的以肺转移为首发表现的47例结肠癌患者资料,采用Kaplan-Meier法分析临床病理特征(年龄、性别、原发灶位置、N分期、分化程度、有无肠梗阻、肺部病灶位置、有无肝转移、肿瘤标志物CEA及CA199)与无疾病生存期(DFS)的关系,并采用多因素Cox模型分析影响患者DFS的独立因素.结果 全组患者中位DFS为16.5个月.单因素分析显示,肺部病灶位置及有无肝转移与DFS有关(P<0.05);而年龄、性别、原发灶位置、N分期、分化程度、有无肠梗阻、肿瘤标志物CEA及CA199与DFS无相关性(P>0.05).多因素分析显示,肺部病灶位置、有无肝转移为影响DFS的独立因素.结论 在以肺转移为首发表现的结肠癌中肺部病灶位置、有无肝转移可能为影响疾病进展的独立预后因素.

根据国家癌症中心发布的最新癌症报告,胃癌是我国发病率第二位、死亡率第三位的恶性肿瘤.胃癌多起病隐匿,约35％的患者在就诊时已有远处转移.部分患者早期手术治疗后仍出现复发或转移,对这些患者来说,全身性治疗是治疗的支柱,但一线治疗失败后的二线治疗尚无标准、有效的化疗方案.近些年,抗血管生成治疗在晚期胃癌的治疗中地位凸显,逐渐被临床医师所重视.

目的 探讨胃癌术后外周血单核细胞、淋巴细胞水平变化对胃癌肝转移患者预后的影响.方法 回顾性分析63例胃癌术后发生肝转移患者的临床资料,分析不同临床特征与肝转移时间的关系、单核细胞与肝转移时间的关系及不同临床特征与生存时间的关系、淋巴细胞与生存时间的关系.结果 共纳入胃癌肝转移患者63例,其中单核细胞升高患者27例,降低患者36例,胃癌术后中位肝转移时间为8.47个月;术后单核细胞升高患者中位肝转移时间为11.97个月,单核细胞降低患者的肝转移时间为7.13个月,二者比较,差异有统计学意义(P<0.05);Cox单因素分析显示,病理分化程度、N分期、原发灶大小、单核细胞水平变化影响胃癌肝转移时间(P<0.05);Cox多因素分析显示,N分期、术后单核细胞变化是影响胃癌术后肝转移时间的独立预后因素;Kaplan-Meier生存分析显示,术后单核细胞升高患者发生肝转移的时间晚于术后单核细胞降低患者(P<0.05).术后淋巴细胞升高患者23例,降低患者40例,肝转移发生后中位生存时间为10.04个月;术后淋巴细胞升高患者中位生存期为11.33个月,术后降低患者生存期为6.93个月,二者比较,差异有统计学意义(P<0.05);Cox单因素分析显示,胃癌原发灶大小、术后淋巴细胞升高、肝转移灶数目、肝转移时ALB升高是胃癌肝转移预后的影响因素(P<0.05);Cox多因素分析显示,术后淋巴细胞变化和原发灶大小是影响肝转移后生存期的独立预后因素.Kaplan-Meier生存曲线显示,术后淋巴细胞升高患者生存期长于降低患者(P<0.05).结论 胃癌术后外周血单核细胞升高的患者发生肝转移时间较晚,淋巴细胞升高患者总生存期较长,而胃癌原发灶大小是肝转移后总生存期的独立危险因素.