Objective:To assess prognostic factors and validate the effectiveness of recursive partitioning analysis (RPA) classes and graded prognostic assessment (GPA) in 290 non-small cell lung cancer (NSCLC) patients with bra...Objective:To assess prognostic factors and validate the effectiveness of recursive partitioning analysis (RPA) classes and graded prognostic assessment (GPA) in 290 non-small cell lung cancer (NSCLC) patients with brain metastasis (BM).Methods:From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors (TKIs) in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox's regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models (RPA and GPA) were validated respectively.Results:All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval (95% CI) was 14 (12.3-15.8) months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different (P<0.001).In the multivariate analysis as RPA and GPA entered Cox's regression model,Karnofsky performance status (KPS) ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion:KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.展开更多
Dear Editor,The placenta separates fetus and mother,with the trophoblast playing a most important role in defense against potential harm from the maternal immune system.Although the placenta is normal tissue,it shares...Dear Editor,The placenta separates fetus and mother,with the trophoblast playing a most important role in defense against potential harm from the maternal immune system.Although the placenta is normal tissue,it shares several common features with malignant cells.1 Based on similar strategies,these cells are able to successfully coexist in an immunologically hostile environment.2 A detailed analysis and comparison of different placental model systems will not only contribute to our in-depth understanding of the exciting field of placental development research but also may offer valuable insights on the broad field of cancer studies.展开更多
Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use ...Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.Methods:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to 2018.During the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered mode.The effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered electromyography.During the study,the III,V,VI,VII,and XII cranial nerves were identified intraoperatively.Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group.The average length of hospitalization was 9 days.Conclusion:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study group.Based on our experience,the trigger electromyography methodology appears quite promising and requires further research.展开更多
A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary l...A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary lesions,who underwent modified hemilaminectomy,were studied retrospectively.The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm),in which the inner parts of the medial and lateral laminae were mostly undercut for wider view.Spinal lesions were cervical in 21 cases,thoracic in 12 cases,lumbar in 10 cases,and multiple in 2 cases.Forty-three cases were completely excised via hemilaminectomy alone.Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy.With respect to neurological status,the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up.At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI),none of the subjects showed spinal deformity or instability.By preserving musculoligamentous attachments and posterior bony elements as much as possible,the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors,especially in patients with meningiomas and neurinomas.展开更多
文摘Objective:To assess prognostic factors and validate the effectiveness of recursive partitioning analysis (RPA) classes and graded prognostic assessment (GPA) in 290 non-small cell lung cancer (NSCLC) patients with brain metastasis (BM).Methods:From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors (TKIs) in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox's regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models (RPA and GPA) were validated respectively.Results:All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval (95% CI) was 14 (12.3-15.8) months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different (P<0.001).In the multivariate analysis as RPA and GPA entered Cox's regression model,Karnofsky performance status (KPS) ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion:KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.
基金supported by the CAMS Innovation Fund for Medical Sciences(CIFMS)[2019-I2M-1-003,2016-I2M-1-001,2016-I2M-3-005]National Key R&D Program of China[2017YFC0908401]+2 种基金the Open Project Program of the State Key Laboratory of Proteomics[SKLP-O201705]the National Natural Science Foundation of China[31571331,61873075,31871338]the Natural Science Foundation for Distinguished Young Scholars of Heilongjiang Province[JQ2019C004].
文摘Dear Editor,The placenta separates fetus and mother,with the trophoblast playing a most important role in defense against potential harm from the maternal immune system.Although the placenta is normal tissue,it shares several common features with malignant cells.1 Based on similar strategies,these cells are able to successfully coexist in an immunologically hostile environment.2 A detailed analysis and comparison of different placental model systems will not only contribute to our in-depth understanding of the exciting field of placental development research but also may offer valuable insights on the broad field of cancer studies.
文摘Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.Methods:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to 2018.During the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered mode.The effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered electromyography.During the study,the III,V,VI,VII,and XII cranial nerves were identified intraoperatively.Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group.The average length of hospitalization was 9 days.Conclusion:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study group.Based on our experience,the trigger electromyography methodology appears quite promising and requires further research.
文摘A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary lesions,who underwent modified hemilaminectomy,were studied retrospectively.The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm),in which the inner parts of the medial and lateral laminae were mostly undercut for wider view.Spinal lesions were cervical in 21 cases,thoracic in 12 cases,lumbar in 10 cases,and multiple in 2 cases.Forty-three cases were completely excised via hemilaminectomy alone.Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy.With respect to neurological status,the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up.At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI),none of the subjects showed spinal deformity or instability.By preserving musculoligamentous attachments and posterior bony elements as much as possible,the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors,especially in patients with meningiomas and neurinomas.
