Organ��berschreitende Schilddr��senkarzinome

Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only.     

肝癌伴胆管癌栓的临床病理及预后分析

目的 探讨肝癌伴胆管癌栓的临床病例特点对预后的影响.方法 回顾性分析了1995-2005年21例肝癌伴胆管癌栓的ll缶床病例特点与预后情况.结果 该组HCC伴胆管癌栓病人的1年生存率为66.7%,3年生存率为42.9%,中位生存时间为29.5个月.有无癌栓侵犯胆管壁的两组病例生存率差异无显著意义(P>0.05),癌栓位置不同生存率无差别(P>0.05).结论 对于HCC伴胆管癌栓病例,胆管壁受侵犯和胆管内癌栓的位置不影响预后.     

Laparoscopic Cholecystectomy: Its Effect on the Prognosis of Patients with Gallbladder Cancer

Numerous reports suggest more recurrences and a worse prognosis after laparoscopic cholecystectomy (LC) than after open cholecystectomy (OC). The objective of this study was to compare the survival rate of patients undergoing a laparoscopic procedure versus those undergoing an open operation. A series of 24 patients with gallbladder cancer detected after LC were compared with 40 consecutive patients with gallbladder cancer detected after OC. Patients were matched by wall invasion, age, and whether they underwent a reoperation or only cholecystectomy. The series included 2 patients with in situ tumors, 2 with mucosal tumors, 1 with muscular invasion, 13 with subserosal invasion, and 6 with serosal invasion. Recurrences were observed in 4 of the 10 patients with subserosal compromise who underwent reoperation. In contrast, in the OC group of 26 patients with subserosal invasion, 20 of whom were reoperated, only 2 had a recurrence. Of the six patients with serosal infiltration, three in the LC underwent reoperation, all of whom had recurrences that precluded resection. Of the 12 patients in the OC group who presented with serosal invasion, 6 were reoperated and 4 had a recurrence. Overall survival curves did not show differences when patients were compared according to the type of procedure performed. Similarly, the analysis of patients according to the level of wall invasion indicated that there was no significant difference in survival. Although multiple reports have shown a worse prognosis for patients with gallbladder cancer undergoing LC, this study did not show a significant survival difference between the two methods. Although there is a higher but insignificant recurrence rate among the patients who underwent LC, this is not translated into survival.     

胃类癌生物学行为及与预后关系的临床研究

目的分析胃类癌特有的生物学行为与肿瘤预后之间的关系。方法总结1964年1月至2005年1月间收治的26例经手术切除、病理证实的胃类癌病例资料,对其肿瘤大小、胃壁侵犯深度、区域淋巴结转移、肝转移、术后辅助化疗和5年生存率进行分析。结果本组患者平均年龄58岁。其中18例(69.2%)肿瘤侵犯胃浆膜;12例(46.2%)有区域淋巴结转移;10例(38.5%)术后接受辅助化疗;14例(53.8%)在随访中出现肝转移。肿瘤大小与胃壁侵犯深度、区域淋巴结转移和肝转移的发生及5年生存率无关(P>0.05)。生存分析提示浆膜浸润、淋巴结转移和肝转移影响生存时间(P<0.05)。有浆膜浸润、淋巴结转移和肝转移的患者5年生存率分别为16.7%、16.7%和0,预后较差;化疗与否5年生存率比较,差异无统计学意义(P<0.05)。结论胃类癌术后辅助化疗并无益处,其预后与肿瘤的浸润深度、淋巴结转移和肝转移有关。     

The prognostic significance of bladder neck invasion in prostate cancer: is microscopic involvement truly a T4 disease?

Since the widespread of prostate‐specific antigen‐based screening, prostate cancer at clinical stage T4 has become rare. Most bladder invasion is actually detected on radical prostatectomy specimens as a microscopic bladder neck involvement (BNI). The 2002 Tumour‐Node‐Metastasis (TNM) classification system classified prostate cancer with BNI within a unified pT4 category and rendered it equivalent to invasion into the pelvic wall musculature or external sphincter; this decision is controversial. Various series have assessed the clinical relevance and the effect of BNI on prognosis. This evidence‐based review provides evidence that BNI should be assigned within the subset of pT3 stage, and that further improvement of the actual TNM staging system should be considered. However, BNI remains strongly associated with adverse pathology and should be regarded as a factor that worsens the prognosis of the underlying tumour stage.     

Classification of aerodigestive tract invasion from thyroid cancer

Background

Widely invasive extrathyroidal thyroid cancer invading the aerodigestive tract (ADT) including larynx, trachea, hypopharynx, and/or esophagus occurs in 1–8 % of patients with thyroid cancer and is classified as T4a (current UICC/AJCC system). The T4a stage is associated with impaired tumor-free survival and increased disease-specific mortality. Concerning prognosis and outcome, further subdivisions of the T4a stage, however, have not been made so far.

Methods

This study is based on a systematic review of the relevant literature in the PubMed database.

Results

Retrospective studies suggest a better outcome in patients with invasion of the trachea or the esophagus when compared to laryngeal invasion. Regarding surgical strategies, ADT invasion can be classified based on a three-dimensional assessment determining surgical resection options. Regardless of the invaded structure, tumor infiltration of the ADT can be subdivided into superficial, deep extraluminal, and intraluminal invasion. In contrast to superficial ADT invasion, allowing tangential incomplete wall resection (shaving/extramucosal esophagus resection), deeper wall and intraluminal invasions require complete wall resection (either window or sleeve). Based on the Dralle classification (types 1–6), particularly airway invasion, can be further classified according to the vertical and horizontal extents of tumor invasion.

Conclusions

The Dralle classification can be considered as a reliable subdivision system evaluated regarding surgical options as well as oncological outcome. However, further studies determining the prognostic impact of this technically oriented classification system are required.     

胰头癌的临床病理特点与根治术后预后的关系

目的　探讨胰头癌临床病理特点与根治术后预后的关系。方法　回顾分析 5 6例行胰头十二指肠切除术的胰头癌病人的临床病理特点 ,并用Kaplan Meier法、log rank法及秩和检验分析术后生存时间及生存时间之间的差异。结果　胰腺前方被膜及组织被肿瘤侵犯的 19例较未被侵犯的 37例、门静脉系被肿瘤侵犯的 18例较未被侵犯的 38例、淋巴结转移的 2 9例较无转移的 2 7例、腹膜种植转移的 3例较无种植转移的 5 3例、肝转移的 5例较无转移的 5 1例、远隔脏器转移 (包括腹膜种植转移和肝转移在内 )的 11例较无转移的 4 5例术后生存率均低 (P >0 0 5 )。而肿瘤大小 ,胰后面组织、胰内胆管、十二指肠壁、动脉系、胰腺外神经丛等被肿瘤侵犯与否与术后生存率均无关。结论　在胰头癌 ,淋巴结转移、腹膜种植转移及肝等远隔脏器转移、胰腺前方被膜及组织和门静脉系受侵可能是胰头十二指肠切除术后的预后决定因素。     

METASTATIC CARCINOMA IN THE NECK: A CLINICAL,COMPUTERIZED TOMOGRAPHY SCAN AND ULTRASOUND STUDY

Metastatic cervical lymph node involvement is a major determinant of treatment planning and prognosis of upper aerodigestive tract tumours. If the metastatic tumour invades the carotid artery wall then complete tumour excision is not possible unless carotid artery ligation or replacement is planned. A prospective study was performed to assess the role of palpation, computerized tomography (CT) and B-mode ultrasound scanning in the detection of metastatic cervical lymph node involvement in patients with upper aerodigestive tract tumours. In particular, detection of carotid artery wall invasion by tumour was examined. Thirty-two neck dissection specimens were available for histopathological confirmation of findings. Palpation under general anaesthesia was 87.5% sensitive and 87.5% specific in the detection of involved nodes. If a positive finding was defined as detection of a node greater than 15 mm in largest diameter, CT scanning was 78.6% sensitive and 93.8% specific, and the sensitivity of ultrasound was 81.3% and specificity was 84.6%. Ultrasound scanning was sensitive in excluding carotid artery wall invasion, identifying five out of five cases with one false positive and no false negative reports. The combination of palpation under general anaesthesia and B-mode ultrasound imaging provides a sensitive means of detecting the presence of metastatic cervical lymphadenopathy and invasion of the carotid artery wall.     

Evaluation of chest wall resection in the patients with breast cancer involving chest wall]

Twenty-three patients with advanced or recurrent breast cancer involving bony chest wall were treated by extended full-thickness chest wall resection and immediate reconstruction. The results were as follows: 1) Distant metastases were found concurrently or subsequently in more than half of the patients. Therefore, we should regard chest wall lesions as a systemic disease. 2) Long term result was encouraging, with 73.9% local control rate. 3) Post-surgical prognosis of the patients with sternal metastasis and solitary chest wall lesions were favorable, in that order. 4) Both local control rate and survival of the patients with mediastinal invasion, however, were fairly poor. 5) Disease-free interval (D.F.I.) after mastectomy longer than 5 years correlated significantly with a long survival after chest wall resection. As a result, we confirmed that chest wall resection was the treatment of choice for the patients with long D.F.I. and solitary chest wall lesion without mediastinal invasion nor metastasis, but the postoperative systemic therapy was indispensable to improve the patient's survival.     

影响进展期大肠癌切除术后长期生存的高危因素分析

目的　探讨影响进展期大肠癌切除术后长期生存的高危因素。方法　对 117例进展期大肠癌术后病人的临床和病理学特征进行回顾性研究。结果　平均随访 8.5年 ,淋巴结转移 ,肿瘤广泛坏死和神经囊膜浸润与不良的预后有关。多元回归分析提示淋巴结转移 ,肿瘤坏死和神经囊膜浸润单独与长期生存有关。单变量分析示年龄、性别、症状持续时间、肿瘤位置、肿瘤大小、肠梗阻、肿瘤分化程度、粘蛋白、血管浸润、肿瘤肠管外围浸润的程度等因素与长期生存关系不大。结论　影响进展期大肠癌切除术后长期生存的主要因素是淋巴结转移、肿瘤坏死和神经囊膜浸润     

Therapeutic efficacy of salvage cystectomy Do results reflect natural history of bladder cancer?

In a retrospective review of patients who underwent salvage cystectomy, patients with muscle-invasive cancers who had initially presented with tumors that were pathologically T_A or T₁ appeared to have a better prognosis than those who had muscle-invasive (T₂ or T₃) cancers on initial clinical presentation. Prognosis in each group appeared to correlate with the stage of tumor at initial clinical presentation rather than with stage of tumor at recurrence after radiation therapy. Prognosis also appeared to correlate with architectural configuration of the presenting tumor as well as the type of invasion. Thus, papillary lesions with muscle invasion by a broad front of histologically cohesive blocks of cells appeared to have a better prognosis than did solid or nodular lesions that appeared to invade the muscle wall in a tentacular fashion with fingerlike tumor cell extensions that seemed to percolate through the bladder wall. Taken together, the results of treatment in these patients may have represented the intrinsic nature of their particular tumors.     

Imaging diagnosis of esophageal carcinoma by computed tomography and magnetic resonance imaging

The staging diagnosis of esophageal carcinoma is important to determine therapeutic modalities and to predict prognosis. The current status of imaging diagnosis of tumor invasion to the adjacent organs and lymph node metastasis is described. The diagnostic criteria used to determine tumor invasion to the adjacent or gans by computed tomography (CT) and magnetic resonance imaging(MRI) are displacement and compression deformity of the tracheobronchial tree and obliteration of the periaortic fat plane over more than 90 degrees of the aortic circumference. Detection of the fat plane between the esophagus and the aorta supported by density profile analyzing software on CT may enable the diagnosis of invasion. Cine-MRI imaging is also useful to obtain dynamic information on the tumor and aorta. Tumor invasion to the aortic wall can be excluded when a low-intensity stripe is recognized between the tumor and the aortic wall. Although the criterion for lymph node metastasis on CT is 10 mm or more in long transverse diameter, the diagnostic accuracy is poor. The accuracy improves when imaging patterns such as heterogeneous internal structures in the enhanced lymph nodes and/or hyperenhancement in the lymph nodes in the early phase by dynamic study are added to the diagnostic criteria. However, small metastatic lymph node remain undetected and it is difficult to diagnose negative lymph node metastasis properly on CT and MRI. It is important to have full knowledge of the advantages and limitations of each imaging modality and to obtain objective information form them.     

Immunohistochemical detection of p53 in colorectal cancer and its relationship to prognosis]

The expression of p53 in colorectal tumors was studied immunohistochemically by monoclonal antibody (PAb1801). No nuclear staining was evident in the tumor cells of colorectal adenomas. p53 immunoreactivity was found in 59 (61.5%) of 96 colorectal cancers. There was no significant correlation between the p53 immunoreactivity and histologic type, tumor size, invasion of bowel wall, lymphatic invasion, venous invasion, lymph node metastasis, peritoneal dissemination, or liver metastasis. However, the p53 negative tumors showed a recurrence rate of 3.3%, while for the p53 positive tumors a recurrence rate of 20.9%. p53 negative tumors were associated with favorable prognosis, whereas those with p53 positive tumors were related to poor prognosis. DNA polymerase alpha positive cells rate in p53 positive tumors was significantly higher than in p53 negative tumors. The results suggested that p53 immunoreactivity might possibly be a useful prognostic marker of colorectal cancers.     

Gastric involvement of oesophageal squamous cell carcinoma.

Among 402 patients with squamous cell carcinoma of the oesophagus, gastric wall involvement was evident in 32 (8.0 per cent). These could be grouped into four types according to the pattern of involvement: group 1 included six patients with gastric involvement via metastases in perigastric lymph nodes; group 2 consisted of 11 patients with gastric intramural metastasis; group 3 contained 12 with direct invasion of the gastric wall by the oesophageal squamous cell carcinoma; and group 4 three patients with intraepithelial spread of oesophageal cancer to the gastric epithelium. Prognosis was poor, all patients dying except for one in each of groups 3 and 4. The mean survival time was 5.6, 8.6, 14.8 and 18.7 months in groups 1, 2, 3 and 4, respectively. Gastric involvement via metastases to lymph nodes and by intramural metastasis therefore indicates an extremely poor prognosis, while the prognosis in groups 3 and 4 was influenced by the depth of invasion and lymph node metastasis of the oesophageal cancer. Histological examination of tissues from group 4 patients demonstrated that malignant squamous cells proliferated and invaded the gastric epithelial layer, that is, there was intraepithelial spread of the oesophageal cancer.     

The importance of neural invasion (NI) as a prognostic factor in diffuse invasive gastric cancer

The relationship between histological factors, including neural invasion (NI), and survival rates in patients with Borrmann type IV diffuse invasive gastric cancer was examined to determine the significance of NI as a prognostic factor. NI was studied histochemically in 75 patients who underwent resection after 1982, 37 of whom underwent curative resection. The 3-year and 5-year survival rates of the 37 patients who underwent curative resection were 37.2% and 12.7% respectively. Recurrence was detected as peritoneal dissemination in 19 of those patients (82.6%), and the most significant prognostic factor was the depth of wall invasio P<0.01). While NI (P=0.06) and lymph node metastasis (P=0.09) appeared to be prognostic factors, there were no significant differences. Therefore, the depth of wall invasion was classified as T2 and T3 or 4 to examine the association of NI and lymph node metastasis with prognosis, whereby NI was shown to be a significant prognostic factor in T2. In conclusion, NI may be a significant prognostic factor in patients with wall invasion of T2 without serosal invasion, as it provides a pathway for the progression to peritoneal dissemination.     

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

Purpose

We investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC).

浸润深度局限在胆囊壁内的T1和T2期胆囊癌的预后分析

目的 探讨不同治疗方式对浸润深度局限于胆囊壁内的T1、T2期胆囊癌预后的影响。方法 对浸润深度局限于胆囊壁内的45例T1和12期胆囊癌患者的预后进行回顾分析。结果 Cox多因素分析显示肿瘤浸润深度（T）、胆囊癌根治术以及术后化疗是影响预后的三个独立的因素。在未用化疗的情况下T1a期、T1b期和T2期胆囊癌在单纯胆囊切除术后的5年生存率分别为100％、67％和0,T1b期与T2期两组生存差异有统计学意义。在未用化疗的情况下T2期胆囊癌在单纯胆囊切除和胆囊癌根治术后的5年生存率分别为0和63％。T2期胆囊癌在单纯胆囊切除术后使用化疗与未用化疗的生存差异有统计学意义。结论 T1期胆囊癌预后明显优于12期胆囊癌。T1a期和T1b期胆囊癌在单纯胆囊切除术后即可获得比较满意的5年生存率。胆囊癌根治术和化疗均可以改善T2期胆囊癌的预后。     

超声造影在下腔静脉癌栓切除术中的应用

目的评估机器人辅助腹腔镜下腔静脉癌栓切除术中超声造影诊断癌栓是否侵犯静脉壁的临床价值。 方法回顾性分析解放军总医院第一医学中心2017年10月至2019年3月收治60例肾癌合并腔静脉癌栓患者的术中超声造影表现,观察、分析超声造影特征,与术中及术后病理结果相对照,以典型术中造影模式鉴别诊断癌栓是否侵犯静脉壁,诊断试验统计其敏感性、特异性、准确性、阳性预告值、阴性预告值。 结果60例腔静脉癌栓患者均接受了机器人辅助腹腔镜根治性肾切除联合下腔静脉内癌栓切除术。癌栓侵犯下腔静脉壁典型的超声造影表现为癌栓与下腔静脉壁同步高增强,下腔静脉壁连续性差,癌栓未侵犯下腔静脉壁典型的超声造影表现为癌栓与下腔静脉壁之间可见造影剂通过,下腔静脉壁连续性好。以典型增强模式判断癌栓侵犯腔静脉壁的敏感性、特异性、准确性、阳性预告值、阴性预告值为分别为93.1%、93.5%、93.3%、93.1%、93.5%。 结论术中超声造影在机器人辅助下腔静脉癌栓切除术中可以提供癌栓是否侵犯静脉壁重要信息,为手术方式的选择提供依据并可在术中及时给予术者实时信息,具有较高的临床应用价值。     

Relationship between the prognosis and the morphology of stromal invasion of the breast cancer

I studied on the relationship between the prognosis and the invasion of the breast cancer clinicopathologically. Eight hundred and thirty-nine cases which had invasive cancer foci and mastectomized between 1950 and 1964 at the Cancer Institute Hospital were analyzed. The largest length of the invasive focus was measured histologically as the invasion size. To evaluate quality of the invasion, all invasive foci were analyzed about the composition of 5 morphological types of invasion, which consisted of one type with tubular formation (papillotubular-cribriform) and 4 types without tubular formation (medullary, small nest, pure scirrhous and mucinous). With proportion to the invasion size, 10-year survival rates were gradually diminishing. Cases with 20mm or less invasion size had better prognosis than cases with more than 20mm invasion size. Between tumors consisted with only one morphological type of invasion and tumors consisted of more than one types, the former had better prognosis than the latter. Cases with tubular formation had better prognosis than cases without tubular formation. In conclusion, the invasion size was the most valuable prognostic factor. About quality of the invasion, invasion focus consisted of only one histological type of invasion or of tubular formation was the indicator for better prognosis.     

Combined pulmonary and thoracic wall resection for stage III lung cancer.

BACKGROUND--Carcinoma of the lung with thoracic wall involvement constitutes stage III disease. The management of patients with this condition is complicated. However, improvement in perioperative care coupled with advances in surgical technique have enabled a more aggressive approach to the problem to be adopted. METHODS--A retrospective review was carried out of 58 patients (40 men) of mean age 63 years who underwent thoracotomy for lung cancer with chest wall invasion between 1980 and 1993. RESULTS--Chest wall resection was performed in 55 patients (94.8%); in three patients the discovery of N2 disease at operation precluded resection. The TNM status was T3N0M0 in 38 patients, T3N1M0 in 13, and T3N2M0 in seven. Squamous cell carcinoma was the commonest cell type (26 patients). Reconstruction of the chest wall was performed in 29 patients (Marlex mesh in six, Marlex-methacrylate in 22, myocutaneous flap in one patient). The morbidity and mortality were 22.4% and 3.4% respectively. Follow up was complete in 51 patients. Nineteen (37.2%) survived > or = 5 years. The absolute five year survival for N0 and N1 disease was 44.7% and 38.4%, respectively. No patients with N2 disease survived five years. CONCLUSIONS--In patients with carcinoma of the lung and chest wall invasion, combined pulmonary and thoracic wall resection offers the prospect of cure with minimal morbidity and mortality. The prognosis of patients with coexistent N2 disease remains poor.