子宫内膜癌腹腔镜手术患者预后不良的因素研究

目的:探析子宫内膜癌患者腹腔镜手术治疗后预后不良的危险因素.方法:回顾性分析,2019年1月-2021年1月本院收治的接受腹腔镜手术治疗的128例子宫内膜癌患者的临床资料.分析患者的预后情况,并根据预后不同分为不良组和良好组.设计基线资料收集表,将可能的影响因素纳入进行对比分析.经多因素回归分析找出子宫内膜癌患者腹腔镜手术治疗后预后不良的危险因素.结果:收集的128例接受腹腔镜手术治疗的子宫内膜癌患者中,21例患者预后不良,占比16.41％.不良组肌层浸润深度、淋巴结转移、脉管癌栓与良好组比较,差异有统计学意义(P<0.05).经回归分析结果显示,肌层浸润更深、淋巴结转移、脉管癌栓可能是子宫内膜癌患者腹腔镜手术治疗后预后不良的危险因素(OR>1,P<0.05).结论:肌层浸润深度、淋巴结转移、脉管癌栓可能是子宫内膜癌患者腹腔镜手术治疗后预后不良的危险因素.     

2005-2010年北京协和医院特殊类型子宫内膜癌回顾性分析

目的 评估特殊类型子宫内膜癌预后及其影响因素.方法 回顾性分析了2005年至2010年北京协和医院妇产科收治的初治子宫内膜浆液性癌、透明细胞癌及癌肉瘤患者的临床资料及随访结局,运用SPSS软件进行数据分析,logistic回归分析影响预后高危因素.结果 48例子宫内膜浆液性癌、透明细胞癌及癌肉瘤患者随访超过3年,中位随访时间70.5个月.FIGOⅠ期和Ⅱ期占66.7%.治疗方式为手术治疗、联合术后化疗或放疗,66.7%患者接受了术后化疗,41.7%的患者接受了术后放疗.早期预后较好,晚期患者预后极差,Ⅲ期患者3年复发率30.8%,且均死亡;Ⅳ期患者3年内复发率和病死率100%;其中晚期浆液性癌3年复发率80%.FIGO分期和盆腔淋巴结转移是影响特殊类型子宫内膜癌预后的主要因素.结论 特殊类型子宫内膜癌总体预后差,盆腔淋巴结转移是其预后高危因素.     

妇科恶性肿瘤术后盆腔淋巴囊肿的防治

正宫颈癌、子宫内膜癌、卵巢癌等是女性常见的生殖道恶性肿瘤,其治疗措施主要包括手术、化疗、放疗等。尽管各种类型肿瘤手术的范围和术式略有不同,但是广泛子宫切除或全子宫切除加盆腔淋巴结清扫术是目前治疗的重要手段之一,而盆腔淋巴囊肿是盆腔淋巴结清扫术后近期常见的并发症。淋巴囊肿较小者多无不适,淋巴囊肿较大者,最初多为下腹部局限性隐痛,可向同侧背部、臀部或腿部放射。淋巴囊肿过大则伴有压迫症状,根据其大小及存在的位置常会引起不     

宫颈癌子宫内膜癌术后阴道残端复发28例临床研究

目的总结宫颈癌、子宫内膜癌初次手术后阴道残端再复发的临床特点、治疗方法及预后分析,为宫颈癌、子宫内膜癌复发诊治提供依据。方法回顾性分析2002年9月至2014年7月收治的28例宫颈癌、子宫内膜癌行广泛性子宫切除术或次广泛子宫切除术后阴道残端复发患者的临床、病理资料。28例阴道残端癌患者根据病情采用部分阴道切除、全阴道切除和阴道扩大切除等手术方式;比较28例患者预后是否与淋巴结转移、阴道旁受累、再次复发时间间隔、组织分化程度等相关。结果高分化及中低分化患者平均生存时间分别是40个月及15个月,3年生存率分别是66.1%和30.7%,差异有统计学意义(P=0.03)。有无淋巴结转移的患者中位生存时间分别是18个月及40个月(P0.05);3年生存率依次是0和24%(P0.05)。复发距离初次手术时间大于24个月及小于等于24个月的中位数生存时间分别是28个月及16个月(P0.05)。结论阴道残端癌的手术治疗安全、有效,预后较好。阴道残端癌的预后与是否淋巴结转移、是否阴道旁受累、再次复发时间间隔、组织分化程度等密切相关。     

子宫内膜癌中S100A4和Snail的表达及临床意义

目的分析正常子宫内膜、内膜不典型增生及子宫内膜癌组织中S100A4和Snail的表达及与子宫内膜癌临床病理特征及患者预后的关系。方法采用免疫组化SP法检测S100A4和Snail蛋白的表达,分析两者表达与子宫内膜癌临床病理特征的关系;采用Spearman等级相关分析两者表达的相关性;采用Kaplan-Meier法绘制生存曲线及Log-rank检验进行生存分析。结果正常子宫内膜、内膜不典型增生和子宫内膜癌组织中S100A4和Snail蛋白的阳性率均呈升高趋势,分别为3.33%和3.33%、30.00%和23.33%、54.55%和49.09%。S100A4表达与子宫内膜癌组织学分级、FIGO分期、肌层浸润深度和淋巴结转移相关(P均0.05);Snail表达与子宫内膜癌FIGO分期和淋巴结转移相关(P均0.05)。子宫内膜癌中S100A4和Snail的表达呈正相关(r=0.531,P0.001)。生存分析发现,S100A4和Snail阳性子宫内膜癌患者的术后生存时间明显短于阴性组(P均0.05)。结论 S100A4和Snail在子宫内膜癌发生、发展中异常表达,S100A4/Snail阳性子宫内膜癌更易发生淋巴结转移,并且与内膜癌患者的不良预后有关,S100A4和Snail有望成为子宫内膜癌靶向治疗和预后评估的指标。     

267例子宫内膜癌的预后因素分析

目的探讨影响子宫内膜癌患者生存及预后的因素。方法回顾性总结中山大学肿瘤医院妇科自2000年1月至2004年1月收治的经手术治疗的267例子宫内膜癌患者的临床病理资料和随访结果,进行生存分析及预后的影响因素分析。结果267例患者3年生存率、5年生存率分别为90．8％、88．1％,单因素分析显示：手术-病理分期、病理分级、组织学类型、肌层浸润深度、淋巴结转移、附件转移、术后是否治疗、ER和PR表达与预后有显著性相关（P〈0．05）。经多因素分析后得出,手术-病理分期、病理分级、组织学类型、PR表达4个因素对子宫内膜癌患者的总生存率均产生显著性影响（P〈0．05）。结论子宫内膜癌的5年生存率较高。手术-病理分期、病理分级、组织学类型、PR表达情况是影响预后的独立因素。     

子宫内膜癌淋巴结转移的危险因素及预后分析

目的探讨子宫内膜癌腹膜后淋巴结转移的高危因素及淋巴结转移对于预后的影响。方法回顾性分析2005年1月至2010年12月期间在北京协和医院妇产科进行诊治的289例行腹膜后淋巴结切除的子宫内膜癌患者的临床病理资料,对影响子宫内膜癌腹膜后淋巴结转移的高危因素和影响子宫内膜癌患者预后的因素进行统计分析。结果 1)289例患者中位发病年龄55岁,Ⅰ期224例(77.5%),Ⅱ期13例(4.5%),Ⅲ期45例(15.6%),Ⅳ期7例(2.4%)。289例行盆腔淋巴结切除,30例(10.4%)有盆腔淋巴结转移;96例行腹主动脉旁淋巴结切除,11例(11.5%)有腹主动脉旁淋巴结转移。复发21例(7.3%),死亡11例(3.8%),中位随访时间37个月,中位无瘤生存时间34个月。2)单因素分析显示术前CA125≥35 U/m L、非子宫内膜样癌、组织学分级为G3、深肌层浸润、肿瘤≥2 cm、宫颈间质受累、腹腔冲洗液细胞学阳性及阴道或宫旁受累是淋巴结转移率的高危因素(P0.05)。多因素分析显示术前CA125值≥35 U/m L、低分化、肌层浸润深度≥1/2是淋巴结转移的独立危险因素(P0.05)。3)Kaplan-Meier单因素分析显示,腹腔冲洗液细胞学阳性、阴道或宫旁受累、附件受累及淋巴结转移缩短无瘤生存时间(P0.05);非子宫内膜样癌、低分化、肌层浸润深度≥1/2、腹腔冲洗液细胞学阳性、附件受累及淋巴结转移缩短总生存时间(P0.05)。COX回归多因素分析显示,腹膜后淋巴结转移是5年无瘤生存率的独立预后因素(未转移者92.1%vs转移者65.3%,P=0.002,95%CI 0.078~0.552);虽不是5年总生存率的独立预后因素,但无淋巴结转移者的5年总生存率有高于淋巴结转移者的趋势(未转移者96.1%vs转移者70.0%,P=0.086,95%CI 0.039~1.238)。结论本研究发现:1)肿瘤分化程度和肌层浸润深度对淋巴结转移有预测意义,能够指导子宫内膜癌患者是否进行淋巴结切除术,为个体化治疗奠定理论基础。2)淋巴结转移患者仍然有较无淋巴结转移者预后更差的趋势,因此对于淋巴结转移的患者需要进行辅助治疗,减少复发风险。     

CyclinD1和PCNA在子宫内膜癌中表达及临床意义

目的探讨CycliD1和PCNA在子宫内膜癌中的表达及临床意义。方法应用免疫组化法检测50例子宫内膜癌,22例子宫内膜不典型增生和8例正常子宫内膜中CyclinD1,PCNA的表达。结果 CyclinD1和PCNA在子宫内膜癌中的阳性表达率分别为54%(27/50)和68%(34/50),明显高于正常子宫内膜组(P0.05)。子宫内膜癌中,CyclinD1的表达与FIGO分期和淋巴结转移密切相关(P0.05),PCNA的表达与病理分级和淋巴结转移密切相关(P0.05)。相关性分析显示,CyclinD1和PCNA在子宫内膜癌中的表达呈正相关(r=0.742,P0.05)。二者协同异常表达者生物学行为较好。结论 CyclinD1和PCNA可能在子宫内膜癌发生发展中起重要作用,可作为评估预后的指标。     

子宫内膜癌的预后因素分析

目的影响子宫内膜癌预后的因素很多,目前这些因素对子宫内膜癌预后的影响,并没有得到一致的认同。因此,我们进一步分析了影响子宫内膜癌预后的相关因素。方法回顾性地分析了中国医科大学第一附属医院妇科.2004年8月到2014年8月共361例子宫内膜癌患者,采用卡方检验进行子宫内膜癌预后因素的单因素分析,并采用COX回归模型对其进行多因素分析。结果单因素分析表明,年龄、雌激素受体、孕激素受体、肌层浸润深度、FIGO(2009)分期、组织学类型、病理分级、宫颈转移、输卵管卵巢转移、淋巴结转移、淋巴血管间隙浸润(LVSI)影响子宫内膜癌的预后(P0.05),而身高体重指数(BMI)、发病时绝经情况、糖尿病、高血压,与子宫内膜癌的预后无关(P0.05)。COX回归分析表明,肌层浸润深度、FIGO(2009)分期、病理分级、淋巴血管间隙浸润为子宫内膜癌独立的预后因素。结论对具有独立预后影响因素的子宫内膜癌患者,在接受手术的同时,应采取积极的放化疗。     

术前子宫内膜癌分段诊刮和B超诊断

目的 :评估分段诊刮和B超诊断子宫肌层受侵在处理子宫内膜癌中的价值。方法 :对 2 10例子宫内膜癌术前分段诊刮标本和术后子宫切除标本行病理检查并进行比较分析 ,同时B超检查子宫肌层受侵情况与术后病理对照。结果 :分段诊刮 2 10例中 16 2例临床诊断宫颈受侵 ,术后病理证实其中的 12 4例受侵。临床诊断符合率76 .5 4 % ,假阳性率 2 3.4 6 %。B超显示肌层受侵 4 8例 ,术后病理证实 4 6例 ,符合率 95 .83%。结论 :分段诊刮有局限性。必要时术中冰冻切片予以纠正。B超诊断子宫内膜癌肌层受侵 ,准确率高 ,经济、实用。术前制定子宫内膜癌治疗方案 ,特别是拟行腹膜后淋巴结清扫时 ,应将分段诊刮和B超诊断结合起来考虑更为合理     

Dedifferentiated endometrial cancer: an atypical case diagnosed from cerebellar and adrenal metastasis: case presentation and review of literature

Dedifferentiated endometrial cancer (DEC) is microscopically characterized by the presence of high-grade areas emerging from low-grade tumour. DEC is an aggressive tumour even when the dedifferentiated component represents only 20% of the entire neoplasm. A proper histological diagnosis is essential to define the most appropriate therapeutic approach for these tumors, since they are characterized by a particularly aggressive trend and by an extremely poor prognosis. We report a single case of DEC associated with dedifferentiated and adrenal metastasis, for which the patient underwent both abdominal-pelvic and cerebellar surgery. Dedifferentiated carcinoma of the endometrium is a poorly recognized neoplasm since they have not been clearly defined the histological features discriminating this neoplasm from high-grade endometrioid adenocarcinoma. Revising existing literature we found 79 described cases of central nervous system secondary involvement and 13 cases where the onset of the disease was characterized by neurological signs and symptoms. We could only find two reported cases of adrenal metastases originating from endometrial neoplasia but in no case of dedifferentiated endometrial carcinoma previously described has been reported the concomitant adrenal-cerebellar involvement.     

18F-FDGPET/CT在卵巢癌中的应用研究

卵巢癌是常见的妇科恶性肿瘤之一,其发病率位于宫颈癌和子宫内膜癌之后,而死亡率一直居于女性生殖器恶性肿瘤的首位。18F-FDGPET/CT可以提供细胞摄取葡萄糖的功能信息及形态学特征,在卵巢肿瘤的定位及定性中有重要作用,有助于早期进行初步诊断、判断复发及转移和全面分期。本文对PET/CT在卵巢癌的诊断、分期、预后预测等方面作一综述,旨在评估PET/CT在卵巢癌的作用。     

Pathology of endometrium treated with tamoxifen.

AIMS--To determine the type of endometrial abnormalities associated with prolonged tamoxifen treatment and to investigate the correlation between tamoxifen dose and any abnormalities detected. METHODS--Endometria from 19 prospectively collected breast cancer patients treated with tamoxifen were ascribed a pathological diagnosis and the findings compared with those in a control group matched for age and presentation. The abnormalities were related to cumulative tamoxifen dose. RESULTS--The two asymptomatic treated patients had generalised simple endometrial hyperplasia at necropsy. No endometrial abnormalities were seen at necropsy in the two control cases. Of the 17 patients treated with tamoxifen who underwent surgery for gynaecological symptoms, 11 had hyperplastic endometrial polyps characterised by epithelial metaplasias and patchy periglandular condensation of stroma. Two women had primary endometrial malignancies with myometrial invasion, and three women, one of whom had previously presented with a benign polyp, had an endometrial polyp-cancer on a background of hyperplasia. Endometrial malignancies were confined to women who had taken more than 35 g of tamoxifen. The control group included no endometrial polyp-cancers, only one patient with an endometrial polyp, four women with endometrial hyperplasia and four with primary endometrial malignancy. CONCLUSIONS--These findings support a link between prolonged tamoxifen treatment and endometrial malignancy and identify a subgroup of patients--that is, those who have taken more than 35 g of tamoxifen, who may be at increased risk of endometrial cancer. The spectrum of pathological findings in patients treated with tamoxifen suggests that the drug promotes endometrial growth and that endometrial polyps may be an important intermediate step in endometrial carcinogenesis.     

Nonsteroidal anti-inflammatory drugs for treatment of advanced gastric cancer: cyclooxygenase-2 is involved in hepatocyte growth factor mediated tumor development and progression

Surgical treatment of gastric cancer patients is dismal because advanced tumor is often noted at diagnosis. In order to obtain better adjuvant therapy for gastric cancer patients after operation, it is important to understand the mechanism of invasion and metastasis. It is well known that binding of hepatocyte growth factor (HGF) to its receptor (c-Met) regulates gastric cancer progression and metastasis. Recently, HGF was found to up-regulate the expression of cyclooxygenase-2 (COX-2) gene and increase prostaglandin (PG)synthesis in gastric mucosa cells. Over-expression of COX-2 and increased PG secretion have also been found to be involved in the growth and metastasis of gastric cancer. These results together suggest that the signaling pathway of HGF and c-Met may be mediated through ERK2 activation, up-regulation of COX-2 and increased production of PGE(2)in gastric cancer cells. In view of the fact that c-Met is over-expressed in the majority of gastric cancer patients with poor prognosis, COX-2 specific inhibitors may provide beneficial effects in these patients.     

循环肿瘤细胞在肺癌诊疗中的临床研究进展

肺癌现已成为发病率及致死率最高的恶性肿瘤,且呈逐年增高趋势,给人类的身体健康及生命安全带来严重威胁。肺癌的复发与转移是导致患者死亡的最主要原因,可能与循环肿瘤细胞（CTCs）进入血液存在一定关系,CTCs在肺癌患者的早期诊断、治疗指导、疗效评估及预后等方面具有十分重要的作用。本文就CTCs在肺癌诊疗中临床应用及研究进展进行综述。     

抗鼠科肉瘤病毒癌基因同源物B1突变与甲状腺乳头状癌淋巴结转移的关系研究进展

近年来随着检查设备敏感性的提高及人们生活、饮食环境的改变,甲状腺癌(TC)的发病率直线上升,10年内增加了近5倍,不同病理类型甲状腺癌发病机制、临床表现、生物学行为、治疗方法和预后有明显不同。甲状腺乳头状癌(PTC)任何年龄均可发病,约占甲状腺癌的90%,疾病进展缓慢,预后良好,但易出现淋巴结转移。是否伴有淋巴结转移对于PTC的预后转归有着重要影响,抗鼠科肉瘤病毒癌基因同源物B1(BRAF)基因突变在PTC的淋巴结转移中发挥着至关重要的作用,深入了解BRAF基因突变在PTC的具体作用及机制,有望对PTC提供新的诊疗思路。     

Adenosquamous carcinoma of the endometrium.

An adenosquamous carcinoma of the endometrium is one which contains both malignant glandular and malignant squamous components; such tumours are considered rare in Britain but are thought to account for nearly one-third of all endometrial neoplasms in the United States. A survey of 675 cases of endometrial cancer seen during the period 1956-75 showed that the incidence of adenosquamous carcinoma was 5%, an incidence that remained static during this 20-year period. The principal difficulties encountered in the diagnosis of these neoplasms are in identifying the squamous component as such and in differentiating it from benign metaplastic squamous epithelium. The prognosis for patients with an endometrial adenosquamous carcinoma is very much worse than for women with a pure adenocarcinoma, and because these neoplasms are often wrongly identified it is possible that the currently accepted prognoses for both pure adenocarcinoma and adenoacanthoma of the endometrium may have to be revised. There appears to be a true variation in the incidence of this neoplasm between Britain and the United States.     

The mechanism and progress of ferroptosis in pancreatic cancer

Pancreatic cancer is one of the deadliest cancers in the world, causing hundreds of thousands of deaths worldwide annually. Because of late diagnosis, rapid metastasis and drug resistance to chemotherapy, pancreatic cancer has a poor prognosis. Although the treatment of pancreatic cancer has made tremendous progress, the options for effective treatment are still limited, and new treatment methods are in crying needs to improve prognosis in clinic. Ferroptosis is an iron-dependent non-apoptotic cell death mode, which is mediated by lipid peroxidation and iron accumulation. Ferroptosis plays a momentous role in regulating different cancers in recent years, such as breast cancer, hepatocellular carcinoma, lung cancer and pancreatic cancer. In this present review, we elaborate on the regulatory mechanisms and signaling pathways of ferroptosis in pancreatic cancer, with the intention of delivering directions and new ideas for the treatment of pancreatic cancer.     

乳腺微钙化促进乳腺癌骨转移的研究进展

乳腺癌是女性发病率最高的癌症,在过去的十年中,全球发病率持续上升,死亡率高居不下。最新的统计学研究表明,仅2018年,全球范围内检测出约210万乳腺癌病例,其中近63万患者死亡,因而也是女性死亡率最高的癌症^[1]。然而,许多癌症患者的死亡并非由于肿瘤在原发部位生长,而是在于肿瘤侵袭或转移至其他部位,其中乳腺癌最容易发生骨转移^[2]。在临床上,骨转移常给患者带来极大的痛苦,严重影响患者生活质量。