肝肠钙黏蛋白在胃癌中的表达及其与患者预后的关系

目的 探讨肝肠钙黏蛋白(CDH17)在胃癌中的表达及其与预后的关系.方法 应用组织芯片和免疫组织化学方法检测264例胃癌、正常黏膜及104例转移淋巴结中CDH17的表达.结果 CDH17在胃癌中的表达率高于正常黏膜(63.26%比9.85%,P＜0.001),与临床分期(P＜0.01)、浸润深度(P＜0.01)、淋巴结转移(P＜0.01)和远处转移(P＜0.05)相关.转移淋巴结的CDH17表达率(81.73%)高于原发癌和正常黏膜(P＜0.001).CDH17表达与术后总体生存率和无瘤生存率负相关,CDH17是影响总体生存[风险比(HR)3.97;95%可信区间(CI)1.39～10.28;P＜0.05]和无瘤生存(HR 2.32;95%CI 1.17～4.52;P＜0.05)的独立预后因素.结论 CDH17在胃癌进展中起重要作用,可作为预测术后转移复发的标记物.

Abstract：

Objective To explore the expressiom of liver-intestine (CDH17) in gastric cancer and its correlation with prognosis. Methods CDH17 protein expression was detected by immunohistochemistry on tissue microarray, which containing 264 samples of primary gastric cancer and the corresponding paracancerous tissue,and 104 paired lymph node metastases (LNM). Results CDH17 was up-regulated in gastric cancer compared with paired nomal gastric mucosa and correlated with clinical stage,invasion depth,LNM,distant metastasis. Immnoreactivity of CDH17 was significantly higher in LNM than in primary gastric cancer and normal mucosa. There was a negative correlation between the high expression of CDH17 and overall survival (OS) or disease free survival (DFS) of gastric cancer patients. CDH17 was an independent prognostic factor for OS [hazard ratio ( HR) 3. 97 ; 95% confidence interval ( CI) 1. 39-10. 28; P ＜ 0. 05] and DFS (HR 2. 32 ;95% CI 1.17-4. 52; P ＜ 0. 05). Conclusion CDH17 may play an important role in gastric cancer progression and could serve as a biomarker to identify patients at risk of metastasis or recurrence after gastrectomy.     

胃肠道肿瘤的新辅助治疗——胃癌的新辅助化疗

胃癌新辅助化疗(neoadjuvant chemotherapy for gastric cancer)。又称术前化疗(preoperative chemotherapy)。主要目的在于使肿瘤缩小，提高手术根治性切除率，改善治疗效果。历史上曾经有应用。终因效果差而废弃，近年由于新型化疗药物的不断出现，又成为治疗进展期胃癌的希望和研究的热点。     

多排螺旋CT在诊断胃癌侵犯胃裸区中的价值

目的研究胃癌侵犯胃裸区(gastric bare area，GBA)的CT表现和解剖基础，探讨多排螺旋CT在诊断中的价值。方法回顾性分析196例连续性胃癌病例的CT资料，其中GBA受累56例(28．6％)，按解剖部位分为近侧胃癌(proximal gastric cancer，PGC)组和远侧胃癌(distal gastric cancer，DGC)组。观察胃癌侵犯GBA的CT表现特征，比较PGC组和DGC组胃癌侵犯GBA的出现率差异。结果56例中．有46例表现为GBA内软组织肿块。10例表现为结节状淋巴结。胃癌侵犯GBA病例的CT征象有：GBA增宽，胃壁与膈肌之问的薄层脂肪间隙中断或消失；GBA内可见不均匀强化的软组织密度肿块或类圆形淋巴结；左膈脚及胃膈韧带不规则增厚并与肿瘤分界不清；膈下腹膜后问隙淋巴结肿大。PGC组中。胃癌侵犯GBA的出现率为70．0％(42／60)，而在DGC组仅为10．3％(14／136)。两者问差异有显著性意义(P=0．025)。结论PGC侵犯GBA的出现率高于DGC。胃癌侵犯GBA有一定的CT表现特征。多排螺旋CT在术前评价GBA受侵和淋巴结转移方面具有重要价值。     

胃肠肿瘤淋巴结转移的影像学评估与精准肿瘤淋巴清扫

正胃肠肿瘤是人类常见病,胃癌(gastric cancer,GC)和结直肠癌(colorectal cancer,CRC)分别占全世界癌症发病率的第4位和第3位;在中国,GC和CRC占男性癌症发病率的第2位和第5位,占女性发病率的第3位和第4位~([1])。胃肠肿瘤的侵袭和转移在肿瘤发生的早期就已出现,此类患者术后生存质量和时间的长短取决于肿瘤是否发生转移和复发~([2]),直接死亡原因有:腹腔种植、远处转移和术后局部复发。术后复发的最常见原因是腹膜转移和淋     

胃癌及癌旁正常组织中微小RNA表达谱的检测

目的 应用微小RNA(miRNA)芯片技术筛选胃癌及癌旁正常组织中差异表达的miRNAs,从中发现与胃癌发生发展相关的miRNAs.方法 收集14例新鲜胃癌组织及癌旁正常黏膜组织,从标本中分离出小RNA,并用Cy3、Cy5双色荧光标记,将标记的小RNA在miRNAs芯片上进行杂交反应.结果 软件MeV4.0对芯片数据进行聚类分析,筛选获得92个在胃癌及癌旁正常组织中差异表达的miRNAs(P＜0.05).相对于癌旁组织,在胃癌组织中有8个miRNAs表达显著上调,11个miRNAs表达显著下调(P＜0.01).结论 胃癌组织和癌旁正常组织中存在差异表达的miRNA分子,它可能与胃癌的发生发展有关.

Abstract：

Objective To screen and identify the microRNA (miRNA) differential expression profiles in gastric cancer and paired adjacent normal tissue by the miRNA microarray technique. Methods Forteen gastric cancer fresh tissue samples and paired adjacent normal mucosa tissue samples were collected. Small RNA was isolated from the samples, labeled with Cy3, Cy5 two-color fluorescence and hybridized on miRNA microarray. Results By analysis of Software MeV4. 0 based on microarrays screening, 92 gastric cancer related miRNAs (P ＜ 0. 05 ) were obtained. In the gastric carcinoma, compared with paired adjacent normal tissue, 8 miRNAs were significantly up-regulated and 11 miRNAs were significantly downregulated (P ＜ 0. 01 ). Conclusion MiRNAs are differentially expressed between gastric carcinoma and adjacent normal tissue, which may be related to the pathogenesis and progression of gastric cancer.     

进展期胃癌根治术后早期复发的危险因素分析

目的 探讨进展期胃癌根治术后复发患者的临床资料和预后情况.方法 对进展期胃癌根治术后复发的147例患者进行回顾性研究,对复发的相关因素进行单因素和多因素Logistic回归分析,对预后的相关因素采用单因素Kaplan-Meier及多因素COX回归模型分析.结果 本组患者早期复发86例(距首次手术≤1年),晚期复发61例(距首次手术＞1年).两组患者的临床资料、肿瘤直径、Borrmann分型、手术方式、T分期、N分期、TNM分期之间相比差异均有统计学意义(均P＜0.05).多因素Logistic回归分析显示,TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素(P＜0.05).单因素分析结果 显示,胃癌术后化疗(P＜0.05)、T分期(P＜0.05)、N分期(P＜0.01)、TNM分期(P＜0.01)、复发时间(P＜0.01)和再手术(P＜0.01)是影响复发患者预后的主要因素;多因素分析结果 显示,TNM分期(P＜0.01)、复发时间(P＜0.05)和再手术(P＜0.01)是复发患者的独立预后影响因素.结论 TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素.胃癌术后复发患者的预后较差,积极行再手术治疗有助于延长患者的生存时间.

Abstract：

Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods The clinical data of 147 patients with recurrent gastric cancer was reviewed. Risk factors correlated with tumor recurrence and recurrent intervals were studied by logistic regression analysis. Survival analyses and comparisons were performed using Kaplan-Meier plots, the log rank test and the Cox proportional hazards model. Results Patients were divided into an "early recurrence group" consisting of 86 patients (recurred within one year after surgery) and a "late recurrence group" of 61 patients (recurred one year or more after surgery). There were significant difference in size of primary tumor, Borrmann stage, type of gastrectomy, T stage, N stage, TNM stage between the two groups(P ＜0.05). Multivariate analysis showed that the TNM stage and N stage independently influenced the recurrent time ( P ＜ 0. 05 ). In univariate survival analysis, post-gastrectomy chemotherapy(P ＜0. 05) , T stage (P ＜0. 05) , N stage(P ＜0.01) , TNM stage ( P ＜ 0. 01) , recurrence-free interval (P ＜ 0. 01) and reoperation (P ＜ 0.01) were significantly correlated with the prognosis. In multivariable analysis, TNM stage(P ＜0. 01) , recurrence-free interval ( P ＜ 0. 05 ) and reoperation ( P ＜ 0. 05 ) were independent factors predicting recurrence. Conclusions The TNM stage and N stage were the important factors predicting the time of recurrence after curative resection for gastric cancer. Patients with recurrent gastric cancer have poor prognosis and reoperation was associated with an improved survival in patients with recurrent gastric cancer.     

胃癌临床病理特征与Line-1低甲基化关系

目的 探讨Line-1(long interspersed nucleotide element-1)甲基化水平与胃癌临床病理特征的关系.方法 收取30例胃癌标本和癌旁正常组织,采用焦磷酸测序技术(Pyrosequencing)对胃癌组织和癌旁正常组织Line-1甲基化水平进行检测.结果 30例胃癌患者胃癌组织中Line-1甲基化平均水平65.8%,而正常组织为75.1%,差异有统计学意义(P＜0.05);30例胃癌组织中,Line-1甲基化水平在不同的发病性别、发病年龄、发生位置和分化程度中差异无统计学意义(P＞0.05);Line-1甲基化程度与浸润深度(T1/T2:68.9%、T3/T4:61.3%)、淋巴结转移(NO:70.0%、N1:69.9%、N2:61.7%、N3:57.6%)和远处转移(MO:67.9%、M1:59.1%)明显相关(P＜0.05),并且随着胃癌的进展而降低.结论 Line-1低甲基化与胃癌浸润和转移有关,可能参与胃癌的进展.

Abstract：

Objective To elucidate the correlation of methylation of long interspersed nucleotide element-1 (Line-1) with clinicalopathological features of gastric cancer.Methods Gastric cancer tissues and paracancerous tissues were collected from 30 patients and methylation status of Line-1 was detected in caner and corresponding normal tissues by using Pyrosequencing.Results The methylation level of Line-1in normal gastric and gastric cancer tissues was 75.1% and 65.8% respectively (P＜0.05).Among 30cancer tissues,methylation status of Line-1 was closely related to tumor infiltration (T1/T2:68.9%,T3/T4:61.3% ),lymph nodes metastasis ( NO:70.0%,N1:69.9%,N2:61.7%,N3:57.6% ) and distant metastasis ( MO:67.9%,M1:59.1% ) ( P ＜0.05) and declined with tumor progression,but wasn't associated with age,gender,location and differentiation ( P＞ 0.05 ).Conclusion Hypomethylation of Line-1 was remarkably related to infiltration and metastasis of gastric cancer and may contribute to the tumor progression.     

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胃癌术后出现梗阻性黄疸并非罕见，除医源性损伤外，多为胃癌术后复发所致，其原因较为复杂，我们认为以下因素均可能导致癌瘤复发时并发梗阻性黄疸：(1)首次手术消化道重建时采用Billroth I式吻合，肿瘤复发常可浸润到肝门部和肝十二指肠韧带；(2)近端胃癌根治术后残胃癌可侵犯肝十二指肠韧带，十二指肠或胰头部；(3)     

胃癌合并胃间质瘤的诊治体会

目的 探讨胃癌合并胃间质瘤的诊断与治疗.方法 回顾性分析1996年1月至2009年12月18例胃癌合并胃间质瘤患者的临床资料.结果 本组18例患者均无特异性临床表现,术前确诊1例,术中确诊3例,术后确诊14例.胃癌病灶大小平均为(3.3±2.3)cm,胃间质瘤病灶大小平均为(0.9±0.5)cm.胃间质瘤病灶处于低度危险性16例,中度危险性2例.所有病例手术顺利,术后1、3、5年总体生存率分别为88%、63%和36%.结论 胃癌合并胃间质瘤的临床表现无特异性,其中胃间质瘤多为早期病灶,恶性程度低,采取以手术为主的综合治疗,预后主要取决于胃癌病灶.

Abstract：

Objective To study the diagnosis and treatment of synchronous gastric cancer and gastric stromal tumor in 18 cases. Methods Clinical data of 18 cases of synchronous occurrence of gastric cancer and gastric stromal tumor from January 1996 to December 2009 were analyzed retrospectively.Results Clinical features of all cases were atypical. There was 1 case diagnosed preoperatively, 3 cases diagnosed intraoperatively and 14 cases diagnosed postoperatively. The mean size of gastric cancer and gastric stromal tumor was (3.3±2.3) cm and (0.9 ±0.5) cm respectively. There were 16 cases of gastric stromal tumor in low risk of malignance and 2 cases in moderate risk of malignance. All cases were operated without complications and the 1-year, 3-year and 5-year overall survival rate was 88.2%, 63.2% and 36. 1% respectively. Conclusions Clinical features of synchronous occurrence of gastric cancer and gastric stromal tumor are atypical, in this series most gastric stromal tumors are in early stage and of low risk of malignance. The prognosis of patients with synchronous occurrence of gastric cancer and gastric stromal tumor mainly depends on gastric cancer.