应用"数学模型"预测临床T1～2N0M0乳腺癌患者腋窝淋巴结转移情况的研究

目的:建立一个数学模型,预测临床T1～2N0M0乳腺癌患者腋窝淋巴结转移情况.方法:对256例行根治术乳腺癌患者进行回顾性研究,按腋窝淋巴结转移情况分为两组,行多因素Logistic回归分析及判别分析.结果:Logistic多元回归分析提示微淋巴管浸润、肿瘤大小、肿瘤部位、癌周浸润、间质浸润等5个指标为腋窝淋巴结转移的高危因素;据高危因素建立的判别函数,阴性预测值高达88.9%,阳性预测值71.8%,判别准确率83.2%.结论:本判别函数数学模型简单,在理论上可以较准确地判断腋窝淋巴结的转移情况,可能有一定的临床参考价值.     

大肠癌淋巴结转移相关因素的多因素分析

目的 探讨大肠癌淋巴结转移的相关因素,为临床诊断和治疗提供参考.方法 对我院2000至2001年施行根治手术治疗的345例大肠癌的资料进行分类整理,用X2检验及Logistic多因素回归分析各临床病理因素与淋巴结转移的关系.结果 大肠癌淋巴结转移率、转移度与患者性别、肿瘤部位等无明显关系,而与浸润深度、淋巴管浸润、大体类型、组织学分级等有关.Logistic多因素回归分析表明,相关因素与淋巴结转移的相关程度依次为肿瘤浸润深度、淋巴管浸润、大体类型、组织学分级、肿瘤类型、肿瘤大小.结论 大肠癌淋巴结转移相关因素浸润深度＞淋巴管浸润,是影响淋巴结转移的最重要因素.     

超声与钼靶及二者联合检查对乳腺癌淋巴结转移的诊断价值

[目的]比较B超、钼靶及二者联合检查对乳腺癌淋巴结显像的能力.[方法]收集武汉大学人民医院经病理证实的乳腺癌患者共118例,比较B超、钼靶及二者联合检查对淋巴结显像的灵敏度、特异性、误诊率、漏诊率、阳性预测值、阴性预测值及总符合率.[结果]超声检查的灵敏度为47.4％,特异性为73.7％,误诊率为26.3％,漏诊率为52.6％,阳性预测值为54.5％,阴性预测值为67.7％,总符合率为63.2％.钼靶检查的灵敏度为88.2％,特异性为24.0％,误诊率为76.0％,漏诊率为11.8％,阳性预测值为61.2％,阴性预测值为60.0％,总符合率为61.0％.二者联合检查的灵敏度为91.3％,特异性为15.4％,误诊率为84.6％,漏诊率为8.7％,阳性预测值为65.6％,阴性预测值为50.0％,总符合率为63.9％.超声检查结果与病理结果的一致性较弱(κ=0.215,P=0.035).以淋巴结转移数目分层,3种方法的检出水平与转移数目无关.[结论]超声在术前诊断乳腺癌淋巴结转移方面优于钼靶、以及超声和钼靶联合检查.此外,乳腺癌淋巴结转移的影像学检出水平与淋巴结转移数目无关.     

应用“数学模型”预测临床T1—2N0M0乳腺癌患者腋窝巴结转移情况的研究

建立一个数学模型,预测临床Ｔ１－２Ｎ０Ｍ０乳腺癌患者腋窝淋巴结转移情况。方法：Ｃ地２５６例行根治术乳腺癌患者进行回顾性研究,按腋窝淋巴结转移情况分为两组,行多因素Ｌｏｇｉｓｔｉｃ回归分析及判别分析。结果Ｌｏｇｉｓｔｉｃ多元回归分析提示微淋巴管浸润、肿瘤大小、肿瘤部位、癌周浸润、间质浸润等５个指标为腋窝淋巴结转移的高危因素;据高危因素所建立的判别函数,阴性预测值高达８８．９％,阳性预测值７１．８％,     

胃腺癌组织中微淋巴管密度的检测及其临床病理意义

 目的探讨原发性胃腺癌中微淋巴管密度的临床病理意义。方法应用单克隆抗体D2-40检测原发性胃腺癌组织周边区和中心区及其正常胃组织中微淋巴管密度(LMVD),分析其与淋巴管浸润、淋巴结转移及其他临床病理参数之间的关系。结果胃腺癌周边区LMVD明显高于中心区LMVD(P<0.05)和正常胃组织LMVD(P<0.05),且淋巴管为功能性的。周边区LMVD与肿瘤的Ming分型、淋巴管浸润及淋巴结转移密切相关(P<0.05),而与患者的年龄、性别、肿瘤的分化程度及浸润程度无关(P>0.05)。中心区LMVD与这些临床病理参数之间均无相关性(P>0.05)。结论原发性胃腺癌癌周LMVD和淋巴管浸润、淋巴结转移密切相关,检测癌周LMVD是预测胃癌淋巴结转移的有效指标之一,有助于判断胃癌的预后。     

D2-40标记食管鳞癌淋巴管浸润的检测及其临床病理意义

  目的   探讨D2-40标记食管鳞癌淋巴管浸润(LVI)的临床病理意义。   方法   应用免疫组织化学S-P法检测107例食管鳞癌D2-40蛋白表达并观察淋巴管受肿瘤细胞浸润的情况, 分析其与食管鳞癌临床病理因素之间的关系, 观察患者总生存期。   结果   食管鳞癌组织LVI阳性组淋巴结转移率70%, LVI阴性组淋巴结转移率21%, LVI阳性组转移率高于阴性组, 多因素分析显示两组间差异有统计学意义(P < 0.001)。LVI阳性组中位生存时间为26个月, LVI阴性组中位生存时间43个月, 单因素分析显示两组间差异有统计学意义(P=0.014), 多因素分析显示LVI不能成为食管鳞癌术后患者预后的独立危险因素(P=0.062), 淋巴转移(P=0.031)、临床分期(P=0.019)和肿瘤残留(P=0.026)是预后的独立危险因素。   结论   D2-40标记的LVI可以预测食管鳞癌患者的淋巴结转移。      

结直肠癌组织VEGF-C和Podoplanin表达临床意义分析

目的:观察结直肠癌组织血管内皮生长因子-C(vascular endothelial growth factor-C,VEGF-C)和Podoplanin的表达,探讨VEGF-C和Podoplanin与结直肠肿瘤淋巴管生成、发生、发展及预后的关系。方法:收集2011-03-15-2012-03-15兰州军区兰州总医院肛肠外科手术切除的结直肠癌组织新鲜标本40例,同时收集距相应肿瘤组织边缘5～10cm的正常结直肠组织(以下简称正常组织)标本40例作为正常对照;应用免疫组织化学SP法检测40例结直肠癌组织及40正常结直肠组织VEGF-C和Podoplanin的表达,并采用t检验、单因素方差分析和χ2检验对两指标表达与临床病理因素之间相关性进行分析。结果:结直肠癌组织和正常组织VEGF-C阳性率分别为55%和15%,P=0.009。结直肠癌组织和正常组织VEGF-C Podoplanin阳性淋巴管密度(lymphatic vessel density,LVD)分别为6.03±3.72和3.33±2.76,P=0.001。结直肠癌组织中淋巴结转移组和无淋巴结转移组VEGF-C阳性率分别为94%和29%,P=0.034;且与pTNM分期和Dukes分期密切相关。结直肠癌组织淋巴结转移组和无淋巴结转移组中LVD值分别为8.11±3.46和4.82±3.31,P=0.004;且与pTNM分期和Dukes分期密切相关。结直肠癌组织VEGF-C阳性和阴性表达LVD值分别为7.73±3.34和3.78±3.40,差异有统计学意义,P=0.001。结论:结直肠癌中VEGF-C阳性率和Podoplanin阳性LVD显著增高,且与淋巴结转移、肿瘤病理分期密切相关,提示VEGF-C可能通过诱导结直肠癌淋巴管生成,从而促进肿瘤细胞的淋巴转移;证实VEGF-C和Podoplanin在结直肠肿瘤淋巴管生成、发生、发展及肿瘤转移中起重要作用,并可能成为肿瘤预后判断的参考指标。     

18FDG PET-CT检测进展期食管癌淋巴结转移的临床价值

目的评价^18FDG PET-CT对进展期食管癌淋巴结转移的诊断价值及临床意义.方法随机选择拟行手术治疗的进展期食管癌患者30例,术前1周内行^18EDG PET-CT检查及CT增强扫描.根据术后病理结果,对比CT与PET-CT诊断食管癌淋巴结转移的敏感性、特异性、阴性预测值、阳性预测值与准确性的差异.结果术后病理原发灶均为鳞状细胞癌,22例存在淋巴结转移.共切取淋巴结243个,病理确定的转移淋巴结49个,平均直径1.4 cm（0.3～2.8 cm）.CT确定的转移淋巴结26个,平均直径1.7 cm（1.1～2.8 cm）;敏感性和特异性分别为40.8%和96.9%,阳性预测值76.9%,阴性预测值86.6%,准确性85.6%.18FDG PET-CT确定淋巴结转移63个,平均直径1.5cm（0.8～2.8 cm）;敏感性和特异性分别为93.9%和91.2%,阳性预测值73.0%,阴性预测值98.3%,准确性91.9%.18FDG PET-CT的敏感性、阴性预测值、准确性均高于CT（P＜0.001、0.001、0.05）.结论18FDGPET-CT是检测进展期食管癌淋巴结转移的有用工具,可指导手术剖胸径路的选择、优化适形放疗计划,临床应用价值优于CT.     

肿瘤微环境在肿瘤淋巴管生成中的作用

恶性肿瘤淋巴结转移是一个复杂的病理过程,与肿瘤淋巴管生成密切相关。肿瘤生长到一定程度,分泌某些淋巴管生长因子,在肿瘤周围或内部形成新生淋巴管,肿瘤细胞侵入管腔并通过淋巴液顺次流入各站淋巴结,逐渐形成淋巴结转移病灶。正常细胞处于一个相对稳定的内环境,按正常的程序进行着增殖、分化、凋亡以及相关因子的分泌和表达,而肿瘤发生、发展则不断打破这一平衡,逐渐形成一个适于自己生长的组织外环境,即肿瘤微环境。而肿瘤微环境中的众多促淋巴管生成因子、炎性条件、组织缺氧、酸性微环境以及间质高压形成等病理生理特性能促进肿瘤淋巴管生成,进而促进肿瘤淋巴结转移病灶的形成。      

前哨淋巴结活检对乳腺癌腋窝淋巴结转移状况的预测价值

目的探讨前哨淋巴结活检(SLNB)对乳腺癌腋窝淋巴结转移状况的预测价值。方法以36例体检无腋窝淋巴结转移的乳腺癌患者为研究对象，用美蓝皮下注射染色法定位前哨淋巴结(SLY)，行SLNB，以病理检查结果计算SLNB的成功率及假阴性率、假阳性率、准确性、灵敏度、特异度、阳性符合率、阴性符合率、阳性结果预测值、阴性结果预测值。结果36例患者行SLNB，成功率为97．2％，灵敏度为92．9％。特异度为100％，假阴性率为7．7％，假阳性率为O％，准确率为95．8％，阳性符合率为92．3％；阴性符合率为95．7％，阳性结果预测值为100％，阴性结果预测值为93．9％。结论美蓝皮下注射染色法行SLNB有很高的成功率，SLNB能够准确地预测乳腺癌腋窝淋巴结转移状况。     

肿瘤出芽计数在预测T1期结直肠癌淋巴结转移中的应用价值

背景与目的：肿瘤出芽是结直肠癌的不良预后因素。本研究使用10个高倍镜视野计数的方法评价肿瘤出芽,并分析其在预测T1期结直肠癌淋巴结转移中的临床应用价值。方法：通过计数307例T1期结直肠癌10个高倍镜视野下肿瘤出芽个数,参比临床病理特征,建立T₁期结直肠癌淋巴结转移的风险分析公式,并在14例新病例中对该公式进行验证。结果：多因素分析结果显示,肿瘤分化水平、脉管侵犯和肿瘤出芽个数与T₁期结直肠癌淋巴结转移显著相关。统计分析得出的淋巴结转移的风险分析公式为：Z=1.571×(脉管状态：侵犯为1;无侵犯为0)+2.661×(肿瘤分化：高级别为1;低级别为0)+0.024×(肿瘤出芽个数)-3.885,概率=1/1+e^-Z。在14例新病例中得到了验证。结论：通过计数10个高倍镜视野下的肿瘤出芽个数,可以精确地评估淋巴结转移风险,从而协助临床作出合理的决策。     

Tumour budding at the deepest invasive margin correlates with lymph node metastasis in submucosal colorectal cancer detected by anticytokeratin antibody CAM5.2

In the past few years, tumour budding at the invasive margin has been reported as a new risk factor for lymph node metastasis in advanced colorectal cancers, but it is sometimes difficult to detect tumour budding in submucosal colorectal cancer by haematoxylin and eosin staining. We immunohistochemically examined tumour budding at the deepest invasive margin of 56 surgically resected submucosal colorectal carcinomas using anticytokeratin antibody CAM5.2, furthermore checked by AE1/AE3, and determined the relation between tumour budding and clinicopathological factors. Moreover, we used the monoclonal antibody D2-40 for immunohistochemistry to detect lymphatic involvement. Tumour budding was detected in 42 cases (75.0%), and the budding-positive group showed a significantly higher rate of lymph node metastasis (including isolated tumour cells) (16/42 vs 0/14; P=0.004) than the budding-negative group. The sensitivity and negative predictive value of tumour budding alone for lymph node metastasis were superior to those of lymphatic invasion alone. Furthermore, the specificity and positive predictive value of the combination of either lymphatic invasion or tumour budding were superior to those of lymphatic invasion alone. Tumour budding detected immunohistochemically by using CAM5.2 is a newly found risk factor for lymph node metastasis and may help to avoid oversurgery in the future.     

结直肠癌患者癌结节的研究现状

癌结节的形成与淋巴结转移、神经侵犯和脉管侵犯有关。癌结节是结直肠癌患者的一个不利预后因素,增加结直肠癌患者复发转移的概率。纳入淋巴结转移计数后评估预后的价值大于七版癌结节分期方法,可为结直肠癌患者的临床治疗提供更精准的依据。     

Lymphatic invasion identified with D2-40 immunostaining as a risk factor of nodal metastasis in T1 colorectal cancer

Background

The management of T1 colorectal cancer after local resection is controversial. Regional lymph node metastasis often occurs, requiring subsequent colonic resection. The aim of this study was to reevaluate the risk factors of nodal metastasis of T1 colorectal cancer, especially to examine lymphatic vessel invasion in serially prepared hematoxylin and eosin sections and D2-40 immunostained sections to determine which is a better indicator of lymph node metastasis of T1 colorectal cancer.

Methods

The study investigated 120 patients who underwent bowel resection and were histologically diagnosed to have T1 colorectal cancer in Kanagawa Cancer Center Hospital from 1995 to 2005. Serially prepared paraffin sections were stained with hematoxylin and eosin, or immunostained with D2-40 antibody or von Willebrand factor, and reevaluated for lymphatic vessel invasion and other risk factors, including venous invasion, histological grade, depth of submucosal invasion, and budding.

Results

Lymphatic invasion diagnosed with either hematoxylin and eosin staining (p = 0.022), or D2-40 immunostaining (p = 0.001), and budding (p = 0.013) were significant risk factors for lymph node metastasis in the univariate analysis. Venous involvement, histological grade, or depth of submucosal invasion was not significant. The multivariate logistic regression analysis for the three risk factors found lymphatic invasion diagnosed with D2-40 as an independent risk factor (odds ratio 6.048, p = 0.018, CI 1.360–26.89). The sensitivity, specificity, positive predictive value, and negative predictive value were 58 %, 88 %, 35 %, and 95 %, respectively.

Conclusions

Lymphatic vessel invasion diagnosed with D2-40 was a better indicator to evaluate the risk for lymph node metastasis by T1 colorectal cancer.     

结直肠癌患者血浆Septin9 DNA甲基化联合FOBT检测的临床应用价值

目的:探讨血浆Septin9 DNA甲基化及粪便隐血试验（FOBT）在结直肠癌（CRC）诊断中的应用价值。方法:回顾性收集2017年6月至2022年1月我院收治并经病理检查确诊的101例结直肠良性腺瘤患者、209例结直肠癌患者分别作为良性腺瘤组和结直肠癌组，选取同期在我院进行体检的98例健康人群作为正常对照组，比较三组一般资料及血浆Septin9 DNA甲基化及FOBT阳性情况，比较不同病理特征、不同临床分期结直肠癌患者血浆Septin9 DNA甲基化、FOBT阳性情况，采用受试者工作曲线（ROC）评估血浆Septin9 DNA甲基化、FOBT单项及联合检测对结直肠癌的诊断价值。结果:三组血浆Septin9 DNA甲基化、FOBT阳性率比较，结直肠癌组高于良性腺瘤组及正常对照组，良性腺瘤组高于正常对照组（P<0.05）；肿瘤低分化、淋巴结转移、脉管/神经侵犯的结直肠癌患者血浆Septin9 DNA甲基化和FOBT阳性率高于肿瘤高分化、中分化及未发生淋巴结转移、未发生脉管/神经侵犯的结直肠癌患者（P<0.05）；随着结直肠癌TNM临床分期升高，血浆Septin9 DNA甲基化及FOBT阳性率升高，差异具有统计学意义（P<0.05）；血浆Septin9 DNA甲基化和FOBT联合诊断结直肠癌的敏感度、曲线下面积（AUC）（87.08%、0.885）均高于两者单独诊断（59.33%、0.744和52.63%、0.643，P<0.05）；血浆Septin9 DNA甲基化诊断结直肠癌的特异度、阳性预测值和阴性预测值分别为89.45%、85.52%和67.68%；FOBT分别为76.38%、70.06%和60.56%，两者联合诊断分别为89.95%、90.10%和86.89%。联合诊断优于单项诊断。结论:随着结直肠病变恶性程度的增加，血浆Septin9 DNA甲基化和FOBT阳性率升高，血浆Septin9 DNA甲基化、FOBT联合检测对结直肠癌具有较高的诊断价值，可作为结直肠癌的实验室诊断指标。     

结直肠癌根治术后复发转移的多因素分析

复发转移是结直肠癌术后非常重要的预后因素,而复发转移的相关因素是大肠癌根治术后个体化随访和辅助治疗的依据。本文旨在探讨结直肠癌根治术后复发转移的相关临床病理因素。     

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study

Depth of invasion in early invasive colorectal cancer is considered an important predictive factor for lymph node metastasis. However, no large-scale reports have established the relationship between invasion depth of pedunculated type early invasive colorectal cancers and risk of lymph node metastasis. The aim of this retrospective cohort study was to clarify the risk of lymph node metastasis in pedunculated type early invasive colorectal cancers in a large series. Patients with pedunculated type early invasive colorectal cancer who underwent endoscopic or surgical resection at seven referral hospitals in Japan were enrolled. Haggitt's line was used as baseline and the invasion depth was classified into two groups, head invasion and stalk invasion. The incidence of lymph node metastasis was investigated between patients with head and stalk invasion. We analyzed 384 pedunculated type early invasive colorectal cancers in 384 patients. There were 154, 156, and 74 endoscopic resection cases, endoscopic resection followed by surgical operation, and surgical resection cases, respectively. There were 240 head invasion and 144 stalk invasion lesions. Among the lesions treated surgically, the overall incidence of lymph node metastasis was 3.5% (8/230). The incidence of lymph node metastasis was 0.0% (0/101) in patients with head invasion, as compared with 6.2% (8/129) in patients with stalk invasion. Pedunculated type early invasive colorectal cancers pathologically diagnosed as head invasion can be managed by endoscopic treatment alone.     

内镜超声检查在早期胃癌术前分期的应用

目的　探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法　对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果　EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论　内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。     

VEGF、MVD和LN与大肠癌微转移的关系

 目的
探讨血管内皮生长因子(VEGF）、微血管密度(MVD）和层黏连蛋白(Laminin,LN）在大肠正常黏膜组织、大肠腺瘤
组织及大肠癌组织中的表达及临床意义。方法应用免疫组织化学SP法检测18例正常大肠黏膜组织、26例大肠腺瘤组
织和68例大肠癌组织中VEGF和LN的表达水平及MVD计数,并分析他们与大肠癌微转移的关系。结果从大肠正常黏膜
逐步发展为大肠癌的过程中,VEGF的表达水平、MVD计数及基底膜明显缺损率均逐渐增加,LN表达减少,大肠癌组
织中VEGF的阳性表达率和MVD计数与大肠癌的浸润深度、淋巴结转移、Dukes分期有关(P<0.05）。大肠癌组织中基
底膜缺损程度与淋巴结转移、Dukes分期有关(P<0.05）。结论 肿瘤的血管形成和LN的表达与大肠癌的淋巴结转移
、Dukes分期等临床病理特征密切相关,联合检测VEGF、MVD和LN的表达对判断大肠癌的浸润和转移倾向,进而估计
患者的恶性程度。     

The complexity of the count: considerations regarding lymph node evaluation in colorectal carcinoma

In patients with colorectal carcinoma, studies have reported improved survival with increasing numbers of retrieved lymph nodes. These findings are puzzling, as increased node sampling was not correlated with significant change in disease staging. Although the physiologic processes underlying this correlation between number of lymph nodes sampled and survival remain unknown, the reported correlation has caused modifications to clinical and non-clinical practices. Herein, we review the literature and discuss potential etiologies responsible for the observed increased survival statistics. Literature regarding colorectal lymph node anatomy, molecular aspects of colorectal cancer, changes in tumor characteristics and utilization of lymph node sample numbers are evaluated. In addition, we present the mathematical concepts available for probabilistic prediction of diagnostic confidence based upon sample size. From evaluation of the aggregate literature, certain facts emerge which are not easily identified within the individual studies. Colorectal carcinoma appears to encompass a number of individual disease entities with different physiologic characteristics and likelihoods of metastasis. In addition, it appears the improved survival is likely multifactorial including effects from intrinsic tumor biology and tumor-host interactions along with ever changing clinical practices. Finally, because lymph node count is dependent on a number of variables and is correlated, but unlikely to be causally associated with survival, use of this number as a quality indicator is unwarranted. Based on statistical considerations, the current recommended goal of 12-15 recovered lymph nodes without evidence of metastatic disease provides approximately 80% negative predictive value for colorectal carcinoma metastasis.Key Words: Lymph node count, colorectal carcinoma, cancer survival, colorectal carcinoma biology