结直肠神经内分泌肿瘤25例临床分析

目的探讨结直肠神经内分泌肿瘤的临床特征、诊治方法及预后。 方法回顾分析湖北省肿瘤医院自2006年1月至2015年1月收治的25例结直肠神经内分泌肿瘤患者的临床资料。 结果肿瘤部位：阑尾3例,升结肠3例,乙状结肠2例,直肠17例。分级情况：NET（G1）11例,NET（G2）3例,NEC（G3）8例,MANEC 3例。免疫组织化学：Syn、CgA、NSE阳性表达率为96%,68%和92%。预后：结直肠神经内分泌肿瘤出现转移部位最多见为肝脏。9例Ⅰ期患者生存时间均长于5年。6例Ⅱ期患者,3年内死亡1例,5年内死亡3例,余1例仍在随访中。8例Ⅲ期患者,1年生存率75%,3年生存率50%,5年生存率25%。2例Ⅳ期患者,1例存活28月,另1例存活37月。 结论结直肠神经内分泌肿瘤缺乏特征性临床表现,主要通过内镜下活组织病理检查明确诊断。结直肠神经内分泌肿瘤治疗方法主要依靠手术治疗,早期预后良好,预后与分期和分级密切相关。     

结直肠腺癌病理分型的临床意义及预后分析

目的 探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后.方法 收集1994年8月至2007年3月结直肠手术患者2089例,其中黏液腺癌144例,印戒细胞癌25例,乳头状腺癌和管状腺癌1837例,剔除其他类型肠道肿瘤83例.比较三组的临床病理特点.对影响结直肠预后的部分临床病理指标,如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析.对三组进行总体生存分析.结果 黏液腺癌患者发病的中位年龄为(54.20±16.25)岁,印戒细胞癌患者为(40.43±12.88)岁,乳头状腺癌和管状腺癌患者为(58.73±13.62)岁,印戒细胞癌发病年龄最低(P<0.001).三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义(P值均<0.05).经单因素和非条件Logistic回归分析发现,黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素,而印戒细胞癌是预示结直肠癌预后的独立因素.三组总体生存时间和生存率间差异有统计学意义(P<0.001).结论 结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差.黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素.     

生长抑素受体2在结直肠神经内分泌肿瘤中的表达及意义

目的:研究生长抑素受体(somatostafin receptor,SSTR)亚型SSTR2在结直肠神经内分泌肿瘤组织中的表达情况,以及与临床病理特征的关系.方法:收集结直肠神经内分泌瘤患者组织标本及相关临床病理资料,应用免疫组织化学En Vision二步法检测肿瘤组织中SSTR2表达情况.结果:56例患者纳入研究,其中SSTR2阳性表达率为76.8%.SSTR2的阳性表达与淋巴结转移、肿瘤浸润肌层、出现远处转移关系密切(P0.05),但是与性别和年龄无关(P0.05).此外,肿瘤的最大径及组织学分级也与SSTR2阳性表达有关(P0.05).结论:SSTR2异常表达与重要的临床病理学特征相关,SSTR2可能成为一个新的结直肠神经内分泌瘤诊断和预后的分子指标.     

尾型同源盒转录因子-2在结直肠腺癌组织中的表达及其与预后的关系

[目的]:探讨尾型同源盒转录因子-2(CDX2)在结直肠腺癌组织中的表达及其与预后的关系。[方法 ]采用免疫组化SP法检测CDX2在68例结直肠腺癌组织、30例结直肠腺瘤及30例正常结直肠组织中的表达情况,了解CDX2与结直肠腺癌患者临床病理特征的关系,并对患者进行随访。[结果]CDX2在结直肠腺癌、结直肠腺瘤及正常结肠组织中阳性表达率分别为52.9%(36/68)、76.7%(23/30)、90.0%(27/30),CDX2在结直肠腺癌组织中阳性表达率明显低于结直肠腺瘤及正常结肠组织(P0.05),CDX2阳性表达与患者肿瘤浸润深度、淋巴结转移相关(P0.05),与患者性别、年龄、部位、形态及分化程度无相关性(P0.05)。CDX2阳性表达患者和阴性表达患者术后5年累积生存率分别为66.7%和53.1%,CDX2阴性表达患者术后生存时间较阳性患者明显缩短(χ2=5.565,P=0.018)。[结论]CDX2在结直肠腺癌组织中低表达,可能与结直肠腺癌的发生、发展及预后相关,可作为结直肠腺癌的参考指标,对结直肠腺癌诊断和预后评估具有重要意义。     

新辅助放化疗治疗局部晚期直肠癌预后危险因素分析

目的探讨新辅助放化疗(RCT)治疗局部晚期直肠癌预后危险病理因素。方法收集该院2010年1月至2014年1月收治的113例进行结直肠手术并接受RCT和长期放射疗法的直肠癌患者,均收集肿瘤样本,记录肿瘤体积、远端切除边缘(DRM)、直肠系膜切除效果,并记录神经侵犯、肿瘤芽殖和坏死情况、胶体反应和钙化情况等,统计患者的总生存期(OS)和无病生存率(DFS)并进行单因素和多因素统计学分析。结果所有患者3年OS和DFS分别为97.3%,67.6%。5例(4.6%)发生局部复发,30例(27.8%)发生远端复发转移,术后死亡率为1.8%;单变量分析显示yp T期、嗜神经和血管侵犯、yp N期、DRM、不完全显微远端或环切及肿瘤芽殖与局部复发具有显著相关性。但并未发现DFS与组织学消退分级具有显著相关性,13例(12%)yp T0期患者的DFS较其他yp T期患者高(P=0.003)。在多变量分析中,只有肿瘤神经侵犯和肿瘤芽殖是较差DFS的两个独立的预后因素(P0.05)。结论直肠腺癌RCT治疗后的标准化病理报告可以加入一些新的病理因素,例如肿瘤神经侵犯和肿瘤芽殖的评价;同时,yp TN分级仍然是肿瘤预后的最可靠的预测方式。     

消化系神经内分泌癌及文献分析209例

目的:探讨消化系统神经内分泌癌(NEC)发生部位、临床表现、内镜及影像学特点、病理特征、诊断和鉴别诊断、治疗及预后.方法:将我院2000-2005年收治的7例NEC病例和文献检索的202例病例分为A、B两组,分别探讨消化系统NEC临床特点,治疗和预后.结果:消化系统NEC临床表现多为无功能NEC,以局部占位及消耗症状为主,壶腹周围NEC可以急性胰腺炎发作为首发表现;有功能的NEC例数约占2.4%.大小在0.5-13.0 cm,分为典型类癌、不典型类癌和小细胞癌,确诊需要进行突触素(Syn)、细胞角蛋白(CK)、神经特异性烯醇化酶(NSE)、嗜铬素A(CgA)、上皮膜抗原(EMA)等的免疫组化检查和(或)电镜检查发现神经内分泌颗粒(NSG).以手术治疗为主,辅以化疗、放疗,必要时栓塞化疗,也可以辅以生物治疗.对于有功能的NEC,首先需要控制因激素分泌过多所致的相关类癌综合征.小细胞癌预后最差,不典型类癌次之,类癌预后较好,5 a生存率可达70%.肿瘤的大小、转移与否、手术切除是否彻底等等亦是影响预后的重要因素.结论:消化系统NEC发生部位以胃、胰腺、直肠等部位多见,临床表现多样,少数可有类癌综合征表现,治疗方法以手术为主,辅以放化疗及生物治疗或介入治疗,根据病理类型判断其恶性程度和预后.     

胰腺神经内分泌肿瘤的治疗及生存分析

目的 分析胰腺神经内分泌肿瘤的外科治疗策略及影响预后的因素.方法 回顾性分析1999年4月至2007年5月之间经手术治疗且病理证实的30例胰腺神经内分泌肿瘤患者的临床资料.根据WHO新的分级标准,对肿瘤大小、手术方式、病理类型与远期生存之间的关系进行分析.结果 30例患者中男性18例,女性12例;平均年龄54岁(28～78岁);5例失访,获得随访的25例患者中,良性20例、恶性5例;良、恶性组中位生存时间分别为74.8和33.8个月(X2=8.90,P=0.003).全组1、2、3、4、5年生存率分别为100%、100%、82.0%、82.0%、65.6%.结论 胰腺内分泌肿瘤是一类比较少见的胰腺肿瘤.手术切除可获得良好的长期生存.新的WHO分型方法可以比较有效地预测肿瘤的预后.     

胃肠混合性腺神经内分泌癌的回顾性病例分析

背景：近年来,胃肠腺神经内分泌肿瘤发病率不断上升,为推动疾病的防治,我国制定了中国胃肠胰神经内分泌肿瘤病理学诊断共识。目的：探讨胃肠混合性腺神经内分泌癌（MANEC）的临床病理特点。方法：选取2002年4月-2009年1月天津大港油田总医院确诊的胃肠腺癌患者100例,对患者肿瘤组织标本进行免疫组化染色,检测突触素（Syn）、嗜铬粒素A（CgA）、癌胚抗原（CEA）、细胞角蛋白8/18（CK8/18）、Ki-67的表达。分析MANEC患者的临床资料,包括性别、年龄、临床症状、病理特征以及预后。结果：100例胃肠腺癌患者中,MANEC 6例,发生率为6%。MANEC临床表现以腹痛、腹胀、便血常见。MANEC发生于胃小弯2例、回盲部1例、升结肠1例、直肠2例。镜下可见MANEC由腺癌和神经内分泌癌两种成分构成。6例患者均接受手术治疗,5例在短时间内复发和（或）腹腔转移。结论：MANEC形态学上与低分化腺癌不易区别,确诊主要依赖于组织学证据和免疫组化标记,预后较普通腺癌差。     

青年人结直肠癌的临床病理特征及预后因素分析

目的 分析青年人结直肠癌的临床病理特征及预后因素.方法 回顾性分析144例青年结直肠癌患者(青年组)和142例老年结直肠癌患者(老年组)的临床资料,分析青年人结直肠癌的临床病理特征及影响预后因素.结果 青年结直肠患者临床症状缺乏特异性,易漏诊和误诊;其原发肿瘤部位较低,直肠中下段占60.4％;标本大体类型以溃疡型多见(占83.3％),组织学类型以腺癌多见;分化程度以低、中分化多见,Duke's分期B、C、D期占91.7％.青年组1、3、5年生存率分别为96％、74％、67％,与老年组(87％、65％、55％)比较差异均无统计学意义(P均＞0.05).Duke's分期和年龄是影响预后的重要独立因素(P均＜0.05).结论 青年结直肠癌肿瘤部位较低,其组织学类型、分化程度较差,恶性程度高,预后差.Duke's分期和年龄是影响预后的重要独立因素.     

结直肠腺癌组织中Cyr61和NF-κB p65的表达及其临床病理意义

目的探讨结直肠腺癌组织中富含半胱氨酸61(Cysteine rich 61,Cyr61)和核因子-κB(nuclear factor-κB,NF-κB)p65的表达情况,及其与临床病理参数和患者预后的相关性.方法收集2011-05/2016-09期间在湖北黄冈市中心医院治疗的结直肠腺癌患者92例,免疫组织化学法和western blot检测结直肠癌组织和癌旁组织中Cyr61和NF-κB p65的表达情况,并分析肿瘤组织中Cyr61和NF-κB p65表达与临床病理特征和预后的相关性.结果免疫组织化学染色和western blot结果均显示结直肠癌组织中Cyr61和NF-κB p65的蛋白表达显著高于癌旁组织(t=24.866,P0.001;t=45.508,P0.001).结直肠癌组织中Cyr61和NF-κB p65的表达显著相关(χ2=14.087,P0.001).而且结直肠癌组织Cyr61表达与肿瘤直径、浸润深度、血管侵犯和TNM分期等临床病理参数显著相关(P0.05).结直肠癌组织NF-κB p65表达与肿瘤直径、淋巴结转移和T N M分期等临床病理参数显著相关(P0.05).而且Cyr61和NF-κB p65高表达患者的5年总体生存率41.30%、45.65%显著低于Cyr61和NF-κB p65低表达患者的5年总体生存率76.09%、71.74%(HR=0.341,95%CI:0.179-0.649,P=0.001;HR=0.465,95%CI:0.245-0.881,P=0.019).结论 Cyr61和NF-κB p65蛋白在结直肠癌组织中高表达,且Cyr61和NF-κB p65蛋白高表达与结直肠癌患者的临床病理参数和预后显著相关,可能为结直肠癌患者的诊断和治疗提供新的指标.     

Neuroendocrine differentiation is a relevant prognostic factor in stage III-IV colorectal cancer

OBJECTIVE: To determine the prognostic relevance of neuroendocrine differentiation in colorectal cancer. METHODS: The survival of 116 patients with colorectal cancer of stages III (n = 59) and IV (n = 57) was correlated with the extent of neuroendocrine differentiation. Chromogranin A and synaptophysin were used as neuroendocrine markers. Based on the degree of immunoreactivity for these markers, tumours were classified as 0 (no expression of neuroendocrine markers), 1 (< 2% cells staining positive for neuroendocrine markers) and 2 (> 2% cells staining positive for neuroendocrine markers). Patients were followed up for more than 5 years or until death. RESULTS: Seven of 59 (11.8%) stage III cancers and 13/57 (22.8%) stage IV cancers belonged to group 2. The 96 patients of groups 0 and 1 lived for 48.9 months, whereas the 20 patients of group 2 survived for only 18.6 months (Kaplan-Meier survival curves, P < 0.001). The difference was most striking in stage III disease with 79.4 months' survival for combined groups 0 and 1, and 38.9 months' survival for group 2 (P < 0.01). Using the multivariate Cox regression model, the presence of more than 2% of cells with neuroendocrine differentiation was found to be an independent prognostic parameter for stage III and IV disease. No correlation was observed between neuroendocrine differentiation and tumour location, grade, depth of invasion or stage. CONCLUSION: Neuroendocrine differentiation is often seen in colorectal cancer. It is an independent prognostic factor in stage III-IV colorectal cancer.     

Partial hepatic resection for liver metastases of non-colorectal origin, is it justified?

BACKGROUND/AIMS: The liver is a common site of metastases for many solid tumors. Resection of noncolorectal liver metastases is controversial. The aim of this retrospective study is to evaluate partial liver resection as a treatment option for non-colorectal liver metastases. METHODOLOGY: During a 20-year period, 480 patients underwent partial liver resection. Thirty-two patients (17 male, 15 female, median age 55 years) who received partial liver resection for noncolorectal liver metastases were identified. A detailed analysis of these patients was conducted. RESULTS: Primary tumors were: medullary thyroid cancer (n=3), Grawitz tumor (n=2), breast carcinoma (n=2), stomach carcinoma (n=2), neuroendocrine carcinoma (n=10), unknown primary origin (n=9) and various other carcinomas (n=4). Operative morbidity and mortality for partial liver resection were 28 and 6%, respectively. The median overall survival time was 37 months, with an actuarial 5-year survival of 42%. Actuarial 5-year survival rates for patients with neuroendocrine and the non-neuroendocrine carcinomas were 22 and 52% respectively (NS). Median survival for patients with carcinoma of unknown primary origin was 43 months with an actual 5-year survival of 44%. CONCLUSIONS: Partial liver resection for liver metastases of non-colorectal primaries can be performed safely and has survival rates comparable to that of colorectal metastases in carefully selected cases and should therefore be considered.     

Small bowel cancer: single-centre results over a period of 12 years

BACKGROUND/AIMS: Tumors of the small bowel are rare, accounting for about 3-6% of all gastrointestinal neoplasms. However, diagnosis and treatment are difficult and an ongoing challenge. METHODOLOGY: Follow-up and clinical data of 43 patients with small bowel cancer who underwent surgery at our hospital. RESULTS: Subgroups consisted of adenocarcinoma (n=16; 37.2%), neuroendocrine tumors (n=12; 27.9%), gastrointestinal stroma tumor (GIST) (n=10; 23.3%), lymphoma (n=3; 7%) and desmoid tumor (n=2; 4.6%). Tumor localizations were within duodenum (46.5%), jejunum (16.3%) and ileum (37.2%). Thirty patients were curatively operated, 13 for palliative treatment or diagnostic purpose. Adenocarcinoma patients showed preponderance of advanced tumor stages: stage I/II in 5 pts, III/IV in 11 patients. Stage distribution for patients with neuroendocrine tumors was 3 each for I and II and 6 for III. Localization was predominantly within the ileum (n=7). Overall survival after five/ten years was 48/37%. Patients with neuroendocrine tumors showed best survival results (75/57%), GIST patients 60/35% and adenocarcinoma (27% each). There was a strong trend towards better survival at early tumor stages in patients with adenocarcinoma and neuroendocrine tumors. CONCLUSIONS: Early diagnosis is essential for prognosis of small bowel malignancies. Cure is unlikely if lymph node or distant metastases have already developed.     

maspin、p27、skp2在大肠肿瘤的表达及意义

目的:探讨大肠癌maspin、p27、skp2的表达, 并探讨其与大肠癌发生、发展的关系．方法:应用免疫组化SP法检测30例结肠管状腺癌、20例结肠腺瘤、20例正常大肠黏膜组织中maspin、p27、skp2的表达情况．结果:30例管状腺癌中maspin、p27、 skp2阳性表达率分别为83．3％(25/30)、 50％(15/30)、36．7％(11/30);20例结肠腺瘤中maspin、p27、skp2的阳性表达率分别为 95％(19/20)、80％(16/20)、10％(2/20),20例正常切缘中maspin、p27、skp2的表达率分别为 95％(19/20)、90％(18/20)、5％(1/20)．maspin 表达与淋巴结转移(P=0．04)和Duke's分期相关(P=0．014);p27、skp2表达与分化程度相关(P=0．014,P=0．001),而与淋巴结转移、 Duke's分期、肿瘤浸润深度无关．maspin表达与p27表达正相关(r=0．447,P<0.05),与skp2 表达无相关性;p27表达与skp2表达无相关性．结论:maspin、p27在大肠癌中表达降低,skp2 在大肠癌中过表达,可作为反映大肠癌分化程度的指标之一．maspin可能在大肠癌的发生、发展(尤其是淋巴结转移)中起作用,有望成为诊断大肠癌及其发生淋巴结转移的分子生物学标记物之一．     

体重指数与结直肠癌预后的相关性研究

目的探讨体重指数(body mass index,BMI)与结直肠癌患者临床病理特征和预后的关系。 方法回顾性分析2005年7月至2011年6月解放军总医院收治的107例结直肠癌患者的临床和随访资料。将患者分为正常体重组(BMI<23.0kg/m²)、超重组(23.0 kg/m²≤BMI<27.5 kg/m²)和肥胖组(BMI≥27.5 kg/m²),比较三组临床病理因素,并分析BMI与5年生存率的关系。 结果正常体重组37例(34.6%),超重组54例(50.5%),肥胖组16例(14.9%)。中位生存时间为37个月,1、3、5年的总生存率分别为95.3%、81.9%、74.0%。单因素生存分析显示,肿瘤位置、浸润程度、淋巴结转移和临床分期对5年生存率有影响(均P<0.05)。BMI与肿瘤浸润程度有关(P＝0.039),对5年生存率无显著影响,但随着BMI增加,5年生存率呈上升趋势(69.2% vs 72.0% vs 93.8%,P＝0.239)。多因素生存分析显示,肿瘤位置和临床分期是本组患者预后的独立危险因素(均P<0.05),BMI非独立危险因素(P＝0.343)。 结论BMI对结直肠癌患者的预后无显著影响。     

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 36 years

BACKGROUND AND OBJECTIVE: This study reports on the demographic features, clinico-pathological results and prognoses of patients aged less than 36 years diagnosed with non-small cell lung cancer (NSCLC). METHODS: This is an observational study of patients with primary NSCLC who had a surgical procedure at a tertiary thoracic surgery centre in Turkey. Data collected were age, gender, history of smoking, symptoms, postoperative histopathological diagnosis, stage, surgical procedure and survival. RESULTS: Of the 31 patients in the study, 27 were male (87%) and the median age was 32 years (10-35 years). Nineteen patients were smokers (61.2%). The most common presenting symptom was cough (n = 23, 67.7%). Histopathological diagnosis was squamous cell carcinoma (SCC, n = 17), adenocarcinoma (n = 12), lymphoepithelioma-like carcinoma (n = 1) and undifferentiated carcinoma (n = 1). Staging of the 17 patients with SCC (58.8%) was stage I and II (n = 10, 58%), and stage III (n = 7, 41%). Staging of the 13 patients with adenocarcinoma was stage IV (n = 2, 16%) and stage III patients (n = 8, 66%). Follow-up data were available on 22 patients (71%) and showed a median survival of 17.2 months. Two and 5-year survival rates were 54.5% and 45.5%, respectively. CONCLUSIONS: SCC comprised a relatively high proportion of NSCLC in these younger patients. Aggressive multimodality treatment may achieve satisfactory 2- and 5-year survival rates in young patients with NSCLC who usually present with advanced disease.     

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.     

Clinicopathologic characteristics of colorectal neuroendocrine tumor]

BACKGROUND/AIMS: Colorectal neuroendocrine carcinoma is a rare neoplasm exhibiting fulminant progression and having poor prognosis. The purpose of this study is to verify the clinicopathologic characteristics of colorectal neuroendocrine carcinoma. METHODS: From June 1997 to December 2004 at Asan Medical Center, ten patients were originally identified as colorectal neuroendocrine carcinoma on the basis of H&E and immunohistochemical staining (IHC). Carcinoid tumors were excluded in this study. Medical records of thirteen patients were reviewed retrospectively. RESULTS: Ten patients (0.2%) with colorectal neuroendocrine tumors were identified from 4,512 patients with colorectal cancer; ten neuroendocrine carcinomas and three adenocarcinomas with neuroendocrine differentiation. Their median age was 60 (41-83) years. The subjects consisted of six males and seven females. Nine tumors were located in the rectum, two in the sigmoid, and each one in the transverse colon and cecum, respectively. Nine of ten neuroendocrine carcinomas expressed synaptophysin, but chromogranin A were expressed in four. All patients were advanced at the time of diagnosis, with AJCC TNM staging: stage IIIB (n=2), stage IIIC (n=3), and stage IV (n=8). The median survival for ten neuroendocrine carcinomas and three adenocarcinomas with neuroendocrine differentiation were 16.4 months and 30 months, respectively. Five patients who received chemotherapy showed median survival of 32 months (stage III) and 17.5 months (stage IV), whereas other five patients without chemotherapy died with a median survival of 6.2 months. CONCLUSIONS: Colorectal neuroendocrine tumors are extremely rare showing aggressive behavior biologically, i.e fulminant early distant metastasis. Nevertheless, improved survival may be achieved by aggressive multimodality therapy.     

胃癌序贯筛查实施现场胃癌患者术后生存分析—11年随访

探讨胃癌序贯筛查法实施后手术治疗对胃癌患者生存率的影响。方法：参加胃癌序贯筛查的人群及作为对照的非筛查人群中发现胃癌并进行手术治疗的67例患者为研究对象,其中筛查组27例,非筛查组40例,自1987年随访至1997年,详细记录其生存时间等资料并进行生存分析。结果：胃癌筛查组患者术后5年及10年生存率均明显高于非筛查组患者、存在显著统计学差异（5年生存率：73．0％比34．5％,P＜0．05;10年生存率：69．0％比0,P＜0．05）。筛查组早期胃癌患者的比例亦明显高于非筛查组（63％比5％,P＜0．05）。结论：实施胃癌序贯筛查可以探查出更多的早期胃癌,手术治疗可以明显延长患者的生存时间。