351例胃癌术后患者的预后因素分析

目的 探讨胃癌术后影响胃癌患者生存的因素.方法 将2004年1月至2009年12月期间在笔者所在医院行手术治疗并获随访的351例胃癌患者作为研究对象,对其临床病理资料及随访资料进行单因素和多因素分析.结果 单因素分析显示患者年龄以及肿瘤部位、T分期、N分期、TNM分期和分化程度与预后有关(P＜0.05);多因素分析显示肿瘤部位、T分期、N分期和术后化疗是影响胃癌术后生存率的独立因素(P＜0.05).结论 肿瘤部位、浸润深度、淋巴结转移率及术后辅助化疗是影响胃癌术后生存的重要因素.对于有淋巴结转移或处于TNMⅢ期的胃癌患者,术后化疗可以提高其生存率.     

胃癌神经旁浸润的临床特征与预后分析

Objective To investigate the association between perineural invasion (PNI) and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma.Methods A total of 178 patients with gastric carcinoma from January 2004 to May 2008 were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent gastric resection were stained with laminin. PNl-positive was defined as infiltration of carcinoma cells into the perineurium or neural fascicles. The association of PNI with clinicopathologic features and prognosis of gastric carcinoma was studied. Results PNI was positive in 78 of 178 patients (43.8%). The proportions of T stage, lymph node metastasis and TNM stage were significantly higher in PNI-positive group than those in PNl-negative group (all P＜0.01 ). The PNI positive rate was correlated with the depth of gastric mural invasion and clinical stage. The overall survival in PNI-positive group was significantly lower than that in PNI-negative group by univariate analysis (P＜0.01). The mean survival of PNI-positive patients (28.6 months) was significantly shorter than that of PNI-negative patients (44.3 months,P＜0.01), which was also influenced by pN stage, pT stage, and clinical stage(P＜0.0l ). By multivariable Cox proportional hazards model of overall survival, the positivity of PNI appeared to be an independent prognostic factor (hazards ratio=2.257,95% CI: 1.268-4.019, P=0.006).Conclusions PNI is associated with the degree of malignancy in gastric cancer. PNI can be a candidate of new prognostic factor.     

RASAL1表达及ras活性与胃肠道肿瘤临床关系的研究进展

大约有20％的人类肿瘤与ras的突变有关。ras蛋白调控细胞的一系列生物学行为,包括细胞增殖、分化、生存及凋亡等。ras蛋白属于小GTP结合蛋白,通过响应细胞外信号产生活性。RASAL1是一种rasGTP酶激活蛋白,可以抑制ras的活性。调节ras以及RASAL1的活性,可能是肿瘤靶向治疗的方向之一。检测ras以及RASAL1的活性有助于胃肠道肿瘤的早期诊断以及预后的判断。本文从ras的结构、功能及突变与肿瘤的关系,RASAL1作为ras的效应分子抑制ras的活性,ras、RASAL1与胃肠道肿瘤的关系三方面来综述了RASAL1表达及ras活性与胃肠道肿瘤临床关系的研究进展。     

实时荧光定量PCR检测胃癌淋巴结微转移及其临床意义

目的使用实时荧光定量PCR(qRT-PCR)法检测胃癌淋巴结的微转移情况,并探讨微转移的临床意义。方法收集我院2010年1～6月期间40例行胃癌根治术切除的281枚和10例行胃十二指肠溃疡手术切除的39枚,共计320枚淋巴结标本,以CEA、CK-19和CK-20为引物进行qRT-PCR检测其微转移情况,并分析微转移的临床病理特点。结果 40例胃癌患者中有28例(70.00%)、31枚(15.35%,31/202)淋巴结检测出有微转移。10例胃溃疡的39枚淋巴结标本,HE染色检测和qRT-PCR检测均为阴性。淋巴结微转移的阳性率与肿瘤分化程度、浸润深度和临床分期有关(P<0.05)。结论 qRT-PCR是检测胃癌淋巴结微转移敏感且特异的方法,对胃癌临床分期、判断预后以及治疗方案选择具有重要意义。     

958例胃癌临床病理资料分析

目的了解近6年来就诊于我院的胃癌患者流行病学及临床病理资料的特点,为疾病的诊断与评估提供帮助。方法将2004年1月至2009年12月期间于我院进行手术治疗的958例胃癌患者作为研究对象,对其一般资料、肿瘤病理类型、发生部位、临床分期等进行回顾性分析。结果 958例胃癌患者中,男697例(72.8%),女261例(27.2%)。年龄26~91岁,平均62.6岁;高发年龄为46~65岁组,占49.4%(473/958),其后依次为≥66岁组及≤45岁组,分别为42.3%(405/958)和8.3%(80/958)。病理的大体分型上,BorrmannⅡ型占大多数(70.1%);病理类型以腺癌居多,占82.3%,印戒细胞癌占7.8%;分化程度以低分化为主,占46.9%。发生部位以贲门居多,占53.0%。TNM临床分期中以Ⅲ期为主,占47.4%。结论①胃癌多见于中老年男性患者,以贲门部低分化腺癌多见,贲门癌发病率明显高于胃窦癌;②在胃癌患者中,恶性程度较高的低分化、印戒细胞癌中所占比例最高者为相对较年轻的患者(≤45岁组);③行手术治疗的大部分为中晚期患者,胃癌的早期诊断有待进一步提高。     

胃癌神经旁浸润的临床特征与预后分析

Objective To investigate the association between perineural invasion (PNI) and clinicopathological factors and the effect of PNI on overall survival in patients with gastric carcinoma.Methods A total of 178 patients with gastric carcinoma from January 2004 to May 2008 were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent gastric resection were stained with laminin. PNl-positive was defined as infiltration of carcinoma cells into the perineurium or neural fascicles. The association of PNI with clinicopathologic features and prognosis of gastric carcinoma was studied. Results PNI was positive in 78 of 178 patients (43.8%). The proportions of T stage, lymph node metastasis and TNM stage were significantly higher in PNI-positive group than those in PNl-negative group (all P＜0.01 ). The PNI positive rate was correlated with the depth of gastric mural invasion and clinical stage. The overall survival in PNI-positive group was significantly lower than that in PNI-negative group by univariate analysis (P＜0.01). The mean survival of PNI-positive patients (28.6 months) was significantly shorter than that of PNI-negative patients (44.3 months,P＜0.01), which was also influenced by pN stage, pT stage, and clinical stage(P＜0.0l ). By multivariable Cox proportional hazards model of overall survival, the positivity of PNI appeared to be an independent prognostic factor (hazards ratio=2.257,95% CI: 1.268-4.019, P=0.006).Conclusions PNI is associated with the degree of malignancy in gastric cancer. PNI can be a candidate of new prognostic factor.     

胃癌神经旁浸润的临床特征与预后分析

目的 探讨胃癌神经旁浸润（PNI）的临床意义.方法 对2004年1月至2008年5月期间178例行胃癌根治术后的胃癌组织石蜡标本行苏木精-伊红染色,以肿瘤细胞浸润神经束或神经束膜判定为PNI阳性.分析PNI与胃癌临床病理特征及预后的关系.结果 PNI阳性78例（43.8%）.PNI与肿瘤浸润深度（P＜0.01）、淋巴结转移（P＜0.01）和TNM分期（P＜0.01）有关,但与患者的年龄、性别、肿瘤位置和分化程度无关.单因素分析显示,胃癌患者总体生存率与PNI、胃癌浸润深度、淋巴结转移和TNM分期有关（均P＜0.01）;PNI阳性患者平均生存期（28.6个月）明显短于PNI阴性患者（44.3个月）（P＜0.01）.多因素分析显示,PNI是影响患者总体生存率的独立因素（相对危险度为2.257,95%CI为1.268～4.019,P=0.006）.结论 PNI与肿瘤的进展有关,胃癌术后检测PNI可以作为判断患者预后指标之一.