早期胃癌淋巴结转移规律的临床病理因素研究

目的探讨早期胃癌临床病理因素与淋巴结转移规律的相关性。方法回顾性分析2012年1月—2018年12月期间在陆军军医大学第一附属医院经胃镜下活检病理确诊,并实施外科根治手术的早期胃癌病例,采用单因素分析及Logistic回归多因素分析相关临床病理因素与各组淋巴结转移的关系。结果164例早期癌患者中,34例出现转移。单因素分析显示病理分化程度、浸润深度、肿瘤最大径、脉管浸润与早期胃癌淋巴结转移相关(P均<0.05)。Logistic回归多因素分析结果显示:肿瘤最大径>2 cm(OR=3.2,95%CI:2.305~4.187)、浸润至黏膜下层(OR=2.5,95%CI:2.091~3.859)、病理分化不良(OR=1.7,95%CI:1.029~2.933)及脉管侵犯(OR=2.1,95%CI:1.817~3.176)是早期胃癌淋巴结转移的独立影响因素(P均<0.05)。上部癌中转移率较高的淋巴结依次是第1组(66.7%)、第3组(33.3%);中部癌中转移率较高的淋巴结依次是第3组(75.0%)、第4组(25.0%);下部癌中转移率较高的淋巴结依次是第6组(33.3%)、第3组(25.9%)、第4组(25.9%)及第7组(14.8%)。从转移站别看,分化良好且肿瘤直径≤2 cm的黏膜内早期癌,各部位癌第1站均未见淋巴结转移。结论早期胃癌肿瘤最大径>2 cm﹑浸润至黏膜下层﹑病理分化程度低及脉管受侵犯是淋巴结转移的危险因素。上、中、下部癌均有其各自的高发区域,早期胃癌的淋巴结胃周转移基本符合由近及远的规律。     

Clinical significance of lymph node metastasis in gastric cancer

Gastric cancer,one of the most common malignancies in the world,frequently reveals lymph node,peritoneum,and liver metastases.Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection,which results in poor prognosis.Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer.Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials,it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year followup study.Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide,but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis.It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer.Besides,the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.     

分化不良型早期胃癌淋巴结转移的危险因素分析

目的评估分化不良型早期胃癌患者淋巴结转移的危险因素,探讨其内镜治疗的可能性。方法回顾性分析2002年9月-2008年12月经手术证实的100例分化不良型早期胃癌患者,对其年龄、性别、肿瘤大小、部位、大体类型、溃疡、组织学类型、浸润深度及淋巴管肿瘤浸润与淋巴结转移的关系进行单因素和多因素分析。结果分化不良型早期胃癌的淋巴结转移率达18．00％。多变量分析显示肿瘤大小（〉2cm）、侵犯至黏膜下层、淋巴管肿瘤浸润均是分化不良型早期胃癌淋巴结转移的独立危险因素（P〈0．05）。肿瘤大小和淋巴管肿瘤浸润是分化不良型黏膜内早期胃癌的淋巴结转移的独立危险因素。在直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内早期胃癌中未发现淋巴结转移。结论直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内癌患者可考虑内镜治疗,术后需密切随访。     

VEGF-C及其受体FLT-4 mRNA的表达在胃癌淋巴转移中的作用

目的研究血管内皮生长因子C（vascular endothelial growth factor C,VEGF-C）及其受体VEGFR-3（FLT-4）mRNA在胃癌、癌旁组织及正常组织中的表达。方法采用RT-PCR技术对34例胃癌的癌组织和癌旁组织及16例正常胃组织中VEGF-C及FLT-4 mRNA的表达进行检测。结果VEGF-C及FLT-4在胃癌和癌旁组织中都有表达;VEGF-C及FLT-4在胃癌、癌旁组织和正常胃组织中的表达有明显差异（PVEGF-C〈0.05,PFLT-4〈0.05）;VEGF-C及FLT-4在胃癌组织中的表达有明显相关性（r=0.6729,P〈0.05）;有淋巴结转移的胃癌与癌旁组织中VEGF-C的表达有明显差异（r=0.5189,P〈0.05）;VEGF-C在中、低分化和高分化胃癌组织中的表达有明显差异（P〈0.05）;BorrmannⅠ、Ⅱ型分别与Ⅲ、Ⅳ型胃癌组织中VEGF-C的表达有明显差异（P〈0.05）,而Ⅰ、Ⅱ型之间的差异无统计学意义（P〉0.05）,Ⅲ、Ⅳ型之间的差异无统计学意义（P〉0.05）。结论VEGF-C及其受体FLT-4在胃癌的生长中起作用;VEGF-C及其受体FLT-4 mRNA的高表达可促进胃癌淋巴管的形成和淋巴结的转移。     

胃癌淋巴结转移规律及其清扫范围探讨

目的　探讨胃癌淋巴结转移规律及其清扫范围。方法　对188例接受手术治疗的胃癌患者,于术中用美蓝-胃癌单克隆抗体(MAb)3H11标记淋巴结,并对染色淋巴结进行清扫,术后统计切除标本的淋巴结转移情况及病理特征。结果 188例胃癌患者的淋巴结转移率为62.8％(118／188)。胃上1／3(U区)、中1／3(M区)、下1／3(L区)及全胃癌患者的淋巴结转移率分别为61.9％、60.0％、57.5％及95.0％。早、中、晚期胃癌患者淋巴结转移率依次呈递增趋势,P<0.05。浸润型(Ⅲ、Ⅳ型)转移率(76.1％)明显高于局限型(Ⅰ、Ⅱ型)(44.3％),P<0.05。肿瘤直径≤4cm、-7cm和≥8cm者的淋巴结转移率依次增加,差异有显著性,P均<0.01。结论 胃癌淋巴结转移率较高。尤其晚期、浸润型及直径>4cm的胃癌,其淋巴结转移率更高,术中应按胃癌的临床病理分期、部位、大小及Borrman分型,选择淋巴结清扫范围。如果根据术中美蓝-MAb3H11标记结果确定淋巴清扫范围将更准确可靠。     

Prediction of risk factors for lymph node metastasis in early gastric cancer

AIM:To explore risk factors for lymph node metastases in early gastric cancer(EGC) and to confirm the appropriate range of lymph node dissection.METHODS:A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery,Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009,were retrospectively reviewed.Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines.The macroscopic type was classified as elevated(type Ⅰ or Ⅱa),flat(Ⅱb),or depressed(Ⅱc or Ⅲ).Histopathologically,papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas,and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas.Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.RESULTS:The lymph node metastases rate in patients with EGC was 14.4%.Among these,the rate for mucosal cancer was 5.4%,and 8.9% for submucosal cancer.Univariate analysis showed an obvious correlation between lymph node metastases and tumor location,depth of invasion,morphological classification and venous invasion(χ 2 = 122.901,P = 0.001;χ 2 = 7.14,P = 0.008;χ 2 = 79.523,P = 0.001;χ 2 = 8.687,P = 0.003,respectively).In patients with submucosal cancers,the lymph node metastases rate in patients with venous invasion(60%,3/5) was higher than in those without invasion(20%,15/75)(χ 2 = 4.301,P = 0.038).Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018,Exp(B) = 2.744].Among the patients with lymph node metastases,29 cases(14.4%) were at N1,seven cases were at N2(3.5%),and two cases were at N3(1.0%).Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node me     

Twist-1表达促进胃癌细胞淋巴结转移的可能机制

目的 检测胃癌组织及转移淋巴结基因谱的表达变化,筛选表达差异基因,并探讨其在胃癌转移中的可能机制.方法 利用U133plus 2.0基因芯片技术检测胃癌组织和转移淋巴结组织上皮细胞的基因表达谱变化,筛选出差异基因Twist-1,Western blot法检测过表达与敲除Twist-1细胞上皮-间质转化相关蛋白( E-Cadherin、Vimentin)的表达变化.结果 与胃癌组织比较,Twist-1在淋巴转移组织中表达明显升高分别为(2.07±0.71比12.12±3.21).阴性对照、空载体对照和Twist-1表达细胞增殖吸光度分别为0.84±0.16、0.74±0.06和0.71±0.07,细胞凋亡率分别为(2.05±0.08)％、(4.31±0.07)％和(3.95±0.09)％,表达Twist-1与细胞增殖及凋亡无明显相关.但细胞迁移能力增高.结论 Twist-1基因的改变可能与胃癌转移相关,并可能通过皮-间质转化方式实现.     

Predictive factors for lymph node metastasis in early gastric cancer

AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors ...     

Unveiling lymph node metastasis in early gastric cancer

With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Currently,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and Japan.In the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/ESD.Generally,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC cases.However,there is some controversy among investigators regarding the validity of these criteria.Further,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic resection.The first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic findings.After endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of invasion.However,evaluation of clinical application data is essential for validating this recommendation.Moreover,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.     

可切除性肺癌胸内淋巴结转移的临床研究

目的　探讨可切除性肺癌的胸内淋巴结转移规律。方法　收集１９９２ 年１ 月～１９９８ 年７月可切除性肺癌１６０ 例,在肺癌术中分区摘除肺门淋巴结（Ｎ１） 和纵隔淋巴结（Ｎ２）,记录各区淋巴结的数量、大小和颜色,按区检查每一个淋巴结有无转移癌。结果　１６０ 例肺癌中有淋巴结转移者９９ 例（６１－９％ ）,Ｎ２ 转移者７３ 例（４５－６％ ） 。离肺门或肺根部最近的１１、１０ 、７、５ 和４ 区淋巴结的转移频度较高,较远的９、６、３、２ 和１ 区则明显降低。淋巴结≥２ ｃｍ 的癌转移度为６０－７ ％ 、≥１ ｃｍ 为１５－５％ 、＜ １ｃｍ 为４－３％ 。有转移癌的最小淋巴结为０－２ ｃｍ 。小细胞肺癌（ＳＣＬＣ）的淋巴结转移明显高于非小细胞肺癌（ＮＳＣＬＣ）（ Ｐ＜ ０－０５） 。结论　多数肺癌的淋巴结转移遵循由近向远、由下向上、由肺内经肺门向纵隔顺序转移的规律。淋巴结转移与肿瘤的部位、大小、病程均无关,ＳＣＬＣ更易发生淋巴结转移。确诊淋巴结有无转移癌必须依靠病理检查。     

老年未分化型早期胃癌淋巴结转移的危险因素分析

目的总结老年患者未分化型早期胃癌（early gastric cancers,EGCs）的临床病理特征,分析未分化型EGCs淋巴结转移的危险因素。方法纳入2010年1月—2019年8月在北京协和医院行根治性胃癌切除+淋巴结清扫术,手术病理诊断符合EGCs的老年（≥65岁）患者,以分化型EGCs为对照,比较分析未分化型EGCs（即印戒细胞癌和低分化腺癌）的临床病理特征。用Logistic回归对老年未分化型EGCs淋巴结转移风险进行多因素分析。结果纳入老年EGCs共165例,其中未分化型EGCs 82例（印戒细胞癌11例,低分化腺癌 71例）,分化型EGCs 83例。淋巴结转移率方面,老年EGCs淋巴结转移率为9.1%（15/165）,分化型EGCs淋巴结转移率为4.8%（4/83）,未分化型EGCs淋巴结转移率为13.4%（11/82）。未分化型EGCs中,低分化腺癌淋巴结转移率为15.5%（11/71）,印戒细胞癌11例均无淋巴结转移。单因素分析提示浸润深度（P=0.019)、病变大小（P=0.006）、合并溃疡（P=0.006）、凹陷型（P=0.003）与老年未分化型EGCs淋巴结转移相关。多因素分析提示黏膜下层浸润（OR=11.98,95%CI:1.17~122.84,P=0.037 ）、病变直径＞2 cm（OR=11.95,95%CI:1.88~76.07,P=0.009)是老年未分化型EGCs淋巴结转移的独立危险因素。所有满足扩大适应证的老年未分化型EGCs无淋巴结转移。结论黏膜下层浸润、病变直径＞2 cm是老年未分化型EGCs淋巴结转移的独立危险因素。满足扩大适应证的老年未分化型EGCs患者适合内镜黏膜下剥离术治疗。     

结直肠癌淋巴结转移相关因素的研究进展

结直肠癌淋巴结转移受多种因素的影响,众多因素之间相互联系、相互作用,临床工作中需对各种因素综合分析才能正确地做出诊断和治疗,本文查阅近十年关于结直肠癌淋巴结转移的相关因素的文献,初步总结了目前被普遍认同的影响结直肠癌淋巴结转移的相关因素,为研究结直肠癌淋巴结转移的独立因素提供思路。目前认为肿瘤的浸润深度、原发部位、分化程度、病理类型以及患者的术前血清CEA水平等与结直肠癌的淋巴结转移具有相关性。而肿瘤的大小和大体形态等因素与结直肠癌淋巴结转移是否具有相关性,目前的认识还不一致。造成以上研究结果出现差异的原因可能有:不同学者对于患者选择的差异、样本数量的多少以及采用的标准不同等。     

Single skip metastasis in sentinel lymph node: In an early gastric cancer

Lymph node status is considered a key prognostic and predictive factor in patients with gastric cancer(GC).Although there is a practical approach to the intraoperative detection of sentinel lymph nodes(SLNs),such a procedure is not included in the European surgical protocol.In this report,we present a practical approach to SLN mapping in a representative case with early gastric cancer(EGC).A 74-year-old female was hospitalized with an endoscopically observed,superficially ulcerated tumor located in the antral region.Subtotal gastrectomy with D2 lymphadenectomy and SLN mapping was performed by injecting methylene blue dye into the peritumoral submucosal layer.An incidentally detected blue-stained lymph node located along the middle colic artery was also removed.This was detected 40 min after injection of the methylene blue.Histopathologic examination showed a p T1b-staged well-differentiated HER-2-negative adenocarcinoma.All of the 41 LNs located at the first,third,and fifth station of the regional LN compartments were found to be free of tumor cells.The only lymph node with metastasis was located along the middle colicartery and was considered a non-regional lymph node.This incidentally identified skip metastasis indicated stage Ⅳ GC.A classic chemotherapy regimen was given,and no recurrences were observed six months after surgery.In this representative case,low-cost SLN mapping,with a longer intraoperative waiting time,totally changed the stage of the tumor in a patient with EGC.     

伴淋巴结转移的早期胃癌病理组织形态学研究

目的通过研究早期胃癌发展过程中组织形态学的变迁，预测其淋巴结转移的难易程度。方法以伴淋巴结转移的81例早期胃癌作为转移组，抽取81例不伴淋巴结转移者作为对照组，两组均含11例黏膜内癌，70例黏膜下癌，组织学分类及肿瘤部位相似，具可比性。将各组的肿瘤灶亚分类为表层部、浸润部，各病灶的病理组织形态学依据规范分为分化型、混合型、未分化型。对各病例相关因子进行统计学分析研究。结果浸润部较表层部组织分化程度低下者，转移组为40．7％，较对照组的11．9％为高。转移组表层部的分化型胃癌和未分化型胃癌，其浸润部同一组织学分化程度较对照组为低，其差异有统计学意义（分别为P〈0．01和P〈0．05）。转移组的表层部与浸润部的分化程度合致率为61．7％，明显低于对照组的77．8％，其差异有统计学意义（P〈0．05）。转移组的男女比率为1．9：1，较对照组的3．3：1为低，其差异有统计学意义（P〈0．05）。结论早期胃癌中，癌灶水平方向和浸润先端部的垂直方向组织学分化程度的变化更易出现。浸润部与黏膜同有层癌组织学分化程度不同者，尤其是组织学分化程度趋低下者易出现淋巴结转移。女性较男性更易出现淋巴结转移。     

早期胃癌淋巴结转移规律及内镜切除指征的探讨

目的探讨不同组织学类型早期胃癌的淋巴结转移情况及内镜下治疗的可行性。方法回顾性分析524例行胃癌根治术治疗并经病理确诊的早期胃癌患者的病例资料,比较不同组织学类型早期胃癌的临床病理特征并对其与淋巴结转移的相关性进行单因素及多因素分析。结果印戒细胞癌与分化型腺癌、低分化腺癌相比,在肿瘤大小（P值分别为0．048和0．023）和浸润深度（P值均为0．000）方面差异均有统计学意义,其淋巴结转移率（9．7％,11／113）明显低于低分化型腺癌（22．2％,20／90）,差异有统计学意义（P=0．018）,但与分化型腺癌（13．t％,42／321）比较差异无统计学意义（P=0．406）。单因素分析显示肿瘤大小（P=0．007）、浸润深度（P=0．000）、组织学类型（P=0．030）、淋巴管肿瘤浸润（P=0．000）和有无溃疡（P=0．002）与淋巴结转移显著相关;多因素分析结果显示浸润深度（P=0．007）、肿瘤大小（P=0．010）、组织学分型（P=0．000）和淋巴管肿瘤浸润（P=0．000）为淋巴结转移的独立危险因素。联合上述4个独立危险因素分析显示肿瘤直径小于2cm且无淋巴管肿瘤浸润的印戒细胞型黏膜内癌未见淋巴结转移。结论印戒细胞型早期胃癌的临床病理特征与分化型和低分化型早期腺癌存在差异,直径小于2cm且无淋巴管肿瘤浸润的印戒细胞型黏膜内癌患者可行内镜切除术。     

胃癌组织中血管内皮生长因子C表达及与淋巴结转移关系

目的探讨胃癌组织中血管内皮生长因子C(VEGFC)的表达及与肿瘤淋巴结转移的关系。方法取30例胃癌患者手术切除的新鲜标本和距癌灶5cm以外的胃组织各1块,采用半定量RTPCR法和免疫组化染色法检测胃癌组织及癌旁正常组织的VEGFC表达,图像分析仪检测VEGFC的免疫组化阳性指数(positiveindex,PI)。结果胃癌细胞呈高水平表达VEGFC,癌旁正常组织则未见表达。在胃癌组织中,有淋巴结转移(PI=1.345±0.079)、淋巴管浸润(PI=1.315±0.037)患者的VEGFC表达水平分别较无转移(PI=1.156±0.045)及无浸润者(PI=1.154±0.043)增高(P<0.05)。高分化胃癌患者的VEGFCmRNA[VEGFC/βactin比值(Ar)=0.846±0.042]和VEGFC表达(PI=1.372±0.023)均分别高于中低分化胃癌者(Ar=0.663±0.007,P<0.01和PI=1.126±0.078,P<0.05)。结论VEGFC阳性表达的胃癌患者可能更易发生淋巴结转移。     

Clinicopathological features associated with lymph node metastasis in early gastric cancer: Analysis of a single-institution experience in China

BACKGROUND:

An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient’s quality of life.

OBJECTIVE:

To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China.

METHODS:

A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated.

RESULTS:

Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis.

CONCLUSIONS:

Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.     

Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer

AIM:To study how lymph node metastasis(LNM) risk is stratified in undifferentiated-type early gastric cancer(undiff-EGC) dependent on combinations of risk factors.METHODS:Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively.Using clinicopathological factors of patient age,location,size,an endoscopic macroscopic tumor form,ulceration,depth,histology,lymphatic involvement(LI) and venous involvement(VI),LNM risk was examined and stratified by conventional statistical analysis and datamining analysis.RESULTS:LNM was positive in 44 of 567 cases(7.8%).Univariate analysis revealed > 2 cm,protrusion,submucosal(sm),mixed type,LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis.In preoperatively evaluable factors excluding LVI,sm and > 2 cm were independent factors.According to the depth and size,cases were categorized into the low-risk group [m and ≤ 2 cm,0%(LNM incidence)],the moderaterisk group(m and > 2 cm,5.6%; and sm and ≤ 2 cm,6.0%),and the high-risk group(sm and > 2 cm,19.3%).On the other hand,LNM occurred in 1.4% in all LI-negative cases,greatly lower than 28.2% in all LI-positive cases,and LNM incidence was low in LInegative cases even in the moderate- and high-risk groups.CONCLUSION:LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively.Among these factors,LI was the most significantly correlated factor.     

胃癌淋巴结转移相关分子研究

淋巴结转移是评价胃癌预后及治疗策略的重要因素。然而,胃癌术前确诊是否存在淋巴结转移非常困难。为此,此文总结近年来国外相关文献,综述胃癌淋巴结转移相关分子学水平的研究,即阐述与胃癌淋巴结转移密切相关的蛋白分子,以探索胃癌淋巴结转移新的诊断方法,为临床胃癌治疗提供新的靶点。     

胃癌组织VEGF-C和CXCR4的表达与淋巴结转移的关系

目的:探讨胃癌组织VEGF-C和CXCR4的表达与淋巴道转移的关系以及两者的相关性.方法:用半定量RT-PCR方法检测50例胃癌组织和相应癌旁组织中VEGF-C和CXCR4的表达水平.结果:在淋巴结转移阴性组(pN_0)胃癌组织(n =12)中VEGF-C的表达指数为0.28±0.09,与pN_1组(0.34±0.08,n=35)比较差别有显著意义(P<0.05);VEGF-C和CXCR4在pN_1组中的表达指数(0.34±0.08,0.3 1±0.08)与pN_2 pN_3组(0.40±0.10,0.43±0.14)比较差别均有显著意义(P<0.05、P<0.01);在淋巴结转移阳性的胃癌组织(n=38)中VEGF-C和CXCR4的表达指数(0.36±0.10,0.35±0.12)高于无淋巴结转pN。组(0.28±0.09,0.26±0.09,n=12),差别有显著意义(P<0.01,P<0.05).VEGF-C和CXCR4在pN_0组中的表达指数(0.28±0.09,0.26±0.09)与相应癌旁组织比较(0.21±0.12,0.20±0.11)差别均无显著意义.经Spearman等级相关分析VEGF-C和CXCR4在胃癌组织中表达之间存在显著相关性(r_s=0.34l,P<0.05).结论:VEGF-C和CXCR4的表达指数随胃癌淋巴结转移的增加而增加,两者之间存在一定相关性,对预测淋巴结转移有重要的临床价值.