肺癌和食管癌淋巴结转移的比较研究

通过肺癌１５２例，食管癌８２例，手术廓清淋巴结１４１２个的区域分布和病理结果的比较分析，显示其共性规律是上位癌向上转移大于向下。上叶肺癌转移路近似于“√”号，下叶肺癌转移路似倒“√”号，上段食管癌其梭形转移圈上长下短，下段食管癌则上短下长。     

215例肺癌的胸内淋巴结转移规律及临床分析

目的 :分析肺癌的胸内淋巴结转移的方式和规律,以探讨可切除性肺癌胸内淋巴结合理的手术清扫范围。 方法 :收集我院从2004年9月至2006年12月的215例肺癌病例,行根治性切除及系统性胸内淋巴结清扫术,分别记录淋巴结的数量及进行病理检查。分析其胸内各组淋巴结转移频度,原发部位与淋巴结转移的关系,肿瘤的大小,病理类型与淋巴结转移的关系的特点和规律。 结果 :215例肺癌患者共清扫胸内1070组的3680个淋巴结,平均每例切除淋巴结17.1个。经病理检查证实其中198个组的468个淋巴结存在转移癌,215例肺癌患者中94例有胸内淋巴结转移,转移率为43.7%。围绕肺门或肺根部的11、10、7、5、4组淋巴结的转移频度比远离肺根部的9、6、8、3、2、1肺上叶癌更易向上纵隔淋巴结转移,而肺下叶(包括中叶)可向上、下纵隔淋巴结转移。组淋巴结高。小细胞肺癌的淋巴结转移率明显高于非小细胞肺癌(P<0.05)。淋巴结转移率随肿瘤增大而增加。 结论 :多数肺癌的淋巴结转移遵循由近及远、自上而下、由肺内经肺门再向纵隔的顺序转移规律,纵隔淋巴结的转移呈\     

Fas/FasL 在肺癌中的表达与淋巴结转移的关系

 目的　探讨 Fas/Fas L在肺癌中的表达及其与淋巴结转移的关系。方法　用免疫组化方法同时检测 42例非小细胞肺癌组织及肺癌转移淋巴结的 Fas/Fas L表达。结果　肺癌的 Fas表达率为 52 .3% (2 2 /4 2 ) ,其中鳞癌为 58.3% (1 4/2 4 ) ,腺癌为 44.4% (8/1 8) ,二者无显著差异 (P>0 .0 5)。肺癌的 Fas表达与有否淋巴结转移无明显相关 (P>0 .0 5)。肺癌的 Fas L表达为 57.1 % (2 4 /4 2 ) ,其中鳞癌 58.3% (1 4/2 4 )与腺癌 55.5% (1 0 /1 8)之间无显著差别 (P>0 .0 5)。肺癌伴淋巴结转移的 Fas L表达为 72 .7% (1 6/2 2 ) ,无淋巴结转移的 Fas L表达为 40 % (8/2 0 ) ,有显著差别 (P<0 .0 5)。1 6例 Fas L阳性肺癌的转移淋巴结均呈表达 Fas L。结论　肺癌表达 Fas L,并可能在肺癌转移机制中起免疫逃避作用。     

非小细胞肺癌13组、14组淋巴结转移规律探讨

背景与目的 淋巴结转移是影响肺癌肿瘤-淋巴结-转移(tumor-node-matastasis,TNM)分期的重要因素之一,在非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的手术中,13组、14组淋巴结因其隐藏于肺叶的深部而忽视做病理检测,影响术后病理分期准确性.本研究旨在探讨13组、14组淋巴结在NSCLC术中的阳性检出率及其对病理分期的影响.方法 选取内蒙古医科大学附属医院100例NSCLC手术患者为研究对象,剖取胸内2组-12组、第13、14组淋巴结行病理检测,分析肿瘤的大小、部位、病理类型等因素与胸内淋巴结转移率的关系.结果 100例患者胸内淋巴结转移率为47.0％,10组-12组、N2淋巴结、13组、l4组淋巴结阳性率有统计学差异(P＜0.0S);不同T分期13组、14组淋巴结漏检率有统计学差异(P＜0.0S);周围型与中央型NSCLC的N1期漏检率无统计学差异(P＞0.05);不同病理类型肿瘤之间N1期漏诊率无统计学差异(P＞0.05).此外,发现有12例患者存在非肿瘤所在叶、段支气管旁淋巴结转移.结论 临床上检测NSCLC13组、14组与非肿瘤所在叶支气管旁淋巴结的转移情况十分必要,有利于获取术后准确的TNM分期,对于指导术后治疗意义重大.     

Laryngeal Metastasis from a Pulmonary Papillary Adenocarcinoma: A Case Report

Metastases to the larynx from distant primaries are very rare.The present article reports a case of metastatic papillary adenocarcinomaof the larynx of lung origin. The patient was a 59-yearold femalenon-smoker, who had a history of adenocarcinoma of the rightlung. For the laryngeal tumor, we performed a partial laryngectomyfollowing biopsy. The tumor of the larynx was a papillary adenocarcinomaresembling the lung tumor, both demonstrating positive immunohistochemical staining for pulmonary surfactant apoprotein.The findings emphatically indicated the laryngeal tumor to bemetastasis from the primary papillary adenocarcinoma of thelung. The present case report presents the clinical findings,course of disease and histopathological findings with briefreviews of the literature.     

Significance of Spread Through Air Spaces in Resected Lung Adenocarcinomas With Lymph Node Metastasis

Background

Spread through air spaces (STAS) is a recently recognized invasive pattern of lung cancer defined by the World Health Organization as micropapillary clusters, solid nests, or single cells spreading within air spaces beyond the edge of the main tumor. Although STAS has been shown to be a significant prognosticator for the postoperative survival in early-stage lung cancer treated with limited resection, its prognostic impact on the survival in completely resected adenocarcinomas with lymph node metastasis remains unclear.

VEGF-C表达与子宫颈癌前哨淋巴结转移的关系

目的：探讨VEGF-C与子宫颈癌前哨淋巴结转移的关系。方法对82例行宫颈癌根治术治疗的患者进行mRNA和ELISA检测,分析VEGF-C在肿瘤中的表达。结果 VEGF-C表达高的多发生淋巴结转移,表达低的患者多数未发生转移,且具有统计学比较意义（P＝0．046）。结论在宫颈癌转移患者体中VEGF-C表达与淋巴结转移呈正相关,VEGF-C极有可能成为宫颈癌转移的分子标志物。     

乳腺癌前哨淋巴结转移的相关因素分析及病理学研究

目的探究乳腺癌前哨淋巴结转移的相关因素。方法回顾性分析162例前哨淋巴结活检技术的乳腺癌患者的临床资料,对乳腺癌临床病理指标与前哨淋巴结转移之间的关系进行因素分析。结果前哨淋巴结阳性共83例,前哨淋巴结阴性共79例。2组间的年龄、性别组成、体重指数、吸烟史和饮酒史等的差异均无统计学意义(P>0.05)。原发肿瘤位置、活检方式与前哨淋巴结转移无关(P>0.05),但病理类型与前哨淋巴结转移有关。随着肿瘤的变大,灵敏度、特异性也随之升高。多元Logistic回归分析显示,肿瘤直径和病理类型是影响前哨淋巴结转移的独立危险因素(P<0.05)。结论乳腺癌前哨淋巴结转移考虑与肿瘤大小及病理类型相关,但具体病例需具体分析后考虑是否可行前哨淋巴结活检术。     

食管癌根治术后复发及纵隔淋巴结转移CT特征分析

目的：探讨食管癌根治术后复发及纵隔淋巴结转移的CT表现特点和术后复发原因。方法：回顾性分析经胃镜活检病理确诊或CT诊断为食管癌术后复发及淋巴结转移患者96例的CT表现特点。结果：纵隔淋巴结转移54例,吻合口复发28例,原肿瘤床区复发14例。结论：食管癌根治术后最常见的复发方式为纵隔淋巴结转移,CT检查应作为食管癌术后复查的常规手段之一。     

Surgical Therapeutic Strategy for Non-small Cell Lung Cancer with Mediastinal Lymph Node Metastasis(N2)

Background and objective Approximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC) are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent,yet due to many reasons,5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of b...     

早期非小细胞肺癌淋巴结转移规律与清扫方式研究进展

目前,肺癌已是全球范围内发病率及死亡率最高的恶性肿瘤,非小细胞肺癌（non-small cell lung cancer, NSCLC）约占肺癌80%。手术治疗在早期NSCLC治疗中占主导地位,而淋巴结分期及手术中清扫程度直接影响着患者术后生活质量及患者的预后。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但对早期NSCLC患者纵隔淋巴结清扫程度问题上一直存在较大争议,精确评估区域淋巴结的转移及淋巴结清扫的程度是影响患者围手术期并发症和预后的重要因素。对于早期肺癌行肺叶特异性或选择性淋巴结清扫已逐渐为国内外学者接受,并可能成为临床I期NSCLC患者标准淋巴结清扫方式。     

A Nomogram for Predicting Lateral Lymph Node Metastasis in Cases of Papillary Thyroid Micro-Carcinoma with Suspected Lymph Node Metastasis

The elevation for lateral lymph node metastasis (LLNM) plays an important role in therapeutic decision-making for thyroid carcinoma. A reliable forecasting model for LLNM in patients with papillary thyroid micro-carcinoma (PTMC) is needed, using clinicopathological characteristics. A total of 576 PTMC patients with suspicious lateral cervical lymph node (II, III, IV or V region) metastasis and known clinicopathological variables were randomly collected at Shenzhen Second People’s Hospital. Cervical lymph node status of every patient was assessed by ultrasonography (US). The patients in this cohort study underwent thyroidectomy and lateral neck lymph node dissection. Univariate analysis and logistic regression analysis were performed to screen out the predictive variables associated with LLNM, and a nomogram was constructed by integrating clinicopathological features collected in our study. The overall LLNM rate was 23.0% (133/576). After statistical analysis, central lymph node metastasis (CLNM), prelaryngeal lymph node metastasis (PLNM), bilateral lesions, tumor location in thyroid (upper or lower), and gross extrathyroidal extension (ETE) were found to be independent predictive factors for LLNM (P < 0.01). The nomogram built to predict LLNM in PTMC patients passed the calibration step and the area under the receiver operating characteristic curve was 0.967, which showed that the nomogram we used had a good predictive effect. The nomogram constructed in this study has a good predictive value for LLNM, which will help thyroid surgeons to make a more accurate surgical plan for patients with PTMC. A strict preoperative evaluation and total thyroidectomy and lateral neck dissection may be indicated when patients with PTMC have a high score.     

乳腺癌组织中P38、VEGF表达与其淋巴结转移及预后的关系

目的 探讨乳腺癌组织中P38、VEGF表达与其淋巴结转移及预后的关系.方法 选取经病理证实为乳腺癌患者88例为研究对象.采用SP法检测P38、VEGF蛋白在乳腺癌组织中的表达,应用COX回归模型,探讨P38、VEGF表达与乳腺癌预后的关系.结果 88例患者中P38阳性表达67例,阴性21例;VEGF阳性56例 阴性32例.所有患者均随访到2016年1月31日,以死亡或肿瘤转移、复发为终点事件,出现终点事件的患者17例;P38、VEGF在Ⅲ期乳腺癌组织中表达水平明显高于Ⅰ、Ⅱ期,而与患者年龄、肿瘤大小无明显相关性.复发及转移患者中P38、VEGF阳性率明显高于无转移和复发者,差异显著,具有统计学意义,P<0.05;多因素分析提示:肿瘤分期(P=0.01)、P38阳性(P=0.001)、VEGF阳性(P=0.02)是乳腺癌患者转移或复发的独立危险因素.结论 P38、VEGF阳性表达患者的转移及复发率高,P38、VEGF阳性是患者转移及复发的独立风险因素.     

CK19表达与子宫颈癌前哨淋巴结转移的关系

目的 观察CK19表达与子宫颈癌前哨淋巴结转移的关系.方法 回顾性分析行宫颈癌根治术治疗的46例宫颈癌患者的临床资料,采用mRNA和免疫组化检测CK19在子宫颈前哨淋巴结中的表达.结果 RT-PCR分析结果显示82个淋巴结中,11个淋巴结CK19高表达,71个淋巴结CK19低表达.免疫组化染色结果显示,11个CK19高表达淋巴结免疫组化染色阳性,71个CK19低表达淋巴结免疫组化染色阴性.多因素分析结果表明CK19高表达与前哨淋巴结转移呈正相关(P<0.05).结论 CK19表达与宫颈癌患者淋巴结转移呈正相关,CK19有可能称为宫颈癌转移的分子标记物.     

肺癌原发灶与纵隔转移淋巴结中EGFR突变差异的研究

目的 探讨肺癌原发灶和转移纵隔淋巴结中EGFR突变率有无差异.方法 采用PCR扩增ARMS法,分析NSCLC原发灶组织中EGFR基因突变与纵隔转移淋巴结中EGFR基因突变情况,比较两者突变率.结果 37例非小细胞肺癌患者原发灶检测到EGFR基因突变,突变率为37％,34例纵隔转移淋巴结检测到EGFR基因突变,突变率为34％.NSLCL患者原发灶和纵隔转移淋巴结中EGFR均有突变95.77％;均没有突变97.67％.肺癌原发灶与纵隔淋巴结EGFR突变一致率达到97％.肺癌原发灶与纵隔淋巴结EGFR突变率比较无差异P＞0.05.结论 肺癌原发灶与纵隔转移淋巴结EGFR突变率无差异.     

成人肺炎性肌纤维母细胞瘤伴淋巴结转移1例

炎性肌纤维母细胞瘤（inflammatmy myofibroblasti ctumor，IMT）是一种少见而独特的间叶性肿瘤，表现低度恶性或交界性肿瘤特点．近年WHO提出此命名，已逐渐得到广泛认同。肺IMT是由肌纤维母细胞和多种炎性细胞成分组成的肺内瘤样团块，较多见于儿童和青少年，现报道成人肺IMT伴淋巴结转移病例1例如下。     

nm23-H1蛋白表达在非小细胞肺癌淋巴结转移的意义

目的:探讨nm23-H1蛋白在非小细胞肺癌(NSCLC)中的表达及与淋巴结转移的关系。方法:应用免疫组织化学法检测60例非小细胞肺癌组织中nm23-H1基因蛋白的表达。结果:NSCLC无淋巴结转移组nm23-H1蛋白阳性表达率为82.76%(24/29),高于NSCLC伴有淋巴结转移组45.16%(14/31),两者差异有统计学意义(P<0.01)。结论:NSCLC中nm23-H1蛋白低表达易发生淋巴结转移,检测nm23-H1蛋白可在一定程度上评估NSCLC的预后。     

T1期非小细胞肺癌纵隔淋巴结转移规律及清扫方式研究进展

肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer,NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。     

CT对原发性肺癌合并肺门,纵隔淋巴结转移的诊断价值

本文报告50例原发性肺癌病人肺门、纵隔等处摘出的210个淋巴结的病理诊断与胸部CT对照研究,探讨CT诊断肺癌淋巴结转移的价值和转移淋巴结的大小阀值。结果表明CT对诊断肺癌淋巴结转移有重要价值,但在发现某些部位的淋巴结肿大和判断转移的特异性方面有一定限制。在CT上显影的164个淋巴结中,若以长径>15mm作为淋巴结转移的阀值,则敏感性为57％,特异性为91％,准确性为81％,阳性预期值(PPV)71％,阴性预期值(NPV)84％。有46个淋巴结(22％)在CT上未能显示,主要是叶支气管周围及肺韧带淋巴结。作者指出,对肺癌合并肺门、纵隔淋巴结转移的诊断要慎重。     

The Metastatic Rate of Internal Mammary Lymph Nodes When Metastasis of Internal Mammary Lymph Node Is Suspected on PET/CT

Purpose

Metastatic status of internal mammary lymph node (IMLN) has a clinical importance in assessing the stage and prognosis of breast cancer. But, when metastasis of IMLN is suspected; the management is controversial. We retrospectively reviewed 36 breast cancer patients who underwent IMLN biopsy, and investigated the pathologic status of IMLN which suspected metastasis with positron emission tomography and computed tomography (PET/CT).

Methods

From January 2007 to December 2012, 36 patients underwent IMLN biopsy for suspected IMLN metastasis on PET/CT, when diagnosed with primary or recurrent breast cancer. Clinicopathologic features of these patients and metastatic status of IMLNs were investigated.

Results

A total of 36 patients were included in this study. Twenty-four patients diagnosed with primary breast cancer and 12 patients diagnosed with recurrent breast cancer underwent IMLN biopsy. The mean number of IMLNs was 2.72±2.05, and the total metastatic rate of IMLNs was 72.2% (26 out of 36). IMLN metastasis was confirmed on pathologic examination in 19 patients (79.2%, 19 out of 24) with primary breast cancer and in 7 patients (58.3%, 7 out of 12) with recurrent breast cancer. The mean standardized uptake values of metastatic and nonmetastatic IMLNs in primary breast cancer were 3.50±2.51 and 3.72±3.55, respectively and those of metastatic and nonmetastatic IMLN in recurrent breast cancer were 3.92±2.67 and 4.12±3.57, respectively. In both groups, there was no statistically significant difference between the SUVs of metastatic and nonmetastatic IMLNs (p=0.291 and p=0.951, respectively).

Conclusion

Due to the recent advances in diagnostic and surgical skills, IMLN biopsy can be performed safely without any complications without performing radical mastectomy. If IMLN metastasis is suspected on PET/CT, IMLN biopsy is useful to assess the exact stage and to determine the treatment for breast cancer. Further follow-up studies are needed to assess the locoregional recurrence and to compare the improvement in overall survival and disease-free survival.