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目的探讨有、无胃癌家族史的胃癌患者之间临床病理特征及预后的差异。方法回顾性分析2011年至2015年456例胃癌患者的临床病例资料,其中有胃癌家族史者102例。采用双侧χ~2检验分析有、无胃癌家族史患者的临床病理特征;生存分析用Kaplan-Meier法,并行Log-rank检验;用Cox比例风险模型分析影响胃癌预后的因素。结果在有胃癌家族史的患者中,年龄≥50岁、肿瘤最大径<5 cm、组织学分级为Ⅰ~Ⅱ级以及M_0分期的比例均显著高于无胃癌家族史者(P<0.05)。有胃癌家族史患者的中位总生存时间(OS)为56.1个月,高于无胃癌家族史者的51.0个月(P=0.318);但在发病年龄<50岁的亚组中,有胃癌家族史患者的中位OS显著优于无胃癌家族史患者(未达vs.53.0个月,P=0.021)。Cox比例风险模型显示,影响有胃癌家族史患者OS的因素为N分期和M分期(P<0.05),影响无胃癌家族史患者OS的因素为肿瘤最大径、肿瘤部位和M分期(P<0.05)。结论有、无胃癌家族史的胃癌患者之间存在临床病理特征的差异,其OS亦可能存在差异。 相似文献
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目的:探讨N0期胃癌患者的临床病理特征及影响预后的危险因素。方法:回顾性分析2003年3月至2012年3月我科收治的296例N0期胃癌患者的临床病理资料。分析其临床病理特征以及通过单因素和多因素分析影响其预后的危险因素。结果:本研究中男性248例,女性48例。中位年龄58岁(28~82岁)。中位肿瘤大小4 cm(0.3~15 cm)。168例患者为TNM I期,126例患者为TNM II期,仅2例患者为TNM III期。患者的中位随访时间为62.3个月(1~73.4个月)。1、3、5年总体生存率分别为97.6%、89.2%和83.7%。单因素分析显示切除方式、CEA、CA125、脉管侵犯、T分期和TNM分期为影响N0期胃癌患者预后的危险因素(P<0.05)。然而,仅CEA、CA125、脉管侵犯和T分期为影响预后的独立危险因素(P<0.05)。结论:N0期胃癌患者总体预后较好。CEA、CA125、脉管侵犯和T分期为影响N0期胃癌患者预后的独立危险因素。 相似文献
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目的:探讨结直肠癌骨转移患者的相关临床病理学特点,分析结直肠癌骨转移患者预后的相关因素。方法:选取2010年1月至2017年7月在四川大学华西医院诊治的156例结直肠癌骨转移患者,收集临床病理及预后资料进行回顾性分析,单因素生存分析采用Kaplan-Meier法和Log-rank检验以及COX回归,多因素生存分析采用COX回归模型。结果:156例患者中直肠癌108例(69.2%),结肠癌48例(30.8%);同时性骨转移61例(39.1%),异时性骨转移95例(60.9%)。确诊肠癌至出现骨转移的中位时间365天,其中异时性骨转移患者发生骨转移中位时间为784天。多发骨转移113例(72.4%),单发骨转移43例(27.6%)。仅30例(19.2%)以骨转移为唯一远处癌转移灶,其余126例(80.8%)患者均存在骨以外的其他转移病灶,其中合并肺转移92例(59.0%),合并肝转移77例(49.4%)。95例异时性骨转移患者中60例骨转移都不是初发,其中46例继发于肺转移。与同时性骨转移相比,癌胚抗原升高、骨痛、肺转移、淋巴结阴性、病理类型中-高分化的患者在异时性骨转移中更常见。结直肠癌... 相似文献
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目的:分析65例可切除老年胃癌患者的临床病理特征和预后。方法:回顾性分析病理证实的65例年龄≥65岁老年可切除胃癌患者的临床病理特征和预后。60例(92.3%)患者行R0切除。62例(95.4%)患者行D2术。18例(27.7%)患者行术后辅助化疗。Kaplan-Meier法分析生存率,Log-rank检验比较组间生存差异。结果:65例患者中,男49例,女16例。60例(92.3%)患者为腺癌。TNM分期为I-II和III期患者分别为15例(23.1%)和50例(76.9%)。32例(49.2%)患者伴有合并症,6例(9.2%)伴有1个以上合并症。全组患者2年总生存率(overall survival,OS)、无进展生存率(progression-free survival,PFS)和癌症特异生存率(cancer-specific survival,CSS)分别为42.6%、28.4%和49.0%。单因素分析发现,N0-1患者的预后明显优于N2-3的患者,2年OS、PFS和CSS分别为77.9%和31.6%(P=0.010)、78.6%和16.3%(P=0.002)以及83.1%和37.3%(P=0.023)。死亡原因分析发现,33例死亡患者中,肿瘤相关死亡25例(75.8%),治疗相关或合并症相关死亡8例(24.2%)。结论:可切除老年胃癌的合并症多见,治疗相关或合并症相关死亡多见,N分期是最重要的临床预后因素。 相似文献
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《European journal of cancer (Oxford, England : 1990)》2014,50(16):2810-2821
BackgroundBone metastasis (BM) is reported as a poor prognostic factor in gastric cancer. However, the clinicopathologic characteristics and clinical outcomes of patients with BM compared with patients without BM have not been well described.Patients and methodsThe medical records of all metastatic or recurrent gastric cancer (MRGC) patients who visited our institution were reviewed. A total of 137 evaluable patients with BM were analysed together with historical control without BM (N = 111).ResultsOf 1342 MRGC patients, 141 (10.5%) had BM. Patients with BM could be divided into initial BM (BM present at initial diagnosis of MRGC; N = 90) and late BM (N = 47) groups. The median survival after the diagnosis of BM in all patients was 4.4 months (95% confidence interval [CI] 3.69–5.11). However, overall survival after the diagnosis of MRGC was significantly shorter in the initial BM group (5.0 versus 12.2 months, p < 0.001). Compared with historical controls, patients with initial BM showed distinct clinicopathologic characteristics. Independent predictors of initial BM were a younger age, signet ring cell histology, primary tumour involving ⩾two-thirds of the stomach, pleural metastasis, thrombocytopenia and elevated alkaline phosphatase. According to a Cox proportional hazard model including both patients with BM and historical controls, initial BM, poor performance status, peritoneal metastasis, hypercalcemia and high carcinoembryonic antigen (CEA) were identified as poor prognostic factors, whereas chemotherapy was identified as a favourable factor (hazard ratio [HR] 0.33, 95% CI 0.22–0.49).ConclusionMRGC with initial BM is a distinct group of diseases with specific clinicopathologic characteristics and poor prognosis. Chemotherapy may improve survival in these patients. 相似文献
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Background Metastasis appearing to bypass or skip tiers of lymph nodes (LNs) has been referred to as skip metastasis. The clinical impact
of skip metastasis in gastric cancer remains unclear.
Methods In patients with gastric cancer, the clinicopathological features and postoperative prognoses of 21 patients with skip metastasis
were evaluated and compared with findings in patients with group 1 (N1) or group 2 (N2) LN metastasis.
Results Of the 21 patients with skip metastasis, 9 patients had metastasis in the LN along the common hepatic artery (No. 8a), 8 patients
had metastasis in the LN along the left gastric artery (No. 7), 2 patients had metastasis in LNs No. 7 and No. 8a, 1 patient
had metastasis in the LN at the splenic hilum (No. 10), and 1 patient had metastasis in LN No. 10 and the LN along the splenic
artery (No. 11). The mean diameter of the tumors in the patients with skip metastasis was 5.7 ± 2.4 cm, which was significantly
smaller than those in the N1 patients (7.9 ± 4.1 cm) and N2 patients (9.3 ± 4.6 cm). The incidence of serosal invasion, lymphatic
vessel invasion, and peritoneal metastasis was lower in patients with skip metastasis compared with N2 patients. The 5-year
survival rates were 70.2%, 62.0%, and 31.2% in patients with skip metastasis, patients with metastasis in group 1 LNs, and
those with metastasis in group 2 LNs, respectively. The prognosis of patients with metastasis in group 2 LNs was significantly
worse than that of patients with either skip metastasis (P = 0.0029) or metastasis in group 1 LNs (P < 0.0001).
Conclusion Our data indicate that both the clinicopathological characteristics and the prognoses of patients with skip metastasis were
similar to those of patients with N1 LN metastasis, but these features were not similar to those in patients with N2 LN metastasis.
The sites of skip metastasis presented in the current study may be the key for applying the concept of the sentinel node in
gastric cancer. 相似文献
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Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with bone metastasis 总被引:6,自引:2,他引:4
Shu-ichi Hironaka Narikazu Boku Atsushi Ohtsu Fumio Nagashima Yasushi Sano Manabu Muto Takahiro Fujii Hisao Tajiri Shigeaki Yoshida 《Gastric cancer》2000,3(1):19-23
Background. Patients with bone metastasis of gastric cancer occasionally experience disseminated intravascular coagulation (DIC), with
a very poor prognosis.
Methods. We treated 18 gastric cancer patients with bone metastasis with sequential methotrexate and 5-fluorouracil (sequential MTX/5-FU
therapy). The treatment schedule comprised weekly administration of methotrexate (MTX; 100 mg/m2, i.v. bolus) followed by 5-fluorouracil (5-FU; 600 mg/m2, i.v. bolus) after an interval of 3 h. Calcium leucovorin (10 mg/m2, p.o. or i.v.) was administered six times, every 6 h starting 24 h after the administration of MTX.
Results. In 11 patients with measurable metastatic lesions, the response rate was 64% (7/11). Nine patients (50%) had DIC before the
initiation of chemotherapy, and 8 of them (89%) recovered from it. Two of these 9 patients (22%) survived for more than 1
year. The median survival times for all patients and for the 9 with DIC were 186 and 113 days, respectively. Grade 4 leukopenia
was observed in 3 patients (17%). No treatment-related deaths occurred.
Conclusion. Sequential MTX/5-FU therapy may have palliative potential and may be a feasible treatment for gastric cancer patients with
bone metastasis with or without DIC.
Received: December 10, 1999 / Accepted: January 28, 2000 相似文献
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目的:探讨青年人胃癌的临床、病理特点,分析误诊的原因。方法:对1980年1月-1995年1月间经手术治疗、病理检验诊断的527例胃癌患者进行回顾性分析,着重对≤35岁青年人胃癌进行分析,并与其他年龄组胃癌进行比较。结果:本组青年人胃癌患者中妇性少于男性,男女之比为1:0.77;5年生存率低于其他年龄组胃癌患者(P<0.05);本组最多见的大体形态为BorrmannⅢ型和Ⅳ型,占87%;其病理学类型主要是低分化腺癌(37%)、粘液细胞癌(26.1%)和未分化癌(19.6%)。结论:青年人胃癌发病率低、病程短、恶性程度高、预后差,一旦确诊,应尽早手术。 相似文献
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目的:研究吉非替尼有效的非小细胞肺癌患者,骨转移是否影响其生存期,并分析骨转移患者的预后因素。方法比较骨转移和无骨转移患者总生存、无进展生存、1年、2年及3年生存率,并分析影响骨转移患者预后的因素。结果无骨转移组44例,骨转移组32例。无骨转移组与有骨转移组总生存期(19.000±3.317月 vs.26.000±2.121月,P=0.625)和无进展生存期(14.000±1.843月 vs.16.000±1.411月,P=0.328)无统计学差异。前组患者1年生存率63.6%低于后者96.9%,2年和3年生存率分别为(34.1%vs.56.3%,P=0.054)和(18.2%vs.18.4%,P=0.950),无统计学差异。对骨转移组进行单因素分析显示年龄>60岁及有肺内进展者预后更差,多因素分析显示影响骨转移患者生存的有效因素为有肺内进展,而性别、病理、吸烟指数、是否合并脑转移、骨相关事件及是否应用放疗、双膦酸盐与骨转移患者中位生存时间均无明显相关性。结论吉非替尼治疗有效的非小细胞肺癌患者,骨转移可能不是影响其生存期的主要因素,肺内进展有可能是非小细胞肺癌骨转移者的主要死因,不能将骨转移作为停用吉非替尼的指征。 相似文献
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目的探讨远处转移部位与胃腺癌患者预后的关系。
方法利用美国SEER数据库中2010年1月至2014年12月间诊断为胃腺癌伴远处转移的病例,Kaplan Meier法绘制生存曲线,采用Cox比例风险回归模型分析影响总生存、肿瘤特异性生存的独立因素。
结果共6532例病例纳入本研究,其中骨转移784例、脑转移126例、肝转移2692例、肺转移958例和远处淋巴结转移2321例。单器官转移患者中,骨转移者较肝转移者的总生存、肿瘤特异性生存差;远处淋巴结转移者较骨转移、肝转移、肺转移、脑转移者的总生存、肿瘤特异性生存好。Cox多因素分析表明,在已发生远处转移的胃腺癌患者中,男性、高龄、未婚、低分化、未行原发灶手术或多器官转移者的总生存和肿瘤特异性生存均较差。
结论不同转移部位对胃癌患者预后的影响不尽相同。在单器官转移的胃腺癌患者中,骨转移患者较肝或远处淋巴结转移者的预后差。对于胃腺癌伴远处转移的患者,男性、高龄、未婚、低分化、未行原发灶手术或多器官转移是影响预后的独立危险因素。 相似文献
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胃癌淋巴结转移与预后的关系 总被引:1,自引:0,他引:1
目的:探讨胃癌淋巴结转移与预后的关系,为胃癌的手术治疗提供依据。方法:回顾性分析2000年-2004年间住院并行手术治疗的胃癌患者361例,建立数据库用SPSS13.0统计软件分析。结果:Logistic多因素回归分析显示胃癌肿瘤大小、浸润深度与淋巴结转移有关(P〈0.01);Kaplan—Meier生存分析显示淋巴结转移与胃癌预后相关(P〈0.05);而在相同浸润深度时,淋巴结转移与胃癌预后无关(P〉0.05)。结论:对于浸润深度相同,而淋巴结转移程度不同的胃癌,积极手术治疗能取得同样的治疗效果。 相似文献
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Kobayashi O Sugiyama Y Cho H Tsuburaya A Sairenji M Motohashi H Yoshikawa T 《International journal of clinical oncology / Japan Society of Clinical Oncology》2003,8(2):0067-0071
Background: The aim of this study was to determine the treatment strategy for ovarian metastases from gastric cancer, by a retrospective
study of the treatment results.
Methods: We reviewed the records of patients with ovarian metastases from primary gastric cancer. Ovarian metastases were found in
24 of 897 female patients with gastric cancer. Of these, 21 patients with histologically proven disease were studied.
Results: Ovarian metastasis was detected before the primary gastric cancer in 1 patient, simultaneously in 6, and after in 14. Ovarian
tumors were detected by computed tomography (CT) in a majority of patients (95%), while uterine tumors were detected in only
29%. Metastasis to the uterus was histologically examined in 14 tumors and confirmed in 11 tumors. All patients with positive
endometrial cytology had uterine metastases. Total abdominal hysterectomy was performed with bilateral salpingo-oophorectomy
in 12 patients and with unilateral resection in 2. In these 14 patients, 5 were curatively operated. In the clinical course,
all patients developed multiple metastases, and patients suffered peritoneal dissemination. None survived for longer than
3 years. The median survival time after ovarian metastases (MST) was 10.3 months for all patients; 3.6 months in patients
in their sixties, and 12.5 months in those in their fifties. Survival was significantly longer in patients who underwent curative
resection (MST, 30.4 months) compared with those who had noncurative resection (MST, 10.3 months).
Conclusion: The prognosis for ovarian metastasis of gastric cancer was poor without curative resection. Because of frequent microscopic
metastases to the uterus, total hysterectomy with bilateral oophorectomy is recommended if curative resection is possible.
Received: August 5, 2002 / Accepted: January 14, 2003
Correspondence to:O. Kobayashi 相似文献
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目的 分析影响以骨转移为首发表现的非小细胞肺癌(NSCLC)患者的预后的因素。方法 回顾性分析2010年8月至2012年8月安徽医科大学附属省立医院及安徽省肿瘤医院确诊的以骨转移为首发表现的46例NSCLC患者资料,采用Kaplan Meier法分析临床病理特征(年龄、性别、吸烟、病理类型、骨转移灶数目、骨相关事件、其他部位转移、ECOG评分、碱性磷酸酶及癌胚抗原)与总生存期(OS)的关系,同时采用多因素Cox模型分析影响患者OS的独立因素。结果 全组患者中位OS为237天。单因素分析显示,病理类型、骨转移灶数目及初诊时ECOG评分为影响OS因素,其中鳞癌、骨转移灶数目≥2个、初诊时ECOG评分2~4分者预后较差;而性别、吸烟、骨转移部位、有无骨相关事件、骨以外的其他部位转移、血清ALK、CEA与OS无关。多因素分析显示,病理类型(OR=2.996, 95%CI: 1.070~8.389, P=0.037)、骨转移灶数目(OR=3.263, 95%CI: 1.083~9.827, P=0.036)为影响OS的独立因素。结论 在以骨转移为首发表现的NSCLC中,病理类型、骨转移灶数目可能为影响患者远期生存的独立预后因素 相似文献