上海市238例前列腺癌新发病例的临床调查

为了解前列腺癌临床流行病学情况，对上海市市区前列腺癌新发病例进行全人群对照研究。２３８例前列腺癌年龄构成为：５０岁～１１例（４．６％），６０岁～６４例（２６．９％），７０岁～１１５例（４８．３％），８０岁～４５例（１８．９％），９０～９３岁３例（１．３％）。肛指检查阳性率６５．５％，合并良性前列腺增生症占５６．３％。临床分期Ｔ１１２例（５．４％），Ｔ２８８例（３９．８％），Ｔ３８４例（３８．０％），Ｔ４３７例（１６．８％）。９０例（３７．８％）确定有远处转移。２２０例（９２．４％）细胞类型为腺癌。１８４例患者病理分级１级２３例（１２．５％），２级７３例（３９．７％），３级８８例（４７．８％）。临床分期与肿瘤远处转移率有关（Ｐ＜０．００１）。平均血清ＰＳＡ为８７．３μｇ／Ｌ，与人群对照组及ＢＰＨ对照组有显著性差异（Ｐ＜０．００１）。对血清ＰＳＡ的价值，前列腺癌的治疗方法进行了初步探讨。     

Clinico-pathological study on prostatic cancer, stage A using step section technic

Of 52 male bladder cancer cases treated with radical cystectomy, 12 cases (23.9%) were incidentally diagnosed as stage A prostatic cancer. Histological analysis was done according to the "general rules for clinical and pathological studies on prostatic cancer." The average age of the prostatic cancer cases was 62.0 years with a range of 50 to 78 years. Three cases were of well differentiated adenocarcinoma, and 9 cases were of moderately differentiated adenocarcinoma. Six cases were at pT1, 3 at pT2, and 3 at pT3. One case was stage A1, and 11 were stage A2 cases. Perineural and capsular invasions were found in 3 cases each. Neither lymphatic nor vascular invasion was found in any case, and no evidence of seminal vesicular, urethral, bladder and rectal invasion was found in any case. Lymph node metastasis was not found in any of the 3 pelvic lymph node dissected cases.     

Studies of progressive factors of stage A prostatic cancer

We studied the progressive factors for incidental carcinoma of the prostate of 38 patients. Effects of anti-androgen drugs for the development of incidental carcinoma were examined. There were no statistical differences with age, tumor size, histopathological grade, or invasion of BPH capsule. However, the tumor progression rate was high for a tumor size of more than 10 mm or poorly differentiated adenocarcinoma. Therefore, tumor progression was related with tumor size and histopathological grade. Of 15 patients with stage A1 disease, two patients had tumor progression. Patients with stage A1 disease are being followed with no treatment, but radical treatment may be necessary for young men. Patients with stage A2 disease must be treated with radical prostatectomy, radiation therapy or hormone therapy case by case. None of the patients who were treated with anti-androgen drugs had stage A1 disease. Patients not treated had stage A1 and A2 diseases. Anti-androgen drugs may have inhibited the development of stage A1 disease.     

A clinical study of prostatic carcinoma

Seventy seven patients with prostatic carcinoma were treated in our clinic between 1977 and 1986. Most of them were treated by a hormonal agent as the first therapy. None of the 9 stage A1 cases showed any reactivation, but 4 of the 5 stage A2 cases relapsed to metastatic disease. The chemotherapy performed in 3 of the 4 reactivated cases had no obvious effect on the disease. Seven of the 8 patients with stage B disease were alive without relapse. Relapse was seen in the other patient who had poorly differentiated carcinoma and chemotherapy in this case resulted in stable disease for the present. Four of the 15 stage C cases including 3 poorly differentiated carcinomas were hormone resistant or reactivated. For these resistant cases radiotherapy and/or the chemotherapy were performed, but a response was seen in only one case. Consequently, the first therapy for stage A2, B and C of poorly differentiated carcinoma must be improved. Of the 40 stage D cases, 4 patients who were treated by an early combination of hormonal therapy and chemotherapy had a better prognosis than the others. These 4 patients had poorly differentiated carcinomas with multiple bone metastases. Two of these 4 patients were alive without relapse for 17 and 72 months, and one of the 2 patients with relapse was also alive for 75 months. We believe that early chemotherapy is the key for better prognosis in stage D cases.     

Papillary breast cancer: A retrospective single‐centre clinical study

Papillary carcinoma (PC) of the breast is a rare malignancy that accounts for 0.5%‐1% of breast cancers. PC remains an understudied cancer, and we still require further information on its behaviour, staging and management. In particular, a significant proportion of PC cases still undergo sentinel lymph node biopsy without clear empirical justification. In the present study, we provide a valuable cohort of 44 PC patients and examine the clinicopathological features and outcome of loco‐regional staging. Our results provide important insights into the behaviour of PC and suggest SLNB may be spared in this condition. Crucially, we show only one histologically confirmed PC case had evidence of nodal metastasis. In addition, up to 5 years postsurgery, no patient in our cohort died from their cancer. Together, our results support further work in the utility of SLNB in PC and highlight the favourable prognosis of this tumour. We propose SLNB should not be routinely indicated for patients with PC treated with breast conservation, and future studies should aim to incorporate prospective data to help inform optimal management of PC.     

Pelvic lymphadenectomy in stage a prostatic cancer

Pelvic lymphadenectomy as a staging procedure in clinically apparent prostatic adenocarcinoma has long been recognized and its value appreciated. Twenty-three recent cases from the University of Colorado of clinically unapparent carcinoma of the prostate were studied with this modality, 5 Stage A₁ and 18 Stage A2 tumors. Four of the 18 Stage A2 tumors but none of the A₁ lesions after negative staging procedures revealed metastatic disease to the pelvic lymph nodes. Our experience indicated this modality should be employed in selected cases of incidental adenocarcinoma of the prostate.     

A retrospective study of the time to clinical endpoints for advanced prostate cancer

OBJECTIVE: To determine the natural history of patients with prostate cancer who start initial androgen-deprivation therapy (ADT) for biochemical failure with no radiographic evidence of disease (D0) or with radiographic metastatic disease (D2), as the history is either not well-defined or is changing, and such data are critical for guiding therapy after prostate cancer recurrence. PATIENTS AND METHODS: We retrospectively assessed the time to androgen-independence (AI), defined as the first sustained rise in prostate-specific antigen (PSA) level on ADT, time to metastatic disease and overall survival for 80 patients with metastatic prostate cancer in clinical trials at the National Cancer Institute. RESULTS: ADT was initiated after metastatic disease in 37 patients and before metastatic disease in 43 patients; in these 43 patients, the median time to developing metastatic disease on ADT was 37.8 months. The median time to AI from the initiation of ADT was 19.3 and 13.1 months in D0 and D2 patients, respectively. The median overall survival from the start of ADT was 89.0 and 63.0 months, and the median overall survival from the time of AI was 63.1 and 44.2 months in D0 and D2 patients, respectively. These 80 patients, which included 43 who had no metastatic disease when starting ADT, had a median survival of 54.8 months after AI prostate cancer. CONCLUSIONS: We describe the natural history of AI prostate cancer in D0 patients who eventually developed metastasis, and in D2 patients. The results suggest a longer than expected survival with AI prostate cancer, and to our knowledge this is the first study to report the time to metastatic disease for D0 patients from ADT and from AI. These results can be used to help design clinical trials in patients with D0 prostate cancer.     

Risk factors for the recurrence of stage II perforated colorectal cancer: A retrospective observational study

BackgroundPatients with perforated colorectal cancer (PCRC) experience higher recurrence rates than those with non-perforated tissue. We identified the promoting factors of stage II PCRC recurrence after R0 surgery.MethodThis retrospective observational study included patients treated for colorectal cancer at a single facility between 2007 and 2016, and compared the clinicopathological features of patients with perforating versus non-perforating stage II tumors who underwent R0 resection, while focusing on recurrences.ResultsThirty-two and 112 patients (predominantly men) with perforating and non-perforating tumors, respectively, were included. The perforated group had significantly higher proportions of T4 tumors than the non-perforated group (44% vs. 15%). The perforated group had significantly lower numbers of resected lymph nodes than the non-perforated group (6 vs. 17). Seven of 17 patients with follow-up data in the perforated group experienced recurrence (41%), versus 19 of 104 in the non-perforated group (18%). In the non-perforated group, male sex (89% vs. 60%, p = 0.030), T4 stage (32% vs. 9%, p = 0.029), and fewer resected lymph nodes (12.5 vs. 18.6, p = 0.003) were significantly associated with recurrence; however, no such influences on recurrence were observed in the perforated group. The recurrence sites in the perforated group were mostly local (6 patients, 86%). Conversely, recurrences in the non-perforated group were mostly distant; 8 of 19 patients (42%) had liver metastasis and 1 (5%) had lung metastasis.ConclusionPatients with stage II PCRC experienced higher recurrence rates regardless of clinicopathological features and had high local recurrence rates indicating possible local tumor cell dispersal owing to perforation.     

Predictors of recurrent clinical stage I nonseminomatous testicular cancer A prospective clinicopathologic study

A prospective clinicopathologic study of 60 patients with clinical Stage I nonseminomatous testicular cancer (NSTC) has been reported. Of 60 patients with clinical Stage I NSTC who underwent retroperitoneal lymphadenectomy (RPLA), 6 proved to be Stage II, a staging error of 10 per cent. In 4 patients of the remaining 54, metastases developed in the lungs. In 1 patient metastases developed both in the lung and in retroperitoneal lymph nodes. There was no death in these groups of patients. These 10 patients with staging error and/or recurrence after RPLA have been analyzed for the causes of treatment failure utilizing a set of prognostic criteria (tumor cell type, vascular or lymphatic invasion in the primary tumor, extension to the spermatic cord, and size of the primary tumors). It has been concluded that embryonal carcinoma (P less than 0.001), vascular invasion (P less than 0.001), and extension of the tumor to the spermatic cord (P less than 0.001) are significant predictors of metastases and/or recurrence after RPLA in Stage I NSTC. A plan of management is suggested based on these criteria.     

Induction therapy with CDDP and ADM for stage D prostatic cancer and its clinical response

From September 1983 to September 1989, 20 patients with newly diagnosed stage D prostatic cancer were treated with cis-platinum (CDDP) and adriamycin (ADM) as the induction therapy. Analysis of histological and clinical effects on the induction therapy revealed partial response (PR) in 13 cases and no change (NC) in 7 cases according to Shimazaki's response criteria, and PR in 4 cases, NC in 15 cases and progression (PD) in 1 case according to NPCP criteria. Histological Ef 0-b effect was found in 2 cases, Ef 1 in 7 cases, Ef 2 in 3 cases, Ef 3 in 2 cases and Ef 4 in 2 cases. Analysis of long-term results revealed relapse in 9 cases and cancer death in 6 cases. The 1-year, 3-year and 5-year continued response rates for all cases were 85.7, 40.2 and 32.1%, respectively. The 1-year, 3-year and 5-year survival rates were 100, 64.3 and 53.6% respectively. Histologically, low responsive cases showed a tendency of relapse and cancer death more frequently than high responsive cases. These results suggest that CDDP and ADM therapy is more effective than hormone therapy in newly diagnosed stage D prostatic cancer as an induction therapy.     

Clinical study of prostatic cancer

Eighty patients with prostatic cancer, who first visited Kyorin University School of Medicine from January 1976 through December 1986, were analyzed. Incidence of prostatic cancer was 3.9% among male inpatients. Age distribution was between 55 and 88, with an average of 72 years old. The most common symptoms were dysuria followed by pollakisuria, hematuria, lumbago and lower extremity pain. Duration from onset of symptom to examination ranged from 6 to 84 months, with an average of 22 months. Clinical stage was A in 7.5%, B in 10%, C in 11.3% and D in 71.3%. According to histological grade, well, moderately, and poorly differentiated adenocarcinomas were observed in 29.9, 29.9 and 40.2%, respectively. According to the General Rules for Clinical and Pathological Studies on Prostatic Cancer, clinical T classification were T0 in 8.7%, T1 in 3.8%, T2 in 47.5%, T3 in 27.5% and T4 in 12.5%. In the correlation between stage and grade, the largest number of poorly differentiated adenocarcinoma cases was in stage D. There was no correlation between stage and T classification. Of the 80 patients, 71.25% were treated with antiandrogen therapy, 16.25% with radiation therapy chiefly, 7.5% by surgery chiefly, and 5% with chemotherapy. Survival rate was calculated by the Kaplan-Meier method. Overall survival rate of the 80 patients was 54.4% at 5 years. Survival rate by stage were 100% in stage A at 4 years, and 100% in B, 87.5% in C and 40.5% in D at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)