手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响.方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨.数据分析采用Kaplan-Meier法.结果 172例中未手术者44例(25.6%),手术者128例(74.4%),其中包括单纯胆囊切除术45例(35.1%)、胆囊癌根治性切除术17例(13.3%)、胆囊癌扩大根治性切除术5例(3.9%)和剖腹探查术61例(47.7%).在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69.2%和40.7%,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年.结论有选择地进行Ⅳ期胆囊癌病例根治性或扩大根治性手术,有助于改善预后.     

胆囊癌50例临床分析

目的 探讨胆囊癌的早期诊断、治疗及预后.方法 回顾性分析50例胆囊癌患者临床病理资料.结果 单纯胆囊切除5例,根治性手术35例,其他10例.1年生存率34.0%,5年生存率4.0%.结论 原发性胆囊癌恶性程度较高,早期诊断是提高胆囊癌患者生存率的关键.对胆囊癌高危患者术前应行全面检查,以提高术前确诊率.     

胆囊癌外科治疗预后影响因素分析

目的:外科治疗是胆囊癌唯一有效治疗方法,但预后仍不令人满意。本文分析我院胆囊癌外科治疗资料,总结影响胆囊癌术后生存的主要因素。方法:收集并分析于2005-2009年在我院肝胆外科和老年外科接受外科治疗的胆囊癌患者围手术期和预后资料,分析影响患者术后生存期的因素。结果:在123例胆囊癌患者中,实施单纯胆囊切除术12例,标准根治性胆囊癌根治术44例,扩大胆囊癌根治术25例,姑息性切除19例,姑息性胆道引流术17例,单纯腹腔活检术6例。术后随访率81.3%,随访时间中位数为30个月。本组胆囊癌患者围手术期死亡率7.3%,术后3年生存率34.1%,术后5年生存率11.4%。单因素分析发现联合局部肝脏切除、R0级根治术、肝十二指肠韧带内淋巴结清扫、TNM分期均影响患者术后的生存期。多因素分析证实联合局部肝脏切除、R0级根治和TNM分期是影响术后生存的独立因素。结论:联合局部肝脏切除、R0级根治术、肝十二指肠韧带内淋巴结清扫、TNM分期是影响胆囊癌患者预后的主要因素。早期发现胆囊癌(较早的TNM分期),并给予联合局部肝脏组织切除和肝十二指肠韧带内淋巴结清扫的胆囊癌根治术可以明显改善早期胆囊癌患者预后。     

107例原发性胆囊癌的外科治疗分析

目的:总结胆囊癌的外科治疗经验.评估其疗效并进一步探讨提高晚期胆囊癌患者术后生存率的方法.方法:回顾性分析1996年1月～2006年12月问经外科治疗的107例胆囊癌患者的临床资料,手术方式和随访结果,分析美国癌症联合委员会(AJCC)分期、外科手术方式等相关因素与预后之间的联系.结果:本组总的手术切除率为82.2%(88/107),其中根治性切除率为57.9%(62/107).根治性手术切除后患者(62例)的中位生存期和1、3、5年生存率(包括累积和无瘤生存率)分别在总体上和在每个不同分期水平上都明显高于经单纯胆囊切除术患者(6例)和姑息性手术患者(39例)组(P＜0.01).MCC分期和手术方式与胆囊癌患者的术后生存率有关(P＜0.01).63例(58.9%)患者术后接受了各种辅助治疗(包括化疗、放疗和中医治疗等),44例(41.1%)未接受辅助治疗.结论:对于原发性胆囊癌患者应充分进行术前评价,并根据临床分期采取积极的外科治疗.可以提高术后患者的生存率.     

49例胆囊癌的外科治疗

目的 研究提高胆囊癌外科治疗疗效的途径。方法 选取1993～2001年间经手术治疗的胆囊癌患者49例,其中病变早期(Ⅰ、Ⅱ、Ⅲ期)组23例,行单纯胆囊切除术10例,根治性手术13例;晚期(Ⅳ、Ⅴ期)组26例,行姑息性手术6例,单纯胆囊切除2例,根治性切除18例。结果 病变早期组与晚期组的预后差异有显著性(P<0.05),早期组好于晚期组;在早期组的Ⅱ、Ⅲ期和晚期组患者,行单纯胆囊切除组与行根治性手术组的预后差异均有显著性(P<0.01),行根治性手术组预后好。结论 早期诊断和根治性手术是提高胆囊癌患者生存率的有效方法。     

根治性切除及单纯胆囊切除对Ⅱ期胆囊癌疗效的Meta分析

目的运用Meta分析软件评价胆囊癌根治手术及单纯胆囊切除治疗Ⅱ期胆囊癌的远期疗效。方法通过Pubmed、WOS、万方、维普、中国生物文摘书库检索自1990年1月至2011年12月相关文献,Jadad质量评分评估文献所涉及研究的质量,治疗组为胆囊癌根治术后患者生存人数,对照组为单纯胆囊癌切除术后患者的生存人数,运用Meta分析评估两组患者1、3、5年的生存差异。结果10篇文献入选病例数共279例,其中根治组146例,单纯切除组133例。Meta分析结果显示：1年生存[OR=3．900,CI=（1．160,13．140）,P=0．030],3年生存[OR=2．780,CI=（1．060,7．310）,P=0．040],5年生存[OR=3．160,CI：（1．130,8．870）,P=0．030],两组差异均有统计学意义。结论同单纯胆囊切除术相比,根治性切除术可提高Ⅱ期胆囊癌术后的1、3、5年生存率。     

直肠癌术后局部复发二次手术临床病理分析

目的:探讨直肠癌术后局部复发再手术的适应证及手术方法.方法:对1998-01-2004-12收治的58例直肠癌根治术后局部复发的患者进行再手术治疗并对其疗效进行回顾性分析.结果:58例患者根治性切除28例(48.27%),姑息性切除20例,剖腹探查或单纯造瘘10例.根治性手术、姑息性手术及未切除患者的5年生存率分别为21.2%、11.1%和0,中住生存期分别为42、19和7个月.结论:对于局部复发性直肠癌积极再手术能有效延长患者的生存期,提高生存率.     

127例NevinⅣ、Ⅴ期胆囊癌的外科治疗

 目的　总结晚期胆囊癌（NevinⅣ、Ⅴ期）的外科治疗经验,探讨提高晚期胆囊癌生存率的方法。方法　回顾性分析2005年1月至2010年1月间经手术治疗并有病理诊断的127例NevinⅣ、Ⅴ期胆囊癌的临床资料,分析不同手术方式与预后之间的关系。结果　127例NevinⅣ、Ⅴ期患者中,67例行胆囊癌根治术,25例行胆囊癌扩大根治术,根治率为72.44%(92/127),根治性切除并发症发生率为25.00%(23/92),手术死亡率为4.35%(4/92)。姑息性切除24例,剖腹探查术5例, 根治切除组与姑息切除组及探查组相比,差异均有统计学意义（P 均<0.05）,而姑息切除组与活检组相比, 差异无统计学意义（P>0.05）。结论　对NevinⅣ、Ⅴ期胆囊癌应进行积极的手术治疗,根治术或扩大根治术是提高患者生存率的有效手段,姑息性切除术也能改善患者生活质量,延长生存期。     

单纯Barrett's食管腺癌108例临床分析

目的分析单纯Barrett’s食管腺癌根治性手术切除后加用放、化疗的临床疗效,探讨影响Barrett’s食管腺癌预后的因素。方法回顾性分析108例Barrett’s食管腺癌患者的临床资料及随访结果。行根治性手术切除者92例,其中术后单纯放疗者76例,术后放疗后加用化疗者16例;姑息性手术治疗者16例,其中有4例患者于术中死亡,另12例患者在术后均采用放疗 化疗。放疗采用60钴或6MV-X线,体外常规分割照射,靶区放射治疗总剂量为55～70 Gy;化疗采用FAM或CMF方案4～6个疗程。结果采用Kaplan-Meier法计算其生存率,本组患者1、3、5年生存率分别为81.5%、51.9%和22.2%,其中根治性手术切除后单纯放疗者5年生存率为15.8%,术后放疗加化疗者为75.0%;有肿瘤外侵者5年生存率为9.1%,无肿瘤外侵者为33.3%;有淋巴结转移者5年生存率为14.3%,无淋巴结转移者为33.3%;姑息性手术治疗术后加放、化疗后5年生存率为0。Log rank检验结果显示,差异均有统计学意义(P<0.05)。结论单纯Barrett’s食管腺癌根治性手术切除后,及时加用放、化疗治疗,有助于疗效的提高。影响预后的主要因素为临床分期、肿瘤外侵、淋巴结转移和根治性手术切除后放、化疗措施的应用。     

肝门胆管癌的外科手术治疗

回顾性分析我院2000-07-2005-07经肝门胆管癌手术治疗的62例患者临床资料和随访结果,总结肝门胆管癌的手术治疗体会.62例手术切除患者中行根治性切除(R0)22例,非根治性切除28例(R1,R2).根治性切除中位生存期34个月,1、3和5年生存率分别为92.0%、40.0%和18.0% ;非根治性切除中位生存期16个月,1、3和5生存率分别为83.0%、22.0%和0.另12例未完成病灶切除,9例行经肿瘤切开放置Y管内支架引流,3例行胆囊桥式肝管一十二指肠吻合,中位生存期10个月,1、3和5年生存率分别为15.0%、0和0.手术切除是治疗肝门胆管癌的有效治疗方法,根治性切除能明显改善预后.     

Adjuvant external-beam radiotherapy with concurrent chemotherapy after resection of primary gallbladder carcinoma: a 23-year experience

PURPOSE: Primary adenocarcinoma of the gallbladder is a rare malignancy. To better define the role of adjuvant radiation therapy and chemotherapy, a retrospective analysis of the outcome of patients undergoing surgery and adjuvant therapy was undertaken. METHODS AND MATERIALS: Twenty-two patients with primary and nonmetastatic gallbladder cancer were treated with radiation therapy after surgical resection. Median radiation dose was 45 Gy. Eighteen patients received concurrent 5-fluorouracil (5-FU) chemotherapy. Median follow-up was 1.7 years in all patients and 3.9 years in survivors. RESULTS: The 5-year actuarial overall survival, disease-free survival, metastases-free survival, and local-regional control of all 22 patients were 37%, 33%, 36%, and 59%, respectively. Median survival for all patients was 1.9 years. CONCLUSION: Our series suggests that an approach of radical resection followed by external-beam radiation therapy with radiosensitizing 5-FU in patients with locally advanced, nonmetastatic carcinoma of the gallbladder may improve survival. This regimen should be considered in patients with resectable gallbladder carcinoma.     

Radical hysterectomy versus radiation therapy for stage IB squamous cell cancer of the cervix

Three hundred forty-five patients with Stage IB squamous cell carcinoma of the cervix were treated at the University of Michigan Medical Center from 1970 to 1985. The overall cumulative 5-year survival rate was 89% and the mean age was 44.6 years. In 213 patients undergoing radical hysterectomy the cumulative 5-year survival rate was 92%; 14 patients were explored for radical hysterectomy that was not performed due to high risk features and their survival rate was 50%. Ninety-seven patients underwent radiation therapy as initial treatment and had a 5-year survival rate of 86%. There was no significant difference when radiation therapy was compared with radical hysterectomy (P = 0.098). The survival rates for lesions 3 cm or smaller were 94% for radical hysterectomy and 88% for radiation therapy. When the lesion was larger than 3 cm, the survival rates were 82% with radical surgery and 73% with radiation therapy. Metastatic disease to lymph nodes was present in 26 of the 213 patients undergoing radical hysterectomy. When 1 to 3 nodes were involved 16 of 19 patients survived and when 4 to 10 nodes were involved 3 of 7 patients survived. The addition of radiation therapy did not influence survival. Complications were similar in both treatment groups. Fistulas occurred in 4 of 213 patients undergoing radical hysterectomy and 1 of 111 undergoing radiation. Second surgery for a complication was required in 6 of 213 patients undergoing radical hysterectomy and 7 of 111 undergoing radiation. Survival and complication rates in early stage squamous cell carcinoma of the cervix are equal with either radical surgery or radiation therapy.     

Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma.

PURPOSE: This study was performed to evaluate the outcome of patients with gallbladder cancer who received postoperative concurrent chemotherapy and radiation therapy. METHODS AND MATERIALS: Curative resection followed by adjuvant combined modality therapy with external beam radiation therapy (EBRT) and chemotherapy was attempted in 21 consecutive gallbladder carcinoma (GBC) patients at the Mayo Clinic from 1985 through 1997. All patients received concurrent 5-fluorouracil during EBRT. EBRT fields encompassed the tumor bed and regional lymph nodes (median dose of 54 Gy in 1.8-2.0-Gy fractions). One patient received 15 Gy intraoperatively after EBRT. A retrospective analysis was performed for the end points of local control, distant failure, and overall survival. RESULTS: After maximal resection, 12 patients had no residual disease on pathologic evaluation, 5 had microscopic residual disease, and 4 had gross residual disease. One patient had Stage I disease, and 20 had Stage III-IV disease. With median follow-up of 5 years (range: 2.6-11.5 years), 5-year survival for the entire cohort was 33%. The 5-year survival rate of patients with Stage I-III disease was 65% vs. 0% for those with Stage IV disease (p < 0.02). For patients with no residual disease, 5-year survival was 64% vs. 0% for those with residual disease (p = 0.002). The median survival was 0.6, 1.4, and 5.1 years for patients with gross residual, microscopic residual, and no residual disease, respectively (p = 0.02). The 5-year local control rate for the entire cohort was 73%. Two-year local control rates were 0%, 80%, and 88% for patients with gross residual, microscopic residual, or no residual disease, respectively (p < 0.01). Five-year local control rates were 100% for the 6 patients who received total EBRT doses >54 Gy (microscopic residual, 3 patients; gross residual, 1 patient; negative but narrow margins, 2 patients) vs. 65% for the 15 who received a lower dose (3, gross residual; 2, microresidual; 10, negative margins). CONCLUSION: Patients with completely resected (negative margins) GBC followed by adjuvant EBRT plus 5-fluorouracil chemotherapy had a relatively favorable prognosis, with a 5-year survival rate of 64%. These results seem to be superior to historical surgical controls from the Mayo Clinic and other institutions, which report 5-year survival rates of approximately 33% with complete resection alone. Both tumor stage and extent of resection seemed to influence survival and local control. More aggressive measures using current cancer therapies and integration of new cancer treatment modalities will be required to favorably impact on the poor prognosis of patients with Stage IV or subtotally resected GBC. Additional investigation leading to earlier diagnosis is warranted, because most patients with GBC present with advanced disease.     

The role of radiation therapy in squamous cell carcinoma of the upper aerodigestive tract with positive surgical margins

One hundred four patients with squamous cell carcinoma of the upper aerodigestive tract and with histologically positive surgical margins were evaluated for this historically controlled study to determine the efficacy of postoperative radiation therapy. Positive margins were defined as the presence of one or more of the following: carcinoma in situ, tumor within 0.5 cm from the surgical margins, microscopic disease, or dysplasia. Patients received either surgery alone (44 cases) or surgery plus postoperative radiation therapy (60 cases) and were followed for a minimum of 2 years. Treatment strategies, stage by stage, were similar for all patients. Surgery varied from simple excision in T1 to composite resection and/or laryngopharyngectomy with radical neck dissection in advanced cases. Radiation therapy was given postoperatively with doses ranging from 4,500 to 7,500 cGy. The overall 2-year survival rate with no evidence of disease (NED) was consistently higher in the surgery plus radiation therapy group. Furthermore, when the subgroup of patients who had dysplasia at the surgical margins was excluded from the analysis, the 2-year NED survival rate difference became statistically significant (p = 0.05). This outcome favored combined therapy (36 of 58 patients) over surgery alone (13 of 32 patients). This favorable result was obtained despite the high percentage of T3-T4 stages (79 vs. 21%) and clinically positive lymph nodes (83 vs. 17%) in patients who had received postoperative radiation therapy. The significance of dysplasia at the surgical margins and the impact of radiation therapy on the tumor and nodal control in this group of patients needs further clarification.     

19例原发性胆囊癌疗效分析

目的:探讨浸润肌层的胆囊癌是否是局部疾病,行单纯胆囊切除术后是否要行二次根治手术治疗方法:回顾分析了19例浸润肌层的原发性胆囊癌患者,8例行单纯胆囊切除术,11例行根治性淋巴结清扫术68个区域淋巴结被检查平均随访时间97个月结果:组织学检查均未发现血管浸润,1例有淋巴管浸润淋巴结均未见转移10年生存率为89%,单纯胆囊切除术与根治术结果相比,差别无统计学意义.2例行根治术的患者死于肿瘤复发结论:多数浸润肌层的早期原发性胆囊癌仅是局部扩散,行单纯胆囊切除术后不需再行根治术。     

Multimodality therapy in advanced paranasal sinus carcinoma: superior long-term results.

PURPOSE: This study was conducted to determine the efficacy of multimodality treatment for stage III and IV, locoregionally advanced paranasal sinus carcinoma. PATIENTS AND METHODS: A subgroup analysis of 19 consecutive patients with stage III or IV paranasal sinus carcinoma treated with multimodality therapy from head and neck cancer protocols between 1984 and 1996 were analyzed for outcome. Sixteen patients received induction chemotherapy consisting of three cycles of cisplatin and 5-fluorouracil, followed by traditional resection (14 patients) or surgical debulking (two patients). Surgery was followed by concomitant chemoradiotherapy with hydroxyurea and 5-fluorouracil in a week-on, week-off sequence in 15 patients. One patient received standard radiation therapy. An additional three patients were treated with a sequence of surgical resection followed by concomitant chemoradiotherapy. The median total dose to the primary tumor was 60 Gy (range, 45-74 Gy). RESULTS: The overall survival at 5 and 10 years by lifetable analysis was 72.7% and 53.9%, respectively, and the disease-free survival at both 5 and 10 years was 66.6%. Local control was 76.1% at both 5 and 10 years. In the subgroup of patients treated with induction chemotherapy, 87% (14/16) achieved a clinical response. A complete response was confirmed at the time of surgery in five patients, whereas 11 patients had residual disease in the surgical specimen. Regional and distant failures were unusual (one patient each), with a 10-year regional control rate of 93% and a distant control rate of 95.5%. Serious, nonreversible long-term complications included two cases of unilateral blindness, one cataract, and one case of ototoxicity. DISCUSSION: An excellent long-term outcome with respect to local control, overall survival, and disease-free survival is achieved in locoregionally advanced paranasal sinus cancer treated with induction chemotherapy, surgery, and concomitant chemoradiotherapy. The 15 patients treated with this regimen had 10-year overall survival, disease-free survival, and local control rates of 56%, 73%, and 79%, respectively. These results are encouraging and are superior to the 40% survival achieved with surgery and radiation therapy. Further investigation of this regimen is warranted.     

乳腺癌锁骨上转移癌综合治疗分析

目的探讨乳腺癌锁骨上淋巴结转移癌的综合治疗方法.方法所有病例均于术前行新辅助化疗,其中12例乳腺癌锁骨上转移癌患者再行乳癌根治术和颈淋巴结清扫术(手术组),并与15例同期术前行放疗,再行乳癌根治术、化疗和放疗("三明治"疗法)患者(放疗组)对比,观察1～3年存活率和复发时间.结果手术组1年生存12例,1～3年存活7例,复发时间18～47个月;放疗组1年生存12例,1～3年存活4例,复发时间11～43个月.结论乳腺癌锁骨上淋巴结转移癌行乳癌根治术和颈淋巴结清扫术及综合治疗,对提高患者生存率和延长复发时间有积极作用.     

Present status on treatment of esophageal cancer in China

The treatment of carcinoma of the esophagus is a challenging problem to clinicians. The 5-year survival rate of surgery reported from large centers is about 25-30%, with resectability rate around 85-90% and operation mortality rate around 5%. However, this is based on highly selected cases. The 5-year survival rate of radiation therapy is about 9-16%, while the patients receiving radiation therapy were mostly the late cases. Pre-operative radiation seems to improve the results of surgery, but more randomized control clinical studies are needed. A combination of chemotherapy with radiation might improve the short-term response rates. Chemotherapy alone may provide some benefits for patients. Intracavitary microwave hyperthermia might open a possibility in the improvement of treatment results in combination with radiation and/or chemotherapy.     

高分化型甲状腺癌侵犯气管的外科治疗

目的探讨高分化型甲状腺癌侵犯气管的临床特点及手术治疗方法。方法对43例高分化型甲状腺癌侵犯气管患者行肿瘤削除术、气管部分切除气管造瘘术、气管袖状切除术和姑息手术。比较各种手术方式的局部复发率及手术并发症。结果34例行根治性手术(包括肿瘤削除术、气管部分切除术、气管袖状切除术)5年局部控制率82·4%(28/34),姑息性手术加术后放射治疗5年局部控制率44·4%(4/9)。9例行姑息性手术患者的生存期比较短。结论根据高分化甲状腺癌侵犯气管的范围和程度,采取相应的手术方式,可达到切除肿瘤,减少复发,保留喉功能和延长生存期的目的。     

Desmoid tumor: prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy.

PURPOSE: To evaluate the therapeutic value of resection and the potential benefits of and indications for adjuvant and definitive radiation therapy for desmoid tumors. MATERIALS AND METHODS: We performed a retrospective review of 189 consecutive cases of desmoid tumor treated with surgical resection, resection and radiation therapy, or radiation therapy alone. Treatment was surgery alone in 122 cases, surgery and radiation therapy in 46, and radiation therapy alone in 21. Median follow-up was 9.4 years. RESULTS: Overall, 5- and 10-year actuarial relapse rates were 30% and 33%, respectively. Uncorrected survival rates were 96%, 92%, and 87% at 5, 10, and 15 years, respectively. For the patients treated with surgery, the actuarial relapse rates were 34% and 38% at 5 and 10 years, respectively. Among 78 patients with negative margins, the 10-year recurrence rate was 27%, whereas 40 margin-positive patients had a 10-year relapse rate of 54% (P = .003). Tumors located in an extremity also had a poorer prognosis than did those in the trunk. For patients treated with radiation therapy for gross disease, the 10-year actuarial relapse rate was 24%. For patients treated with combined resection and radiation therapy, the 10-year actuarial relapse rate was 25%. The addition of radiation therapy offset the adverse impact of positive margins seen in the surgical group. CONCLUSION: Wide local excision with negative pathologic margins is the treatment of choice for most desmoid tumors. Function-sparing resection is appropriate because adjuvant radiation therapy can offset the adverse impact of positive margins. Unresectable disease should be treated with definitive radiation therapy.