广东惠东地区结直肠癌的发病特点

目的:研究近10年广东省惠东地区结直肠癌发病特点的变化.方法:回顾性分析2001-01/2010-12广东省惠东县人民医院结肠镜检出结直肠癌患者的流行病学、临床、内镜及病理资料,并对前后5年的资料进行对比分析.结果:2001-01/2010-12共行肠镜10 532例,检出结直肠癌853例.2001-01/2005-1...     

国内外结直肠癌筛查的对比分析及启示

我国结直肠癌的发病率和死亡率在逐年升高,严重威胁人民群众的健康,亟待采取行之有效并且适合我国国情的结直肠癌筛查策略,从而降低结直肠癌的疾病负担。目前面临的突出问题是,我国人群结直肠癌筛查项目覆盖尚不广泛,方法并不统一,有待形成完善的国家结直肠癌筛查体系。建立筛查体系的作用在于发现癌前病变和早期病例,从而降低发病率并提高早期病例构成比,具有很重要的卫生经济学意义。本文结合国内外最新指南共识,阐述国内外结直肠癌筛查的历程和现状,比较了结直肠癌筛查常用的方法,并对我国筛查的发展提出了展望,以期未来能够建立具有我国特色的结直肠癌筛查策略。     

国内外结直肠癌早诊早治现状

结直肠癌(CRC, colorectal cancer)是世界范围内常见的恶性肿瘤，根据2012年全球肿瘤数据统计，其在男性恶性肿瘤中排名第三，在女性中排名第二，是人类重要的疾病负担之一。以往认为，CRC在中国的发病率相对偏低，但随着中国居民饮食结构的改变，CRC在中国的发病率持续上升，在北京上海等部分大城市已经成为最常见的消化系统恶性肿瘤，整个东亚地区CRC的发病率已经逐渐接近于北美地区。2013年的中国癌症数据统计显示，CRC的发病率已经超过了食管癌，成为目前消化系统第三常见的恶性肿瘤。虽然目前数据统计显示，中国CRC的发病率居于胃癌和肝癌之后，但是根据标准人口测算时，我国CRC发病率趋势居于所有消化系统恶性肿瘤之首，随着我国社会人口老龄化的不断加速和饮食结构的持续改变，CRC的发病率将进一步升高，很可能超越胃癌和肝癌成为我国最常见的消化系统恶性肿瘤。因此，降低我国CRC的发病率和死亡率，成为亟待解决的重大公共卫生问题。研究数据显示，结直肠从正常黏膜转变为晚期恶性肿瘤，中间会经历息肉、腺瘤、上皮内瘤变和早癌等多个病理过程，中间期限达15到20年，如果能及时这段时间内进行筛查，发现这些早期癌前病变，就能够大大的降低CRC的发病率和死亡率。同大多数恶性肿瘤一样，CRC的预后与诊治的时机密切相关，早期诊断和治疗能够大大的提高患者的五年生存率。但是，我国CRC患者的五年生存率却一直偏低，不仅明显落后于欧美等发达国家，与日韩等国也有不小的差距，早诊早治的意识严重偏低，到目前为止，尚没有全国范围内的大数据来支撑和反映我国CRC的诊治现状。     

异时性多原发结直肠癌临床特点分析31例

目的:探讨异时性多原发结直肠癌的临床特点, 为临床诊治提供参考.方法:回顾性总结31例异时性多原发结直肠癌的临床资料, 分析肿瘤发生、分布及治疗与预后.结果:31例患者, 平均5.1年出现次发癌, 平均3.8年后3例出现第3癌, 平均3.5年后2例再发第4癌. 45.2%的患者合并存在腺瘤. 59.5%的首发癌位于直肠、乙状结肠;大部分次发癌的分化程度、病理分期好于首发癌或与之相同;首发癌术后平均存活8.3年, 5年生存率84.8%.结论:大多数异时性多原发结直肠癌的首发癌位于直肠及乙状结肠. 合并存在腺瘤是发生该病的危险因素, 根治术后应进行定期复查.     

近10年北京协和医院直肠癌发病模式的变迁和临床特点分析

目的探讨近10年来我院直肠癌发病模式的变迁和临床特点。方法回顾性分析1999～2008年北京协和医院985例直肠癌住院患者的临床资料,将其发病情况与既往进行比较,并分析其临床表现、实验室检查、确诊方法、治疗手段和临床分期。结果近10年来直肠癌在大肠癌中所占的比例有下降趋势（44．4％V852．7％）,其中男性及老年患者明显增加（P〈0．01）;便血（76．9％）、大便习惯改变（71．6％）和腹痛（63．2％）是主要临床表现;便常规检查异常者占76．6％,血红蛋白下降和CEA异常并不常见;直肠指诊有87．9％的患者发现病变;治疗手段以新辅助治疗和手术切除为主,Duke分期以B、C为主。结论近年来直肠癌中老年患者明显增加,临床表现缺乏特异性,临床上应重视直肠指诊,以期早期诊断。     

MUTYH基因与结直肠癌发病的关系

目的:检测家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)家族成员MUTYH 基因SNP位点,为结直肠癌易感人群的筛检提供依据.方法:应用PCR-SSCP及基因测序方法检测三个疑似FAP家系患者MUTYH基因SNP位点.PCR-CTPP方法检测中国医科大学附属第一医院结直肠癌组患者283例与对照组307患者血液DNA中MUTYH IVS1-5 A＞C SNP突变位点的情况,分析其多态性与结直肠癌易感性的关系.结果:发现MUTYH基因3个SNP位点,分别为IVS1-5 A＞C(A/C);IVS6 35 A＞G(A/G,G/G)及c.G972C(Q335H)(G/C).结直肠癌患者中发生MUTYH IVS1-5 A/C与MUTYH IVS1-5C/C突变的患者分别为11和2例,对照组中发生MUTYH IVS1-5 A/C突变的患者为4例,但未发现MUTYH IVS1-5 C/C纯合性突变.对照组中MUTYH IVS1-5 A/C等位基因频率与结直肠癌组相比,有显著性差异(X2=7.43,P=0.006).MUTYH IVS1-5 A＞C多态性与结直肠癌易感性有相关性.结论:MUTYH IVS1-5 A＞C位点基因多态性在结直肠癌发生中起着作用,其对了解结直肠癌的发病机制及对高危人群的筛检具有重大意义.     

代谢综合征组分与结直肠癌发病关系的研究进展

代谢综合征(MS)是一组以胰岛素抵抗为核心,具体表现为中心性肥胖、高血糖、高血压、血脂异常的症候群。近年来,越来越多的研究发现MS与结直肠癌(CRC)的发病有着密切关联。虽然MS造成CRC发病率升高的机制目前尚未完全明确,但许多研究已证实MS组分对CRC造成影响,可为CRC的早期预防提供依据。此文就MS相关组分与CRC发病之间关系的研究进展作一综述。     

便秘与结直肠息肉及结直肠癌关系的研究进展

目前便秘与结直肠息肉及结直肠癌的发生、发展的相关性仍存在争议.有研究显示便秘可能参与了结直肠息肉和结直肠癌的发生、发展,其机制可能是肠道菌群失调引起菌群代谢产物异常,导致肠道运动功能障碍和(或)免疫微环境异常.便秘可能可以作为结直肠息肉和结直肠癌发病的预警症状.尽早对便秘患者行结肠镜筛查,并定期随访和适时干预,有助于发...     

美国白人与中国人原发性结直肠癌病理特点对照

目的　比较研究美国白人与中国患者原发性结直肠癌 (CRC)的病理学特征。方法　回顾性分析 1990～ 2 0 0 0年美国克里夫兰佛罗里达临床中心结直肠外科 6 90例和中国第一军医大学南方医院普外科 870例连续完整的CRC患者资料。结果　美国白人与中国患者比较 :36 .3%比 2 6 .0 %的肿瘤位于近侧 (右侧 )结肠 (P <0 .0 0 1) ,6 3.7%比 74 .0 %位于远侧 (左侧 )结肠 (P <0 .0 0 1) ;中位年龄 72比5 4岁 (P <0 .0 0 1) ;腺癌 84 .3%比 85 .3% ,黏液腺癌 13.6 %比 11.4 % ,印戒细胞癌 1.5 %比 2 .7% ,腺鳞癌 0 .6 %比 0 .6 % (P >0 .0 5 ) ;高分化癌 16 .7%比 4 0 .2 % ,中分化 6 1.9%比 4 8.5 % ,低分化 2 1.4 %比11.3% (P <0 .0 0 1) ,近侧结肠癌中低分化比例在两种族患者中均较高 ;TNM分期 ,0期 5 .4 %比 1.3%(P <0 .0 0 1) ,Ⅰ期 34.8%比 18.9% (P <0 .0 0 1) ,Ⅱ期 2 9.9%比 33.2 % (P >0 .0 5 ) ,Ⅲ期 2 0 .3%比2 2 .8% (P >0 .0 5 ) ,Ⅳ期 9.6 %比 17.0 % (P <0 .0 0 1)。进展期癌更常见于近侧结肠和中国患者。结论　美国白人易患近侧结肠癌 ,中国患者远侧结直肠癌更常见 ,进展期比例高 ,年龄明显小。低分化和进展期癌更常见于近侧结肠。     

23例腹腔镜结直肠癌手术临床分析

目的探讨腹腔镜结直肠癌根治术临床疗效。方法回顾性分析我院2009年8月～2012年4月所实施的23例腹腔镜结直肠癌根治术患者的临床资料。结果全组手术均在腹腔镜下完成。行腹腔镜下Dixon术10例,Miles术8例,乙状结肠癌根治术2例,左半结肠癌根治术1例,右半结肠癌根治术2例。手术时间为110～255 min(平均180 min),术中平均失血25 ml。无围手术期死亡者。术后胃肠道功能恢复时间1～2 d。术后至今均获随防,随坊时间为6～24个月。1例术后第8个月出现腹腔广泛转移,其余患者均为无瘤生存。结论腹腔镜结直肠癌根治术具有微创、安全、恢复快等优势,可以替代传统的开腹手术。     

大肠癌临床病理特征分析

[目的]分析大肠癌患者的临床病理特征,探讨其发病特点及临床诊断线索。[方法]回顾性分析经手术病理诊断的75例大肠癌患者的临床资料。[结果]75例中以65岁以上患者所占比例最高,腹痛、排便习惯改变及粪便性状改变是其主要的临床表现。右半结肠癌女性发病例数高于男性,左半结肠癌中男性发病例数高于女性,右半结肠癌组大便潜血阳性率及贫血发生率高于左半结肠癌组。血清CEA阳性率高于CA19-9、CA125,病理类型以中分化腺癌最多见,TNM分期以T4期最多。[结论]大肠癌老年女性发病率有增多倾向,不明原因的贫血、便潜血阳性是大肠癌报警症状,血清CEA在大肠癌的诊断中有一定的价值。     

Clinical outcome of endoscopically removed early colorectal cancer

BACKGROUND AND AIM: Endoscopic resection is widely adopted for early colorectal cancer. Most studies examining the effectiveness of endoscopic treatment of early colorectal cancer are from Japan, and little is known about the success of this treatment in other areas of the world. The authors performed this study to investigate the effectiveness of endoscopic treatment of early colorectal cancer. METHODS: The medical records of patients with histologically proven early colorectal cancer and who were treated by endoscopic resection between January 1985 and December 2000 were reviewed retrospectively. Information regarding the demographic data of patients, clinicopathological characteristics of the tumors, and follow-up events were recorded and analyzed. RESULTS: Altogether 91 patients, including 73 with mucosal cancers and 18 with submucosal invasive cancers, were enrolled. Nineteen patients (eight with mucosal cancers and 11 with submucosal invasive cancers) underwent subsequent surgical colectomy. Larger tumors, and those with sessile or flat depressed morphology, and deep submucosal invasion were more difficult to remove completely through endoscopic resection alone. Five patients had local recurrent tumors, occurring between 4 and 12 months after endoscopic resection, and were treated surgically. Furthermore, two patients died of unrelated diseases, one at 1 month and one at 3 years after treatment. All the other patients were well after an average follow-up interval of 40.9 months (range 18-189 months). CONCLUSIONS: Endoscopic resection safely and effectively removed most early colorectal cancers. Careful histological examinations of resected specimens to determine the indications of subsequent surgical colectomy, and close post-treatment surveillance would improve the outcome and life quality for these patients.     

Clinical role of endoscopic ultrasonography for the diagnosis of early colorectal cancer and selecting the treatment procedure

Background: Accurate evaluation of the depth of tumor invasion, including the degree of submucosal invasion, is a prerequisite to selecting the treatment procedure for early colorectal cancer (CRC). The purpose of the present study was to evaluate the significance of endoscopic ultrasonography (EUS) for diagnosing the depth of invasion of early CRC and selecting the treatment procedure. We concurrently estimated the usefulness of three‐dimensional EUS (3‐D‐EUS) compared with that of conventional EUS. Methods: We studied 413 consecutive early CRC for which the depth of invasion was examined by EUS. They consisted of 239 lesions of mucosal cancers and 174 lesions of submucosal cancers (sm cancers). We divided sm cancers into two groups, sm‐slight cancers (38 lesions) and sm‐massive cancers (136 lesions), according to the degree of infiltration in the vertical direction in the submucosa. The diagnostic accuracy of the depth of cancerous invasion by EUS and the characteristics of tumors that were difficult to image by EUS were examined. For 59 lesions, the depth of invasion was concurrently evaluated by 3‐D‐EUS to compare the clinical usefulness of this diagnostic tool with that of conventional EUS. Results: In 364 lesions (88%) of early CRC, we could diagnose the depth of invasion by EUS. Differentiation between mucosal or sm‐slight cancers, which were generally treated by endoscopic resection or local excision, and sm‐massive cancers, which were suitable for radical operation, was possible in 90%. A total of 49 lesions (12%) could not be imaged by EUS. Difficulty in imaging often occurred with lesions located proximally to the transverse colon and with protruded‐type lesions. The accuracy rate of 3‐D‐EUS for differentiating between mucosal or sm‐slight cancers and sm‐massive cancers, including difficult‐to‐image lesions, was 86%. This figure was slightly, but not significantly higher, than the accuracy rate of 73% for conventional EUS (P = 0.07). However, the concurrent application of 3‐D‐EUS was considered useful in 31 of the 59 lesions (53%) evaluated by both techniques. Conclusion: EUS is useful for evaluating the depth of tumor invasion and selecting the treatment procedure for early CRC. The concurrent use of 3‐D‐EUS may further improve diagnostic accuracy and decrease the number of difficult‐to‐image lesions.     

人粪便SFRP2基因甲基化分析对结直肠癌的诊断价值

目的探讨人粪便中分泌型卷曲相关蛋白2(SFRP2)基因甲基化分析用于结直肠癌(CRC)早期诊断的可行性。方法从87例结直肠癌或良性病变的患者及24例正常对照者的粪便中分别提取DNA,采用甲基化特异性PCR(MSP)技术分析其SFRP2基因甲基化状态。结果CRC、腺瘤、增生性息肉和溃疡性结肠炎患者的SFRP2基因甲基化阳性率分别为94.2%(49/52)、52.4%(11/21)、37.5%(3/8)和16.7%(1/6)。1例正常对照SFRP2基因甲基化检测阳性。检测SFRP2基因甲基化诊断CRC及癌前病变的敏感性和特异性分别为90.5%和85.4%。结论SFRP2基因甲基化是CRC进展过程中的早期事件。粪便SFRP2基因甲基化分析可望成为CRC早期无创诊断或CRC高风险人群筛查的新途径。     

Clinical features and prognosis of early colorectal cancer treated by endoscopic mucosal resection

Background and Aims: The incidence of early colorectal cancer (ECC) has been increasing. The aim of this study was to evaluate the clinical outcome and prognosis of ECC treated by endoscopic mucosal resection (EMR). Methods: A total of 129 ECC patients who were initially treated by EMR between April 2005 and August 2007 were enrolled. Clinicopathological characteristics and prognoses were evaluated retrospectively. Results: En bloc resection was performed in 85% of ECC patients, and piecemeal resection was performed in 15% of patients. Clear lateral and deep margins were achieved in 86% of cases. Of the 129 patients, 64 were found to have intramucosal cancer and 65 had submucosal cancer. Clinical characteristics were not different between patients with intramucosal cancer and submucosal cancer; however, poor differentiation and the absence of background adenoma showed significant association with submucosal cancer. Seven patients with submucosal cancer underwent subsequent surgical resection; five had lymphovascular invasion or a positive resection margin, one had perforation, and one patient requested surgical resection. Of these seven patients, one had residual cancer and two had lymph node metastasis. All patients with intramucosal cancer had no recurrence during the follow‐up period. Seven patients with submucosal cancer showed adverse outcomes within 3 years, such as residual/recurrence of primary cancer or lymph node metastasis; five showed lymphovascular invasion or a positive deep margin, and two had no histological risk factors. Conclusions: Our results suggest that intramucosal cancer shows good prognosis, and a cure could be expected after EMR; however, adverse outcomes can occur in submucosal cancer. Therefore, meticulous endoscopic follow up is needed in patients with submucosal cancer for at least 3 years after EMR.     

早期大肠癌临床、病理特点及黏膜凹窝分型分析

目的 探讨早期大肠癌的诊断和治疗方法。方法 经手术证实的早期大肠癌33例，对临床症状、肿瘤的部位、大小、大体形态、黏膜凹窝分型、治疗方法、肿瘤的浸润深度及随访结果进行分析。结果 临床症状以便血为多，占60．6％(20／33)，肛检阳性率高，占60．6％(20／33)，肿瘤位于直肠及右半结肠多，占90．9％(30／33)，形态以隆起型为主，其中亚有蒂型占57．6％(19／33)，直径1.6cm的占90．9％(30／33)，pit panern分型IV V、V型占80％(8／10)，肿瘤局部切除加内镜下治疗占36．4％(12／33)，手术切除占63．6％(21／33)，经7个月-5年6个月随访，均无复发。结论 通过临床症状分析、变焦大肠镜下黏膜凹窝分型有助于提高早期大肠癌的检出率，尤其是平坦及凹陷型病变的检出。早期大肠癌可积极开展镜下治疗，包括内镜、腹腔镜下治疗。术后化疗与否对延长生存率无差异。     

The value of folate receptor-positive circulating tumor cells in the diagnosis of lung cancer and its correlation with clinical characteristics

Objective

The aim of this research is to investigate the feasibility of folate receptor-positive circulating tumor cells (FR+CTCs) as a biomarker for the diagnosis of malignant pulmonary nodules and the correlation between clinicopathological factors and FR+CTC levels.

Methods

Patients initially diagnosed with one or more pulmonary nodules from a computed tomography scan were prospectively included. Three milliliters of peripheral blood was collected from each participant for FR+CTC analysis prior to surgery. Clinical and pathological parameters and FR+CTC levels were compared between patients with lung cancer and benign diseases.

Results

Six hundred fifty-three patients had lung cancer and the other 124 had benign lung diseases based on pathological examinations of the resected specimens. The median FR+CTC value of the lung cancer group was 12.0 (95% CI 9.6–16.2) FU/3 mL and that of the benign group was 7.2 (95% CI 5.78–11.2) FU/3 mL. The difference was statistically significant (P < 0.0001). In a receiver operating characteristic analysis to distinguish the two groups, the area under curve of FR+CTC was 0.7457 (95% CI 0.6893–0.8021; P < 0.0001) using a cutoff of 8.65 FU/3 mL. The sensitivity was 86.37%, and the specificity was 74.19%. Combined with conventional serum tumor biomarkers, the area under curve was 0.922 (0.499–0.963). The sensitivity was 92.20%, and the specificity was 83.05%. FR+CTC levels were related to tumor staging (P4 < 0.001), the degree of tumor invasion both in single (P = 0.011) and multiple lesions (P = 0.022), pathological subtypes (P = 0.013), and maximum tumor diameter (P = 0.014).

Conclusions

FR+CTC is an effective and reliable biomarker for the diagnosis of lung cancer. Further, FR+CTC level is correlated with tumor staging, degree of invasion, pathological subtypes, and tumor size.     

Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer

Sex significantly influences the clinical and pathological characteristics of colorectal cancer (CRC). These include differences in incidence and mortality rates, clinical presentations including age, emergency surgery for complications from CRC, screening participation rates, site, stage and treatment utilization, histopathology and survival. Environmental, behavioral and biological factors contribute to the differential risk. Recent advances in the molecular biology of CRC, specifically in microsatellite status, estrogen hormone and estrogen receptor β, have led to greater understanding of the effect of estrogen in colorectal carcinogenesis. Estrogen may preferentially protect against microsatellite unstable cancers through its effect on selected molecular targets; however, the exact pathways have not been elucidated. Recognition of important sex disparities in these areas may lead to the implementation of specific measures to diminish these differences and facilitate equitable distribution of health resources. Identifying specific molecular targets on CRC that interact with estrogen may stimulate research to improve the overall outcomes of all patients with CRC.