胃癌病理生物学行为对手术的指导意义：附148例分析

随访１９８２年１月－１９９１年３月胃癌切除术病人１４８例，其中早期胃癌１６例，进展期胃癌１３２例。随经８５．５％。全组均行次或近全胃切除加Ｒ１－３淋巴结清扫术。结果提示：（１）生存率比较：早期胃癌Ｒ１与Ｒ２Ｐ〉０．０５。进展期胃癌Ｒ１与Ｒ２Ｐ〈０．０１；Ｒ１与Ｒ３Ｐ〈０．０５；Ｒ２与Ｒ３Ｐ〉０．０５。（２）病灶浸润深度与淋巴结转移程度呈正比，两者相辅提示病期预后。（３）肿瘤大小与生存率无统计学意义     

胃癌病理生物学行为对手术的指导意义（附148例分析）

随访１９８２年１月～１９９１年３月胃癌切除术病人１４８例，其中早期胃癌１６例，进展期胃癌１３２例。随访率８５．５％。全组均行次全或近全胃切除加Ｒ１～３淋巴结清扫术。结果提示：①生存率比较：早期胃癌Ｒ１与Ｒ２Ｐ＞０．０５。进展期胃癌Ｒ１与Ｒ２Ｐ＜０．０１；Ｒ１与Ｒ３Ｐ＜０．０５；Ｒ２与Ｒ３Ｐ＞０．０５。②病灶浸润深度与淋巴结转移程度呈正比，两者相辅提示病期预后。③肿瘤大小与生存率无统计学意义。④早期胃癌Ⅲ型生长、进展期胃癌浸润型生长预后最差。分析讨论表明：早期胃癌行次全胃切加Ｒ１、选择性Ｒ２淋巴结清扫为宜。进展期胃癌拟行距肿瘤５ｃｍ以上的次全或近全胃切加Ｒ_２、选择性Ｒ_３淋巴结清扫为宜。     

早期胃癌126例临床分析

目的分析早期胃癌病例的临床表现和手术治疗的远期疗效。方法早期胃癌１２６例，占同期收治胃癌患者的４．８７％。其中小胃癌１０例，微小胃癌７例，一点癌３例，男与女之比为２．５：１。平均年龄为５１岁。平均病程为１２．２个月。胃窦小弯病变多见，有７８例（６１．９％）。有１例呈双病灶。管状腺癌多见，有５０例（３９．７％），低分化腺癌或印戒细胞癌４９例（３６．５％）。结果均行规范性Ｒ２根治术。淋巴结转移率为１９．０４％（２４／１２６）。手术后５年和１０年生存率分别为９９．１８％和９６．５７％。预后与肿瘤浸润深度、淋巴结是否转移密切相关。结论提高胃癌生存率的关键是早期发现。胃肠Ｘ线造影检查与胃镜相互配合，对溃疡可疑的病灶作多方位活检、刷片，并在短期内复查，可发现更多的早期胃癌。     

111例食管癌锁骨上淋巴结转移放射治疗疗效分析

目的　探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素。方法　１９８４ 年９ 月至１９９２ 年１２ 月收治食管癌锁骨上淋巴结转移１１１ 例,均采用６０Ｃｏ 外照射,食管ＤＴ６０ ～７０Ｇｙ,锁骨上ＤＴ５０～６６Ｇｙ。结果　治疗后的１、３ 、５ 年生存率分别为４９．６ ％ 、１０．８％ 、６．３ ％ ;病变长度≤５．０ ｃｍ 、５．１ ～８ ｃｍ 、＞ ８ ｃｍ 的５ 年生存率分别为１５％ 、２．５ ％ 、０（ Ｐ＜０．０５） ;疗终Ｘ线表现基本消失与部分消失的５ 年生存率分别为１２．５％ 、１．８％（ Ｐ＜ ０．０５）;锁骨上淋巴结＜３ ｃｍ 和≥３ ｃｍ 的５ 年生存率分别为８．１ ％ 、０ 。结论　食管癌锁骨上淋巴结转移应积极治疗,淋巴结大小、食管病灶长度、疗终Ｘ线表现、放疗剂量是影响预后的主要因素     

111例食管癌锁骨上淋巴结转移放射治疗疗效分析

目的 探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素。方法 １９８４年９月至１９９２年１２月收治食管癌销骨上淋巴结转移１１１例，均采用＾６０Ｃｏ外照射，食管ＤＴ６０～７０Ｇｙ，锁骨上ＤＴ５０～６６Ｇｙ。结果 治疗后的１、３、５年生存率分别为４９．６％、１０．８％、６．３％；病变长度≤５．０ｃｍ～８ｃｍ、〉８ｃｍ的５年生存率分别为１５％、２．５％、０（Ｐ〈０．０５）；疗终Ｘ线表现基本消失与部     

早期胃癌缩小手术与扩大手术治疗结果的比较

目的：探讨早期胃癌缩小手术的适应征。方法：对１３８例早期胃癌的淋巴结转移特点及缩小与扩大手术治疗结果进行研究。结果：粘膜内癌淋巴结转移率为５．１％,其中Ⅰ站为３．９％,Ⅱ站为．３％,１ｃｍ以下癌灶无淋巴结转移,１．５ｃｍ以上凹陷型早期胃癌开始出现淋巴结转移。粘膜下层癌淋巴结转移率为１８．３％,其中Ⅰ站淋巴结转移率为１８．３％Ⅱ站为１ｃｍ大小的癌灶开始发现淋巴结转移。随访５年以上的１０９例中的 ３３     

男性乳腺癌预后因素分析

男性乳腺癌临床少见，我院自１９７５年１月～１９９５年１月共收治经手术治疗的男性乳腺癌４８例，占同期乳腺癌的１．２２％（４８／３９３９）。本文就影响男性乳腺癌的预后因素进行探讨。１材料与方法１．１一般资料本组４８例均经病理确诊，年龄２８～８１岁，中位年龄５４．５岁。仅１例首发症状为乳头溢血，其余均为乳腺肿块初诊。皮肤受侵１９例，占３９．５８％，肿块大小０．８～１１cm，腋淋巴结转移３３例，其中转移数超过４个者２３例。１．２病理分类非浸润性癌２例，均为非浸润性导管癌。浸润性癌４６例，其中非特殊型３８例…     

食管癌淋巴结转移的预后评价：附212例分析

对２１２例经手术根治性切除及病理证实有淋巴结转移的胸段食管鳞癌，进行淋巴结转移状态和预后关系的回顾性分析。全组共切除淋巴结３４１９个，平均每例１６．１个，其中癌性转移淋巴结的６６３个，转移频度１９．４％，随访５年生存率１９．３％（４１／２１２）。分析结果表明：颈、胸及腹转移部位间５年生存率差异无显著性意义（Ｐ＞０．０５）；在淋巴结转移的数量上，１个的５年生存率高于２个及２个以上，差异有非常显著性意义（Ｐ＜０．０１）；转移度≤１０％与＞１０％的５年生存率差异有显著性意义（Ｐ＜０．０５）；颈部吻合与胸内吻合的５年生存率差异无显著性意义（Ｐ＞０．０５）。作者认为，食管癌淋巴结转移按数量、转移度分级有助于评价预后和选择综合治疗。     

胃类癌8例临床病理分析

类癌可发生于消化道的任何部位,以前文献报道胃类癌只占胃肠道类癌的３％左右,目前认为可达４１％;并有２％～９％胃类癌伴有恶性贫血。现将我院１９８０年以来收治的８例胃类癌报道分析如下。方法男性７例,女性１例。年龄４３岁～７６岁,平均６４．９岁。肿瘤位于胃窦部４例（５０．０％）,胃小弯３例（３７．５％）,贲门部１例（１２．５％）。肿瘤最小０．３ｃｍｘ０．３ｃｍｘ０．２ｃｍ,最大５．２ｃｍｘ４．０ｃｍｘ２．５ｃｍ．直径＜１．０ｃｍ２例,１．０ｃｍ～２．０ｃｍ１例,＞２．０ｃｍ５例。７例病人有不同程度的上…     

非小细胞肺癌根治术后残端复发的放射治疗

目的评价和分析非小细胞肺癌根治术后残端复发的放射治疗疗效及预后因素。材料与方法从１９７０年２月至１９９３年初，３９例肺癌根治术后残端复发的病人入组分析。中位年龄５９岁，术后至复发时间３～５０月，始发复发症状至确诊时间０～２０月。伴有淋巴结转移者１８例，残端复发有组织学诊断２８例。８例加腔内放疗８～３０Ｇｙ／１～３次，２例加化疗，６例单纯腔内放疗１２～３０Ｇｙ／２～３次。单纯外照射剂量为４５～７０Ｇｙ，加腔内放疗者为２０～６０Ｇｙ。结果症状缓解率达９０％左右，５年生存率２３．０±７．５％。单纯残端复发者５年生存率３８．１±１１．０％，而伴有淋巴结转移者无３年存活（Ｐ＜０．００３）。始发复发症状至确诊时间＜２月与≥２月者，５年生存率分别为３３．７±１２．０％与１２．６±８．２％（Ｐ＞０．１０４５）。在６例行单纯腔内放疗中，２例长期生存。Ｃｏｘ回归分析仅残端复发是否伴有淋巴结转移为影响预后的重要因素。结论放射治疗是治疗非小细胞肺癌根治术后残端复发的重要手段，尤其单纯残端复发者可取得满意结果     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

早期胃癌淋巴结转移因素分析

目的探讨影响早期胃癌淋巴结转移的因素。方法对74例术后早期胃癌患者的资料,对各临床病理指标与淋巴结转移的关系进行分析,以确定淋巴结转移的危险因素。结果早期胃癌患者的淋巴结转移率为14.9%（11/74）。单因素分析显示黏膜下癌的淋巴结转移率（27.6%）明显高于黏膜内癌（6.7%）（P=0.020）;未分化型癌的淋巴结转移率（27.6%）明显高于分化型（6.8%）（P=0.042）;肿瘤最大径≤2 cm、〉2-4 cm、〉4 cm 3组间淋巴结转移率有统计学意义（χ2=6.549,P=0.038）。采用Log istic回归进行的多因素分析显示,肿瘤最大径（OR=2.688,P=0.047）和浸润深度（OR=4.508,P=0.044）是影响早期胃癌淋巴结转移的独立危险因素。结论早期胃癌淋巴结转移与肿瘤最大径和浸润深度密切相关,这可为手术方案的选择提供参考。     

Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma.

BACKGROUND: Gastric carcinoma invading the submucosa is often accompanied by lymph node metastasis. However, the relation between the depth of submucosal invasion and the status of metastasis has not been investigated. The objective of this study was to clarify the relation between lymph node status and the histologic features of gastric carcinoma invading the submucosa. METHODS: The histopathology of 118 patients who underwent gastrectomy and lymph node dissection for gastric carcinoma invading the submucosa was examined. These pT1 tumors with invasion of the submucosa were confirmed by histologic examination of the resected specimens. Tumor size, depth of submucosal invasion, histologic type, and macroscopic type were investigated in association with presence or absence of and anatomic level of lymph node metastasis. RESULTS: Among the 118 patients, 16 (14%) had lymph node metastasis, and the status of metastasis significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis to perigastric lymph nodes and extragastric lymph nodes was 0% and 0% for < or =1-cm tumors, 5% and 1% for 1- to 4-cm tumors, and 46% and 15% for >4-cm tumors, respectively. There was no lymph from a node metastasis in tumors with less than 300 microm of submucosal invasion. The frequency of lymph node metastasis for tumors with 300-1000 microm and >1000 microm of submucosal invasion were 19% and 14%, respectively. CONCLUSIONS: Tumor size and depth of submucosal invasion serve as simple and useful indicators of lymph node metastasis in early stage gastric carcinoma. Optimal lymph node dissection levels are as follows: 1) local resection (D0) for lesions < or =1 cm, 2) limited lymph node dissection (D1) for 1- to 4-cm lesions, and 3) radical lymph node dissection (D2) for lesions >4 cm. When submucosal invasion of a locally resected tumor is more than 300 microm, additional gastrectomy and lymph node dissection are necessary.     

Application of minimally invasive treatment for early gastric cancer

BACKGROUND AND OBJECTIVES: Although various types of minimally invasive treatment have emerged as the best front-line therapies for early gastric cancer (EGC), there have been no established indications that these attempts are applicable. The purpose of this study was to propose indications for the application of minimally invasive therapy for EGC. METHODS: A total of 566 patients with EGC who had undergone gastrectomy with D2 or more extended lymphadenectomy, from July 1993 to December 1997 were retrospectively analyzed. The risk factors that determine lymph node metastasis were investigated by univariate and multivariate analysis. RESULTS: The rate of lymph node metastasis was 11.8% for all EGC, 3.4% for mucosal cancer, and 21.0% for submucosal cancer. Lymph node metastasis was associated with submucosal invasion, larger tumor size, undifferentiated histology, and the presence of lymphatic or blood vessel invasion (LBVI) by univariate and multivariate analyses. When LBVI was absent, there was no lymph node metastasis if the tumor was smaller than 2.5 cm with differentiated histology, and smaller than 1.5 cm with undifferentiated histology, regardless of depth of invasion. Extra-perigastric lymph node metastases were noted in patients with submucosal tumors that have LBVI while none of mucosal cancer showed extra-perigastric lymph node metastases. CONCLUSIONS: Minimally invasive treatment can be possibly applied for patients with EGC using these four independent risk factors for lymph node metastasis in EGC. For mucosal cancers, EMR is indicated for EGCs without lymph node involvement based on tumor size and histology. When we found LBVI by pathologic examination after EMR, gastrectomy with D1 lymph node dissection is mandatory. For submucosal cancers, patients with small tumors could be treated with laparoscopic wedge resection without lymph node dissection. However, patients with larger sized tumors or tumors with LBVI should be treated with extended (D2) lymph node dissection.     

未分化型早期胃癌的淋巴结转移规律分析

目的探讨未分化型早期胃癌(EGC)的淋巴结转移规律。方法对1994年1月至2008年12月手术治疗的335例早期胃癌的临床病理学资料进行回顾性分析。结果未分化型早期胃癌的淋巴结转移率为17.9%,其中黏膜内癌(M癌)和黏膜下层癌(SM癌)的淋巴结转移率分别为10.5%、25.6%,直径≤2.0cm和>2.0cm的淋巴结转移率分别为8.0%和25.8%,脉管瘤栓阳性和脉管瘤栓阴性的淋巴结转移率为50.0%和16.3%。单因素分析显示,肿瘤大小、浸润深度、脉管瘤栓与未分化型早期胃癌淋巴结转移相关(P<0.05)。多因素分析显示,肿瘤最大径>2cm、黏膜下层浸润和脉管瘤栓是未分化型早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、黏膜内癌、无脉管瘤栓的未分化型早期胃癌发生淋巴结转移风险小。     

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

Background: An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. Materials and Methods: A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. Results: The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. Conclusions: Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.     

200例食管癌根治术淋巴结清扫的分析

自1987年～1990年对200例食管癌患者进行根治手术并对病理淋巴结分析.其中肿瘤<3cm者18例,无1例淋巴结转移.肿瘤在3cm～5cm者100例,左下肺静脉淋巴结10例(10％)转移,左肺动脉淋巴结无1例转移.胃左动脉淋巴结有20例(20％)转移,气管隆突淋巴结14例(14％)转移,肿瘤5cm～7cm长度者64例中,左下肺静脉淋巴结11例(17％)有转移,左肺动脉淋巴结无1例转移.胃左动脉淋巴结25例(39％)有转移,气管隆突淋巴结34例(53％)有转移.8cm以上病例18例,其中左下肺静脉淋巴结4例(22％)有转移,胃左淋巴结18例(100％)有转移,气管隆突淋巴结16例(88％)有转移.左肺动脉淋巴结1例(5.8％)转移.结合淋巴结转移规律对手术切除范围作了探讨.     

专利蓝示踪胃癌前哨淋巴结及其微转移检测

目的探讨专利蓝示踪法检测胃癌前哨淋巴结(sentinel lymph node,SLN)的可行性和临床意义。方法34例胃癌术中病灶周围浆膜或黏膜下注入专利蓝溶液,将首先染色的淋巴结视为SLN,并进行常规病理检查和淋巴结微转移(lymphnode micro metastasis,LNMM)检测。结果胃癌SLN检测成功率为94.1%(32/34),SLN检出个数平均为1.8个/例,SLN转移率明显高于非SLN(55.1%vs14.1%),由SLN诊断胃癌区域淋巴结转移情况的准确性为93.7%(30/32),假阴性率为8.3%(2/24),2例胃癌病例因SLN的LNMM检测阳性而使病理分期上调。结论专利蓝示踪检测胃癌SLN可准确预测胃癌区域淋巴结的转移情况,并使部分胃癌淋巴结的病理分期上调。     

Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type,depth of wall invasion,and lymph node metastasis

Background Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy for early tumors should therefore be based on a complete cure, and limited surgery must thus have clear indications. Methods D2 gastric resection was performed in 278 early gastric adenocarcinomas, and a retrospective histological review of the specimens was made. The extended indications for EMR or ESD, according to the Japanese Gastric Cancer Association Treatment guidelines for gastric cancer in Japan, were also assessed. Results Of the 278 early gastric cancers, 115 were mucosal (M) cancers without ulcer. No lymph node metastases were seen in these specimens. Six of the 41 specimens of M cancer with ulcers had lymph node metastases at the N1 level only. One of these had lymph node metastases from a tumor measuring less than 3 cm in size. Twenty-eight of 122 submucosal cancers had lymph node metastases (23%). Twenty of these were SM1 tumors and 5 had lymph node metastases; 4 of these 5 had lymph node metastases despite the absence of vascular invasion. Conclusion Three cases had lymph node metastases that met the extended criteria for EMR/ESD. EMR and/or ESD should be limited to M cancers without ulcer or differentiated-type M cancer with ulcers smaller than 2 cm. When the depth of tumor invasion is deeper than M, then a gastric resection with lymph node dissection is necessary.