53例局限期原发食管小细胞癌治疗与预后分析

[目的]分析局限期原发食管小细胞癌的治疗疗效及预后。[方法]回顾性分析2002年1月至2011年12月经病理证实的53例局限期原发食管小细胞癌患者的临床资料。生存率分析采用Kaplan-Meier方法,组间生存率比较用Log-Rank检验,预后因素采用Cox回归分析。[结果]全组中位随访时间18个月,中位生存时间14.5个月。1、3、5年生存率分别为62.3%、29.2%、15.6%。手术联合放化疗组的中位生存时间为17.4个月,单纯手术组的中位生存时间为7.1个月,两者比较有统计学差异(P=0.007)。单因素生存分析显示,基础疾病、治疗原则、区域淋巴结转移、脉管瘤栓等因素对预后有影响;Cox回归分析显示脉管瘤栓是影响预后的独立因素。[结论]脉管瘤栓是局限期原发食管小细胞癌的独立预后因素,综合治疗可改善患者生存。     

宫颈腺鳞癌83例预后分析

背景与目的:宫颈腺鳞癌是宫颈癌特殊的病理类型,对其临床病理特点及影响预后凶素的分析报道比较少见.本文通过回顾性研究来探讨宫颈腺鳞癌的临床特点及其预后影响因素.方法:选取1982年11月至2006年5月在中山大学肿瘤防治中心妇科住院治疗的经病理确诊的83例宫颈腺鳞癌的病例资料进行回顾性分析.结果:83例病例的中位总生存时间为47个月,中位无瘤牛存时间为43个月.5年生存率为74.0%,复发率为30.1%(25/83).淋巴结阳性患者的中位总生存时间和无瘤生存时间分别为58个月和54个月,淋巴结阴性患者分别为37个月和21个月,两者差异均有统计学意义(P=0.005和P<0.001).肿瘤直径>4 cm患者的无瘤生存时间为47个月.直径≤4 cm患者为16个月,两者有统计学差异(P=0.015).淋巴结转移与FIGO分期、肿瘤直径和浸润深度相关.保留卵巢患者的复发率为33.3%(3/9).结论:对于宫颈腺鳞癌,淋巴结转移仍是影响预后的独立的危险因素,术后辅助外照射治疗可以改善生存时间和延长无瘤生存时间.肿瘤直径>4 cm是无瘤生存时间的独立预后因素.尚不能确定保留卵巢对预后的影响.     

300例结直肠癌肝转移患者的临床预后分析

目的 探讨结直肠癌肝转移患者的临床特征及预后因素.方法 对300例结直肠癌首发肝转移患者的临床特征及肝转移后的生存情况进行回顾性分析.结果 300例患者中,原发病灶位于结肠者152例,位于直肠者148例.原发肿瘤为管状腺癌272例,黏液腺癌18例,类癌5例,印戒细胞癌4例,鳞癌1例.原发肿瘤为高分化19例,中分化217例,低分化27例.无区域淋巴结转移104例,有区域淋巴结转移162例.原发肿瘤分期为Ⅰ、Ⅱ期62例,Ⅲ、Ⅳ期为237例.同时性肝转移206例,异时性肝转移94例.肝转移灶为单发48例,多发252例.肝转移灶最大直经≤5 cm249例,>5 cm 51例.300例患者转移后中位生存期为19.0个月,肝转移后1、2和5年生存率分别为79.0%、29.0%和3.0%.单因素分析结果显示,患者KPS评分、组织学分级、原发肿瘤T分期、有无区域淋巴结转移、原发肿瘤分期、有无脉管瘤栓、肝转移灶部位、肝转移灶最大直径、肝转移灶数目、同时合并其他转移均与预后有关.多因素分析结果显示,KPS评分、脉管瘤栓、肝转移灶数目、肝转移灶最大直径是结直肠癌肝转移患者预后的独立影响因素.结论 KPS评分、脉管瘤栓、肝转移灶数目和最大直径是结直肠癌肝转移患者预后的影响因素,KPS评分越高、无脉管瘤栓、肝转移灶数目越少、转移灶最大直径越小的患者预后越好.     

206例Ⅰ_B期宫颈鳞癌患者手术+放疗的预后分析

目的 探讨Ⅰ_b期手术治疗宫颈鳞癌患者的无瘤生存时间和预后因素.方法 回顾分析2006年前7年本院行PivermⅢ型颈癌根治术+盆腔淋巴结清扫术的206例Ⅰ_b期宫颈鳞癌患者资料.其中Ⅰ_(B1)期103例,Ⅰ_(B2)期103例;术前放疗79例,术后辅助治疗111例.生存率用Kaplan-Meier法计算并Logrank检验和单因素预后分析,Cox模型进行预后多因素分析.结果 随访率为92.7%,随访满5年者106例.全组5年无瘤生存率和总生存率分别为86.8%和96.3%,Ⅰ_(B1)、Ⅰ_(B2)期的分别为94.6%和100%、77.9%和92.2%.单因素分析显示肿瘤大/b(FIGO分期)、脉管瘤栓、穹窿以下阴道受累、宫旁阳性和淋巴结转移数>2个对Ⅰ_b期5年无瘤生存率有影响,分别为77.9%:94.6%(χ~2=5.58,P=0.018)、74.6%:89.8%(χ~2=10.44,P=0.001)、50%:87.9%(χ~2=7.01,P=0.008)、63.5%:89.5%(χ~2=17.69,P=0.000)和43.6%:89.4%(χ~2=21.47,P=0.000).多因素分析显示HGO分期、脉管瘤栓、淋巴结转移数>2个对全组5年无瘤生存率有影响(χ~2=4.73,P=0.030;χ~2=9.81,P=0.002;χ~2=6.30,P=0.012);脉管瘤栓、淋巴结转移数>2个对Ⅰ_(B2)期5年无瘤生存率有影响(χ~2=6.38,P=0.012;χ~2=3.92,P=0.048).结论 对宫颈鳞癌,脉管瘤栓是Ⅰ_(B1)期无瘤生存的重要预测指标.术后放疗能减少Ⅰ_(B2)期复发,但不提高总生存.Ⅰ_(B2)期术后必须辅助放疗者,术前放疗只用于提高手术成功率,对无瘤生存无影响.Ⅰ_(B1)期术后只有深肌层浸润者,宜减少术后补充放疗.     

1826例非小细胞肺癌的预后因素分析

目的 探讨影响非小细胞肺癌(NSCLC)预后的相关因素,分析分期和脉管瘤栓对非小细胞肺癌预后的影响.方法 回顾1826例NSCLC患者的临床资料,将可能影响NSCLC预后的风险因子进行单因素和多因素分析,确定NSCLC预后的影响因素.应用Kaplan-Meier法分析分期和脉管瘤栓对患者生存率的影响.结果 单因素分析显示,影响NSCLC预后的因素为肿瘤家族史(P=0.02)、组织学类型(P=0.005)、分期(P=0.002)和脉管瘤栓(P=0.002).经Cox回归分析,分期为Ⅲ期和有脉管瘤栓是影响NSCLC预后的独立危险因素.Ⅰ、Ⅱ、Ⅲ期患者的5年生存率分别为57.4%、34.2%和18.7%(P=0.001),同一分期中,有无脉管瘤栓患者的生存率差异有统计学意义(P＜0.05),有脉管瘤栓或无脉管瘤栓者在各分期之间的生存率差异亦有统计学意义(P＜0.05),有脉管瘤栓患者复发或转移的发生率(69.9%)显著高于无脉管瘤栓者(36.7%,P＜0.001).结论 分期和脉管瘤栓是影响NSCLC预后的重要因素,并且脉管瘤栓还可作为判断NSCLC侵袭和转移的重要因子.     

淋巴结跳跃转移与胸段食管鳞癌预后相关性分析

目的 近年来虽然食管鳞癌的治疗方法在不断改进,但是其预后仍然较差.淋巴结转移情况是影响预后的因素之一,本研究旨在探讨胸段食管鳞癌孤立淋巴结跳跃转移的分布情况以及淋巴结跳跃转移对食管鳞癌预后的影响.方法 回顾性分析2009-01-01-2013-12-31就诊于山东大学附属山东省肿瘤医院的62例手术切除的胸段食管鳞癌患者的临床病理资料,建立数据库.选取年龄、性别、肿瘤长度、肿瘤部位、T分期、分化程度、清除淋巴结数、术后治疗方法等临床特征因素,应用寿命表法计算患者术后总的1、3、5年生存率,用Kaplan-Meier法计算患者累积生存率,并绘出生存曲线,组间比较用Log-Rank检验,多因素分析采用Cox模型分析.统计分析采用SPSS 17.0软件包进行分析.结果 全组患者有淋巴结跳跃转移31例,转移率为50.0％.其中中段及下段发生跳跃转移数分别为26例(83.9％)和5例(16.1％).生存分析显示全组中位生存时间和5年生存率为43.7个月和26.0％.伴随跳跃转移者中位生存时间及5年生存率为33.6个月和16.0％,无跳跃转移中位生存时间及5年生存率为51.9个月和35.0％,P=0.036.单因素分析发现,淋巴结跳跃转移(P=0.005)和术后治疗方式(P=0.037)影响预后;多因素分析表明,淋巴结跳跃转移(P=0.039,HR=1.793,95％CI:1.031～3.120)是预后的独立影响因素.结论 跳跃转移在胸段食管癌中常见,淋巴结跳跃转移是食管鳞癌患者预后的危险因素.     

46例首诊伴远处转移鼻咽癌的预后分析

目的 回顾性分析初诊时即伴有远处转移的鼻咽癌患者的治疗结果 并探讨其预后.方法 3年余共收治46例初诊伴有远处转移的鼻咽癌患者,其中43例为单器官转移,3例为多器官转移.肝转移19例,骨转移11例,肺转移7例,腋窝淋巴结和纵隔淋巴结各6例,脑转移1例.所有患者均接受了鼻咽部及颈部40～85 Gy放疗.41例接受了1～5周期PF方案化疗,23例接受了远处转移灶姑息性放疗.结果 随访率为100%.1、2、3、5年生存率分别为66%、47%、30%、19%,中位生存时间为20个月.转移灶是否放疗及KPS评分是影响生存的预后因素.转移灶放疗与末放疗的中位生存时间分别为39个月和13个月(X2=8.63,P=0.012),KPS评分≥80和<80的中位生存时间分别为26个月和12个月(X2=3.95,P=0.035).结论 首诊远处转移的鼻咽癌患者得到积极治疗后仍有长期生存可能,KPS评分高者预后好,在全身化疗、原发灶放疗及支持治疗的同时转移病灶局部治疗可能延长生存时间.     

肝癌腹腔淋巴结转移的相关因素及预后分析

[目的]探讨肝细胞肝癌患者腹腔淋巴结转移的临床病理学相关因素及预后。[方法]2005年1月至2010年1月经手术切除的382例肝细胞肝癌,将伴腹腔淋巴结转移的13例患者设为淋巴结转移组,同时期不伴淋巴结转移的369例肝癌患者设为非淋巴结转移组,对两组患者的年龄、性别、HBsAg、症状、肝硬化、AFP值、肿瘤部位、肿瘤大小、大体类型、分化程度、有无包膜、病灶数目、门静脉癌栓和生存期等情况进行分析。[结果]淋巴结转移发生率为3.40%（13/382）。肿瘤大小、大体类型、门静脉癌栓与腹腔淋巴结转移相关。淋巴结转移组中位生存时间10个月,而非淋巴结转移组中位生存时间23个月。[结论]肝细胞肝癌淋巴转移发生率较低,病理类型、门静脉癌栓及肿瘤大小影响预后。     

T1期HER-2阳性乳腺癌靶向治疗预后分析

目的 随着人们健康意识的增强和诊断技术的提高,越来越多的小肿块乳腺癌被确诊和治疗.本研究初步探讨T1期HER-2阳性乳腺癌患者的临床病理学特征及抗HER-2靶向治疗对预后的影响.方法 收集新疆医科大学第三附属肿瘤医院2009-06-01-2014-12-31,218例T1期HER-2阳性乳腺癌患者的临床病理学、治疗及预后信息并进行回顾性分析.结果 在218例T1期HER-2阳性乳腺癌患者中,T1a期15例(6.9％),T1b期43例(19.7％),T1c期160例(73.4％).肿瘤直径越大,肿瘤的组织学分级越高、Ki-67表达越活跃,更易发生脉管浸润和腋窝淋巴结转移,P＜0.05.中位随访42(4～75)个月.16例(7.3％)患者发生复发转移,3年无病生存(disease-free survival,DFS)率和总生存(overall survival,OS)率分别为90.4％和99.5％.Kaplan-meier法生存曲线显示,T1期HER-2阳性乳腺癌3年DFS与脉管浸润(P=0.020)、腋窝淋巴结转移(P=0.011)和抗HER-2靶向治疗(P=0.048)有关.Cox多因素比例风险模型分析显示,发生腋窝淋巴结转移将T1期乳腺癌的复发转移风险提高了3.433(95％CI=1.247～9.454,P=0.017)倍,腋窝淋巴结转移是T1期HER-2阳性乳腺癌患者的独立风险因素.47例(21.6％)患者完成了了标准1年抗HER-2靶向治疗.在激素受体(hormone receptor,HR)阴性、发生脉管浸润或伴有腋窝淋巴结转移患者中抗HER-2靶向治疗可以有效提高患者预后,3年DFS分别提高15.9％、26.2％和25.6％.结论 腋窝淋巴结转移是影响T1期HER-2阳性乳腺癌患者预后的独立风险因素,抗HER-2靶向治疗可显著改善伴有HR阴性、脉管浸润或腋窝淋巴结转移患者的预后.     

胃混合型印戒细胞癌预后影响因素分析

目的探讨印戒细胞比例低于50%的胃混合型印戒细胞癌(SRCC)的预后及其影响因素。方法回顾性分析2014年1月至2016年12月四川省资阳市第一人民医院收治的110例接受根治性胃癌切除术、且印戒细胞比例低于50%的胃混合型SRCC患者的临床资料。对患者进行随访,随访终点为全因死亡,分析SRCC患者预后的影响因素。结果中位随访时间为32.5个月(0.9~70.0个月),中位总生存(OS)时间为40.0个月(7.0~61.0个月),3年OS率为46.5%。Kaplan-Meier生存分析显示,年龄≥60岁、男性、肿瘤位于胃中上部、肿瘤最大径≥5 cm、肿瘤侵犯胃壁全层、淋巴结转移、脉管神经侵犯的胃混合型SRCC患者3年OS率分别为34.3%、31.1%、30.0%、33.3%、40.7%、28.9%、37.5%,均低于年龄<60岁、女性、肿瘤位于胃下部、肿瘤最大径<5 cm、肿瘤未侵犯胃壁全层、淋巴结未转移、未发生脉管神经侵犯的患者(57.6%、57.5%、52.9%、57.6%、56.7%、74.6%、62.3%),差异均有统计学意义(均P<0.05)。Cox多因素分析结果显示,年龄≥60岁(OR=1.225,95%CI 1.089~3.481,P=0.003)、淋巴结转移(OR=1.077,95%CI 1.059~2.674,P=0.034)、肿瘤侵犯胃壁全层(OR=1.342,95%CI 1.117~7.225,P=0.002)、脉管神经侵犯(OR=1.104,95%CI 1.087~2.541,P=0.018)是胃混合型SRCC患者OS的独立危险因素。结论高龄、淋巴结转移、侵犯胃壁全层、脉管神经侵犯的印戒细胞比例低于50%的胃混合型SRCC患者预后差。     

Extrapulmonary small-cell carcinoma compared with small-cell lung carcinoma: a retrospective single-center study

BACKGROUND: The study was conducted with the aim of reviewing the clinical features, therapy, and natural course of patients with extrapulmonary small-cell carcinoma (EPSCC) and small-cell lung carcinoma (SCLC) to better define current concepts regarding EPSCCs. METHODS: The medical records of patients with proven diagnosis of small-cell carcinoma (SmCC) between January 1999 and May 2006 were retrospectively reviewed. A total of 65 SmCC cases were included in the study (11 [17%] cases of EPSCC and 54 [83%] cases of SCLC). RESULTS: Progression-free survival of all patients with EPSCC and patients with extensive EPSCC disease was 7 months (95% confidence interval [CI], 0.58-13.42) and 7 months (95% CI, 4.71-13.29), respectively. Overall survival of all patients with EPSCC and patients with extensive EPSSC disease was 32 months (95% CI, 18.74-45.26) and 28 months (95% CI, 12.24-43.76), respectively. Progression-free survival and overall survival for all patients with SCLC were 5 months (95% CI, 2.26-7.74) and 10 months (95% CI, 5.95-14.05), respectively. Progression-free survival and overall survival for patients with extensive disease were 3 months (95% CI, 4.71-13.29) and 5 months (95% CI, 3.33-6.67), respectively. Overall survival was significantly better in all patients with EPSCC and in patients with extensive EPSCC disease compared with all patients with SCLC and patients with extensive SCLC disease (P = .014, P = .004, respectively). Early death and brain metastasis were observed in a higher number of patients with SCLC compared with EPSCC; however, these results were not statistically significant (P = .33 and P = .076, respectively). Smoking history was significantly less in the EPSCC group (P < .0001). CONCLUSIONS: EPSCC is usually treated similarly to SCLC. However, this study suggests some differences such as etiology, clinic course, survival, frequency of brain metastases, and early death between these entities. These possible differences may influence the choice of therapeutic approach.     

Extrapulmonary small cell carcinoma: single center experience with 61 patients

Extrapulmonary small-cell carcinoma (EPSCC) is a clinicopathological entity distinct from small-cell carcinoma (SCC) of the lung. The aim of this study was to review the clinico-pathologic features, treatment modalities, and factors prognostic for survival in patients with EPSCC. We retrospectively reviewed the medical records of patients with EPSCC diagnosed between January 1995 and July 2004 at the Asan Medical Center. We identified 61 patients with EPSCC, 37 with limited disease (LD) and 24 with extensive disease (ED). The most common primary sites were the gastrointestinal (GI) tract (56%) and uterine cervix (18%). Overall survival (OS) at 1 and 3 years was 59% and 29%, respectively, with a median survival of 16 months (range, 1 approximately 56 months). Treatment information was available for 51 patients, 34 with LD and 17 with ED. Of the 34 LD patients, 25 underwent surgery. Surgery was the only treatment modality in five patients, two of whom remained alive and disease free at last follow-up, 27 and 47 months after surgery, respectively. Adjuvant chemoradiotherapy was administered to 11 patients, nine of whom (82%) had distant failure with a median overall survival of 23 months. Of the eight patients who received adjuvant chemotherapy, four (50%) had distant failure, with a median survival of 21.7 months. In univariate analysis, advanced disease status, as measured by VALSG (LD vs. ED) stage, was a significant prognostic factor for OS (p<0.001). Interestingly, there were no statistically significant differences in progression-free survival or OS between patients with pure (n=45) and mixed (n=16) EPSCC. Overall, the response to various treatment modalities and the median survival time observed were discouraging. Patients with GI primary tumors had poorer prognoses than those with primary tumors at other locations. Fifty six percent of patients with a GI primary tumor had ED at the time of diagnosis, whereas 100% of patients with SCC of the uterine cervix had LD at the time of diagnosis and showed a favorable clinical course. The majority of patients with LD SCC who underwent surgery, followed by adjuvant chemotherapy or chemoradiotherapy, showed tumor recurrence and/or systemic metastases. Clinical trials are needed to define adequate treatment strategies for EPSCC.     

322例广泛期SCLC不同转移部位的生存分析

目的 探讨广泛期SCLC患者不同转移部位对预后的影响。方法 回顾分析本院2011-2015年间收治的经病理学或细胞学诊断的广泛期SCLC患者322例,其中原发病灶伴远处器官转移246例,原发病灶伴非区域淋巴结转移76例。转移累及单器官261例,累及多器官61例。322例患者绝大多数接受EP、CE方案化疗,187例接受胸部3DRT。采用Kaplan-Meier法计算生存率,Logrank法比较组间生存差异,Cox模型多因素预后分析。结果 全组中位生存期和1、2年OS分别为11.7个月和47.9%、19.5%;转移累及单器官者分别为12.4个月和52.5%、21.9%,转移累及多器官者分别为8.9个月和30.5%、11.2%(P=0.014)。单器官转移中肝转移预后最差,中位生存期仅为8.5个月,非区域淋巴结转移预后最好,中位生存期为14.5个月(P=0.001);除去肝转移以外单器官转移生存差异无统计学意义(P=0.139)。多器官转移中伴肝转移和伴骨转移预后最差(P=0.016、0.006),而有无脑转移对广泛期SCLC多器官转移患者预后影响不大(P=0.995)。单纯肝转移和多器官转移预后无明显差异(P=0.862)。结论 广泛期SCLC患者初诊时单器官转移累及肝脏对预后有影响且预后最差;多器官转移伴肝转移以及伴骨转移预后最差,而有无脑转移对预后影响不大。转移一旦累及肝脏,单器官受累和多器官受累生存无明显差异。     

The Role of Integrated 18F-FDG PET-CT as a Staging Tool for Limited-Stage Small Cell Lung Cancer: A Retrospective Study

Background: The aim of this study was to evaluate whether positron emission tomography-computed tomography (PET-CT) could be used as part of the staging work-up in patients with limited-stage disease (LD) small cell lung cancer (SCLC). Patients and Methods: Between January 2002 and December 2007, a total of 73 patients with presumed LD on CT, who underwent a PET-CT scan, were included in this study. Results: Conventional work-up revealed distant metastases in 12 patients. Out of 61 patients diagnosed as LD SCLC, PET-CT found unexpected distant metastases in 15 (24.6%) patients (LD/extensive-stage disease (ED)) of whom 13 (21.3%) were upstaged as a consequence. In 10 (76.9%) of the 13 upstaged patients, treatment was changed. The median survival of LD/LD SCLC patients who underwent concurrent chemoradiotherapy and chemotherapy only was 21.9 and 17.5 months, respectively. The median survival of LD/ED and ED/ED SCLC patients who received chemotherapy only was 17.4 and 14.1 months, respectively. The median survival of LD/LD SCLC patients who received concurrent chemoradiotherapy was superior to that of LD/ ED and ED/ED patients who received chemotherapy only (p = 0.037 and 0.004, respectively). Conclusion: The addition of PET-CT seems to allow more accurate staging and may thus protect a percentage of SCLC patients from potentially futile and toxic radiotherapy.     

Should extrapulmonary small cell cancer be managed like small cell lung cancer?

BACKGROUND:

The aim of this study was to determine if extrapulmonary small cell carcinomas (EPSCC) should be managed using protocols similar to those for small cell lung cancer (SCLC).

METHODS:

Treatment strategies, survival, patterns of failure, and prognostic factors for patients with EPSCC were analyzed retrospectively at a large cancer center. SCLC was excluded by thoracic computed tomography (75%) or chest radiography (25%).

RESULTS:

Of 120 eligible patients, 70% had limited disease (LD). Treatment modalities included chemotherapy (n = 82; 68%), radiotherapy (RT) (n = 80; 67%), and surgery (n = 41, 34%). The median survival for patients with LD and extensive disease was 1.4 years and 0.7 years, respectively. Gynecologic (n = 31) and gastrointestinal (n = 28) were the most common primary tumor sites. Gynecologic and head and neck primary tumor sites had better 1‐year survival than other sites (P = .019 and 0.005, respectively). Brain metastasis was the site of first distant failure in 4.1% of patients versus 35% for soft tissue metastases. The lifetime risk of brain metastasis was 13%. Definitive RT (P = .004), LD (P = .028), and prophylactic cranial irradiation (PCI) (P = .022) were found to be positive prognostic factors and weight loss (P < .001) was a negative prognostic factor on multivariate analysis.

CONCLUSIONS:

Patients with EPSCC usually experienced short survival, often with early distant metastasis. Although PCI was associated with improved overall survival, brain metastasis was less frequent than in patients with SCLC, and therefore the potential benefit of PCI was less than in patients with SCLC. Definitive chemoradiotherapy was associated with better outcomes and should be delivered whenever feasible. Cancer 2010. © 2010 American Cancer Society.     

The optional extent of lymph node dissection for pancreatic head cancer

Objective The extent of lymph node dissection for pancreatic head cancer(PHC)is uncertain and controversial;therefore,this study evaluated whether PHC patients can benefit from different extents of lymph node dissection.Methods A total of 106 PHC patients underwent standard regional lymphadenectomy(SRLN;n=56,52.8%)and extended regional lymphadenectomy(ERLN;n=50,47.2%)between September 2015 and September 2019.None of the study participants had distant metastases.The median survival time and complications were compared between the two groups.Results The median survival time in the SRLN and ERLN groups was 27.01 months and 21.17 months,respectively(P=0.30).The postoperative major morbidity and mortality rates were 37.50%and 1.79%in the SRLN group,and 46.00%and 2.00%in the ERLN group,respectively.Moreover,the tumor differentiation,tumor diameter,lymph node involvement,perineural invasion,vascular invasion,and margin status all correlated with survival(P<0.05).Conclusion For PHC patients,ERLN cannot provide a significant survival benefit over SRLN.Moreover,ERLN increased morbidity and mortality,although without statistical significance.This indicates that ERLN should not be considered in PHC patients.     

Lymph node dissection for clinically evident lymph node metastases of malignant melanoma.

AIMS: A considerable number of melanoma patients present with clinically evident regional lymph node metastases. Factors influencing prognosis following therapeutic lymph node dissection (TLND) were evaluated. METHODS: In total 140 patients (68 women, 72 men, median age 53 years) with established regional lymph node metastases, but without clinically detectable distant metastases, received cervical, axillary or ilioinguinal TLND between 1978 and 1997 and were retrospectively reviewed. Uni- and multivariate survival analysis was performed. RESULTS: Median survival for all 140 patients was 25 months; the observed overall 5 year survival rate was 30%. Age greater than 50 years, primary tumour site on the trunk, more than three lymph node metastases and extracapsular spread were associated with a poor prognosis. In multivariate analysis age (< or =50 years vs >50 years, P=0.02), location of the primary tumour (non-truncal vs truncal, P=0.005), number of lymph nodes involved ( n< or =3 vsn >3, P=0.01) and extracapsular spread (none vs present, P=0.04) proved to be independent prognostic factors. CONCLUSIONS: TLND is worthwhile and offers a potential chance of cure in about one-third of melanoma patients with established regional lymph node metastases. There are subgroups with a particularly poor prognosis in whom the benefit of radical surgery alone is limited.     

嗜铬粒蛋白A在小细胞肺癌患者中的表达情况及与淋巴结转移和手术预后的关系

目的探讨嗜铬粒蛋白A(CgA)在小细胞肺癌(SCLC)患者中的表达情况及与淋巴结转移和手术预后的关系。方法收集37例接受手术治疗的SCLC患者的临床资料,采用免疫组织化学染色法检测CgA的表达情况,分析不同临床特征SCLC患者中CgA的表达情况及淋巴结转移情况,采用Cox比例风险回归模型分析SCLC患者总生存期(OS)和无病生存期(DFS)的影响因素。结果不同淋巴结转移情况的SCLC患者中CgA的表达情况比较,差异有统计学意义(P﹤0.05);不同肿瘤直径的SCLC患者的淋巴结转移情况比较,差异有统计学意义(P﹤0.05)。全部患者的中位OS为21个月,中位DFS为15个月,1、3、5年生存率分别为64.1%、30.9%、26.7%。Cox多因素分析结果显示,CgA阳性表达和术后未接受辅助化疗均是SCLC患者OS的独立危险因素(P﹤0.05),CgA阳性表达是SCLC患者DFS的独立危险因素(P﹤0.05)。结论对于恶性程度高的SCLC,在手术后积极进行辅助化疗是有必要的,CgA可以作为预测SCLC患者淋巴结转移及预后的标志物。     

Lymph node status and survival in cutaneous malignant melanoma--sentinel lymph node biopsy impact.

AIM: The survival benefit of sentinel lymph node biopsy (SLB) with lymphadenectomy for microscopic melanoma metastases to regional lymph nodes (SLND) is uncertain. The aim of the study was to analyse the factors influencing clinical outcome (overall survival (OS) and disease free survival (DFS)) of patients undergone lymph node dissection (LND) as result of positive sentinel lymph node disease (SLND) or as consequence of clinically detected metastases (CLND). PATIENTS AND METHODS: This was a single-institution retrospective analysis of survival data of 350 consecutive, prospectively collected, melanoma patients who underwent radical LND in 1995-2001. One hundred and forty-five patients underwent SLND and 205 underwent CLND. RESULTS: The median OS and DFS times of the entire group of melanoma patients, computed from the date of primary lesion excision, were 46.3 months and 26.5 months (5-year OS ratio 41.8% and 5-year DFS ratio 31.5%). The factors which correlated with poor OS by multivariate analysis were: primary tumour Breslow thickness >4 mm (p=0.001), extracapsular extension of lymph node metastases (p=0.004), male sex (p=0.001) and metastases to more than one regional lymph node (p=0.04). The negative factors for DFS were: nodal extracapsular invasion (p=0.00002) and primary tumour Breslow thickness >4 mm (p=0.004). There were no significant differences in OS and DFS between SLND and CLND groups, when calculated from the date of primary tumour excision. However, if OS and DFS were estimated from the date of LND, the SLND group demonstrated significantly better survival in comparison with CLND. CONCLUSION: The study demonstrates no survival benefit from SLB with subsequent radical regional LND in malignant melanoma patients with lymph node metastases.     

小细胞肺癌脑转移发生时间与预后分析

目的 探讨小细胞肺癌(SCLC)脑转移发生时间与预后的关系。 方法 回顾分析2007-2015年收治的首发远处转移部位为脑的局限期SCLC患者 131例,依据中位无脑转移生存期(BMFS)将病例分为A、B两组,其中BMFS≤10个月为A组(61例),BMFS>10个月为B组(70例)。Kaplan-Meier法计算生存率,Logrank法比较组间差异,Cox模型多因素预后分析。 结果 131例SCLC患者中位总生存期及1、2、3年生存率分别为22.5个月及87.3%、44.7%、20.8%;全组中位脑转移后生存期及1、2年生存率分别为9.3个月及39.3%、14.8%。由于A、B组脑转移后中位生存期相近(分别为8.6、9.3个月,P=0.695),进而对未行预防性脑照射的A、B两组患者进行分析,其脑转移后生存期也相近(P=0.240~0.731)。 结论 SCLC脑转移发生时间与总生存相关,而与脑转移后生存无关,因此着重预防和减少脑转移的发生可能是提高SCLC患者生存的重要手段。