VEGF、TGF-β1在早期胃癌中的表达及意义

目的:探讨VEGF、TGF-β1在早期胃癌中的表达及意义.方法:应用免疫组化方法检测130例早期胃癌中VEGF、TGF-β1的表达,分析其与早期胃癌临床病理特征及预后的关系.结果:早期胃癌VEGF表达率为17.7%, TGF-β1表达率为46.9%.VEGF表达与临床病理特征无关,Logistic回归分析提示TGF-β1表达与淋巴结转移、癌周明显肠化相关,VEGF、TGF-β1表达与预后无关.结论:早期胃癌VEGF、TGF-β1检测对早期胃癌预后判断价值有限,但TGF-β1检测可用于评估淋巴结状态,指导手术方式的选择.     

早期胃癌组织Galectin-3表达与淋巴结微转移关系的探讨

目的:研究早期胃癌组织中半乳凝素3(Galectin-3)表达水平与淋巴结微转移的关系。方法:采用免疫组化技术检测56例早期胃癌患者胃癌组织Galectin-3的表达水平,采用淋巴结组织HE染色和角蛋白AE1/AE3表达检测判断淋巴结微转移情况分析Galectin-3表达水平与淋巴结微转移的关系。结果:56例早期胃癌患者中,7例患者13枚淋巴结发现AE1/AE3阳性细胞,总阳性率12.5%(7/56),淋巴结总转移率11.67%(14/120);Galectin-3免疫反应在不同病理亚型早期胃癌组织中程度不同,随着分化程度降低而增强,有淋巴结转移或微转移的早期胃癌组织中Galectin-3表达比无淋巴结转移或微转移的早期胃癌组织中Galec-tin-3表达明显增强。结论:胃癌组织Galec-tin-3高表达有较高的淋巴结转移风险,这对判断预后和指导治疗有重要意义。     

早期胃癌淋巴结转移评估方法的研究现状

早期胃癌的定义为癌灶仅局限于黏膜层或黏膜下层,无论病灶大小及有无淋巴结转移。研究证实淋巴结转移是早期胃癌的独立预后因素,并且对评估早期胃癌患者的预后以及指导治疗具有重要临床意义。评估早期胃癌淋巴结转移的方法有很多,临床上常常应用CT及超声内镜等影像学检查评估早期胃癌淋巴结转移,此外病理活检、分子标志物及前哨淋巴结示踪活检等方法也在早期胃癌淋巴结转移的评估中占有重要位置,本文就早期胃癌淋巴结转移相关评估方法现状予以综述。     

早期胃癌淋巴管密度预测淋巴结转移的研究

目的:检测淋巴管内皮标志物D2-40计算早期胃癌淋巴管密度(LVD),探讨LVD与早期胃癌有无淋巴结转移之间的关系.方法:用免疫组化SP染色法,对80例早期胃癌淋巴结未发生转移与20例早期胃癌淋巴结发生转移的癌周检测D2-40标记阳性LVD的表达水平,并进行统计学分析.结果:D2-40标记阳性LVD在早期胃癌伴有淋巴结转移癌周高于早期胃癌不伴有淋巴结转移癌周(P＜0.05),光镜下LVD的截断(cut-off)值为18.50个.结论:早期胃癌伴有淋巴结转移癌周的LVD高于早期胃癌不伴有淋巴结转移癌周,D2-40阳性LVD可用来判断有无淋巴结转移.     

淋巴结转移阴性早期胃癌的临床病理特点及预后分析

目的:探讨淋巴结转移阴性早期胃癌的临床病理特点及其预后因素,为临床治疗提供理论依据。方法:回顾性分析1983年1 月～2003年12月河北医科大学附属邢台人民医院肿瘤外科收治132 例淋巴结转移阴性早期胃癌患者的临床病理特征与预后的关系。结果:淋巴结转移阴性与淋巴结转移阳性早期胃癌在肿瘤直径和浸润深度组间有显著性差异（P<0.05）。 两者在性别、年龄、家族史、肿瘤数目、肿瘤部位、大体类型和组织学类型分组中有显著性差异（P>0.05）。 本组获随访126 例,6 例失访,随访率为95.5% 。3 年生存率为91.3%（115/126）,5 年生存率为84.9%（107/126）。 单因素分析经Kaplan-Merier 分析筛选出浸润深度与淋巴结转移阴性早期胃癌预后关系密切（P=0.001）。 结果表明浸润深度是淋巴结阴性早期胃癌的独立预后因素。黏膜内癌患者的生存率与黏膜下癌者比较,差异有统计学意义（P<0.05）。 结论:浸润深度是淋巴结转移阴性早期胃癌的独立预后因素。术前或术中正确评估早期胃癌的淋巴结转移状态是选择合理的治疗方案和改善预后的重要条件。      

早期胃癌中淋巴结微转移及LMO4、DLEC1表达的临床意义

目的探求早期胃癌中淋巴结微转移及LMO4、DLEC1表达的临床意义。方法纳入研究对象为早期胃癌患者共50例,均行胃癌根治术。术后平均随访35.2个月(28~60个月),每位患者平均淋巴结24.5枚不等,将所有淋巴结用HE和CK进行免疫组化染色。对淋巴结微转移情况及LMO4、DLEC1的表达进行统计分析。结果淋巴结微转移明显高于常规淋巴结转移率,组织学类型和浸润胃壁深度与淋巴结微转移有正相关性,而其他临床病理因素与淋巴结微转移无明显相关性。LMO4表达与浸润深度、淋巴结微转移、组织分化程度、肿瘤大小呈明显正相关,DLEC1表达与浸润深度、淋巴结微转移、组织分化程度、肿瘤大小呈明显负相关。LMO4与DLEC1表达存在负相关。淋巴结微转移与无淋巴结微转移的患者5年无瘤生存率无显著差别。结论对于早期胃癌,若淋巴结中检测出微转移,其预后较差,术后复发率较高,术后应予以积极的辅助治疗。     

早期胃癌的治疗现状与趋势

1962年日本胃肠内镜学会确定了早期胃癌的定义：癌灶仅限于黏膜层或黏膜下层的胃癌,无论病灶大小及有无淋巴结转移。顾名思义,早期胃癌定义如上主要由于早期胃癌的发展过程以及预后与进展期胃癌差别较大。目前,由于早期胃癌诊断率不断提高,以及基础医学与临床医学的深入研究和发展,对早期胃癌的转移规律、微转移特征、肿瘤复发现象等生物学特性得到了更为明确的认识,     

早期胃癌的临床诊疗特点和预后分析

目的:探讨早期胃癌的诊断和治疗特点,并分析其预后的影响因素.方法:回顾性的分析本院1998年至2002年在本院行外科治疗的128例早期胃癌.结果:早期胃癌的诊断发现主要依靠胃镜检查(93.0%)和上消化道造影(78%),确诊主要依据胃镜活检及术中活检.5年总生存率为90.9%.黏膜内癌和黏膜下癌的淋巴结转移率分别为4.3%和24%,P<0.01,而5年生存率分别为93.1%和88%,无淋巴结转移组和有淋巴结转移组的5年生存率分别为94.2%和73.3%.结论:胃镜检查和上消化道造影是发现和诊断早期胃癌的主要手段.肿瘤的浸润深度和淋巴结转移存在显著的相关性,浸润深度和淋巴结是否转移对预后的影响不明确.     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要。运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量。     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要.运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量.     

PN0胃癌淋巴结微转移的检测及其预后意义

目的　评估细胞角蛋白免疫组化染色诊断PN0 胃癌区域淋巴结微转移的临床病理意义。方法　采用免疫组织化学方法 ,用细胞角蛋白 19单抗检测了 3 9例经传统HE染色诊断为无转移 (PN0 )胃癌患者的 3 74个淋巴结。结果　淋巴结微转移率为 3 3 .3 % ( 13 /3 9) ,微转移度为 4.5 % ( 17/3 74) ,微转移与其它临床病理特点无显著相关性 (P >0 .0 5 )。微转移阳性者与阴性者总生存率显著不一致 (P =0 .0 2 73 )。多变量分析表明淋巴结微转移是独立的预后因素。结论　细胞角蛋白 19单抗免疫组化染色方法较常规组织学检查方法敏感性更高 ,提高了淋巴结微转移的检出率和临床分期的准确性。淋巴结微转移对胃癌预后有重要作用     

常规检查淋巴结阴性胃癌的淋巴结微转移研究

目的 研究常规病理检查无淋巴结转移的胃癌之淋巴结转移的特点,分析微转移与各种临床病理因素及预后的关系。方法 选用抗低分子量细胞角蛋白抗体ＡＥ１,运用免疫组化方法,检测１０５例常规病理检查无淋巴结转移的胃癌根治根本的胃周淋巴结１２４５个,并进行统计处理。结果 ３１例（２９．５％）胃癌的８１个淋巴结（６．５％）出现微转移。弥漫型胃癌的淋巴结微转移阳性率（４１．５％,２２／５３）明显高于肠型胃癌（１７．     

PN0食管癌淋巴结微转移的检测及与预后的关系

目的探讨食管癌淋巴结微转移的免疫组化诊断方法并评价其预后意义.方法采用免疫组织化学方法,用细胞角蛋白19和粘蛋白1单抗检测56例经传统HE染色诊断为无转移(pN0)食管癌患者的118个淋巴结.对患者随访,应用x2检验比较患者的生存差别.结果淋巴结微转移率为25.0%(14/56),食管癌淋巴结微转移与TNM分期(T1/T2、T3)统计学处理结果显著相关(P＜0.05),而与其它临床病理特点无显著相关性(P＞0.05).有淋巴结微转移患者的3年生存率为53.85%,无转移者3年生存率83.63%,两组相比较差别非常显著(x2=7.24,P＜0.05).单变量与多变量分析结果显示,肿瘤浸润深度和淋巴结微转移是独立的预后因素.结论细胞角蛋白19和粘蛋白1单抗免疫组化染色方法较常规组织学检查方法敏感性更高,提高了淋巴结微转移的检出率,可以用来诊断淋巴结微转移,对pN0食管癌预后评价有一定价值.     

Detection and significance of lymph node micro-metastases in patients with node-negative gastric carcinoma

Lymph node ndcrometastases refer to minute cancermetastases in lymph nodes whose diameter is less than 2nun,l'] and they are difficult to be observed with routinehistologic exndnation. In early years serial sectioningwas frequently used in detectingl lymph node ulnicrometastases. Since the 80's inununohistochemicaltechnique has been commonly employed, and recentlyreverse iran s criptas es -polymeras e chain reaction is al s oaPPlied in order to detect ndcrometastases.12--SJ Althoughall techn…     

Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

BACKGROUND: The authors evaluated the accuracy of sentinel lymph node biopsy in predicting lymph node status for patients with early cervical carcinoma. In particular, the authors set out to determine the false-negative rate associated with sentinel lymph node biopsy in this setting. METHODS: Twenty-nine consecutive patients with early cervical carcinoma who were treated with pelvic laparoscopic lymphadenectomy and radical surgery underwent sentinel lymph node biopsy following lymphatic mapping with patent blue dye. All sentinel and nonsentinel lymph nodes were evaluated for micrometastases via multilevel sectioning followed by immunohistochemical staining. RESULTS: At least one sentinel lymph node was identified for each patient. On routine pathologic evaluation, 3 patients (10%) were found to have positive lymph nodes. Among the remaining 26 patients, multilevel sectioning in conjunction with immunohistochemical analysis identified 5 patients (19%) who had micrometastases in the pelvic lymph nodes. Two of these five patients had micrometastases in a sentinel lymph node; however, the more notable finding was that the other three patients had micrometastases in nonsentinel pelvic lymph nodes despite having negative findings on sentinel lymph node biopsy. Thus, the negative predictive value of sentinel lymph node biopsy in the current study was 87.5%. CONCLUSIONS: Multilevel sectioning followed by cytokeratin immunohistochemistry may identify additional patients who have lymph node micrometastases; in the current study, this technique identified cases in which micrometastases were present in nonsentinel lymph nodes even when sentinel lymph nodes were found to be negative for disease on biopsy. This high false-negative rate associated with sentinel lymph node biopsy, raises questions regarding the validity of the sentinel lymph node concept in cervical carcinoma.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

Identification of occult micrometastases in patients with early gastric cancer using anti-cytokeratin monoclonal antibodies

The presence of occult micrometastases was evaluated in 1488 lymph nodes removed from 139 patients with node-negative early gastric cancer (EGC). Additional multiple levels of the lymph nodes were examined with haematoxylin-eosin staining and keratin immunostaining. Occult nodal micrometastases were detected in 24 patients (17%) in one or more lymph nodes dissected after a gastrectomy. The cases investigated were a small group from a total of 412 EGC patients who underwent surgical treatment in our hospital between 1976 and 1997; the mean follow-up period was 9 years (range 1-22). We found no significant differences between cytokeratin-negative and positive patients regarding the following clinicopathological parameters: age, gender, tumour size and site, macroscopic and microscopic type, depth of invasion and type of infiltration, according to Kodama's classification. The survival rate at 5 years was 88% and 87% for cytokeratin-negative and positive patients, respectively (log-rank = 0.6; ns). Our data suggest that occult micrometastases do not add useful information and immunohistochemical studies to detect them are probably unnecessary.     

Patterns of lateral pelvic lymph node metastases and micrometastases for patients with lower rectal cancer.

AIMS: We aimed at investigating the patterns of lymph node metastases and micrometastases in regions of lateral pelvic area, examining circumferential margin involvement and clarifying their prognostic significance. METHODS: Large tissue slice and tissue array were adopted in the study of 67 patients with AJCC stages I-III lower rectal cancer who underwent total mesorectal excision with systematic lateral pelvic dissection. The outcomes were followed. RESULTS: Altogether, 726 lateral lymph nodes were examined, with 32 and 38 were involved by tumor metastases and micrometastases, respectively. Fifty-eight (82.9%) of the involved lymph nodes were smaller than 5mm. Status of lateral nodes was related to that of mesorectal ones. Middle rectal root (45.5%), internal iliac (31.8%) and obturator (22.7%) regions were more likely to be involved by metastases. Patients with lateral metastases, similar to the group with micrometastases, suffered more recurrence and poorer survival when compared with the ones without metastases. The occurrence of circumferential margin involvement suggested poor prognosis and was related to lateral node status. CONCLUSIONS: In lateral pelvic area, the majority of lymph nodes harboring tumor were small and could easily be neglected by conventional examination. Incidence of lateral metastases differed among regions, thus more attention should be given to the clearance of the highly occurred areas. More extensive range of dissection and/or adjuvant therapy was recommended for patients with lateral node metastases, micrometastases and circumferential margin involvement, since they predisposed poor prognosis.     

cN0舌鳞癌颈淋巴结微转移检测及其临床意义

背景与目的:常规病理检查颈淋巴结阴性舌鳞状细胞癌(简称舌癌)术后出现颈部复发可能与微转移有关。本研究探讨临床颈部阴性(cN0)舌癌患者淋巴结微转移情况及其临床意义。方法:49例患者523枚颈淋巴结同时行常规HE染色和CK19免疫组化(IHC)染色,所有病例随访9～83(平均56)月。结果:HE染色检出5例患者7枚(1.3%)淋巴结转移;IHC染色检出19例34枚(6.5%)淋巴结转移,两种检测方法差异有统计学意义(P<0.05)。14例患者27枚(5.2%)淋巴结存在微转移。HE染色将3例cN0舌癌分期上升至pN1期,2例cN0上升至pN2b期;IHC染色将3例cN0舌癌分期上升至pN1期,16例cN0上升至pN2b期。淋巴结微转移与性别、年龄、T分期、分化程度和浸润深度无相关性(P>0.05)。有、无微转移患者5年生存率分别为78.5%和86.7%,两者之间差异无统计学意义(P>0.05)。结论:免疫组化染色可提高舌癌颈淋巴结转移的检出率和病理分期的准确性。本实验未能证明微转移与预后的关系,该问题仍有待进一步研究。     

RELATIONSHIP BETWEEN LYMPH NODE METASTASES IN ESOPHAGEAL CARCINOMA AND ITS PROGNOSIS

The prognosis of patients with respectable esophageal carcinoma still remains poor. The 5-year survival rates range from 20% to 36% after intentionally curative surgery[1-3]. Early metastatic relapse after complete resection of an apparently localized primary tumor indicates that micro- metastastic tumor cells spread at the time of surgery, undetected by current staging methods and by routine histopathology. The lymph node metastases play a pivotal role in patients with esophageal cancer. It i…