叉头转录蛋白P1在胃黏膜相关淋巴样组织淋巴瘤中的表达及意义

目的 探讨胃黏膜相关淋巴样组织淋巴瘤中叉头转录蛋白P1的表达水平与组织学形态的相关性及其对预后的影响.方法 对43例胃黏膜淋巴组织样淋巴瘤进行组织形态学观察,分析叉头转录蛋白Pl和核因子kB(NF-KB)表达与临床病理因素及预后的关系.结果 胃黏膜相关淋巴样组织淋巴瘤中叉头转录蛋白Pl阳性表达率为44%(19/43),其中强阳性7例,中度阳性12例.单形组叉头转录蛋白P1阳性4例,多形组15例,两组之间比较差异有统计学意义(15%比88%,P＜0.01).术后复发病例均为叉头转录蛋白P1强阳性者,与叉头转录蛋白P1阳性表达率密切相关(P＜0.05),且NF-KB与叉头转录蛋白P1阳性表达率密切相关(P＜0.01).多形组的中位生存时间(26个月)明显短于单形组(123个月)(P＜0.01),叉头转录蛋白P1阴性者中位生存时间显著长于核表达中度及核表达强者(115个月比55个月比12个月)(P＜0.05),NF-KB核阳性者的中位生存时间明显短于阴性者(26比131个月)(P＜0.01).Ⅰ期及Ⅱ期的中位生存时间(98个月及121个月)显著长于ⅡE+Ⅳ期病例(33个月)(P＜0.01).多因素COX回归分析显示,叉头转录蛋白P1表达水平和临床分期为胃黏膜相关淋巴样组织淋巴瘤预后的风险因素.结论 叉头转录蛋白Pl有可能成为判定胃黏膜相关淋巴样组织淋巴瘤恶性转化及预后的一个指标.     

Prognostic significance of clinical and angiogenesis-related factors in low-grade oligodendrogliomas

BACKGROUND: Keeping in mind that oligodendrogliomas have unpredictable biological behavior, the aim of this study is to investigate the prognostic significance of VEGF expression and microvessel density in a homogeneous series of low-grade oligodendrogliomas. METHODS: For this study 36 patients with a low-grade oligodendroglioma treated by surgical resection and radiotherapy were selected. At the time of surgery, in all cases the Karnofsky Performance Scale (KPS) score was more than 70, and the study of the resected tumor disclosed a Ki-67/MIB-1 labeling index (MBI-1 LI) less than 1%. In this homogeneous series, immunohistochemical studies were performed using monoclonal antibodies against VEGF in order to study the expression of this cytokine, and against vascular endothelial CD-34 antigen, in order to identify microvessels. RESULTS: Our results show that in contrast to low-grade astrocytomas, low-grade oligodendrogliomas lacked immunoreactive VEGF. Oligodendrogliomas with low vascular density (less than 20 microvessels per microscopical field, at 200 x) or high vascular density (more than 100 microvessels per field, at 200 x) were identified, but this factor had no influence on the survival rate of patients. On the other hand, analysis of the present series showed that clinical factors, such as age or extent of surgical resection, were not significantly associated with survival. CONCLUSIONS: In contrast to low-grade astrocytomas, the angiogenesis score of low-grade oligodendrogliomas (counting the number of microvessels in tumor tissue) adds little information to help predict tumor behavior.     

Prognostic factors for gastric cancer influencing clinical practice

Despite a slow decline in the incidence of gastric cancer over the last 90 years, we can still expect to see over 100,000 patients die of this disease each decade in England and Wales. The 5-year survival rate has not improved during this century, which is largely due to the stage at diagnosis being unchanged. There are a number of prognostic determinants in gastric cancer which have clinical relevance. Age is an important determinant; patients under 40 years commonly have more advanced diffuse lesions than older patients so that a higher index of suspicion needs to be maintained in younger patients with persistent symptoms. Conflicting reports make it unclear whether the duration of symptoms bears any relationship to tumor stage, but there is some evidence that actively shortening the symptom duration by early investigation can have a beneficial effect in the proportion of patients diagnosed with early cancers. The site of the tumor is important; unfortunately, the proportion of patients with cardia lesions is increasing and this has had the effect of reducing the overall survival. Tumor size should not play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is the most important prognostic determinant and efforts to increase the proportion of stage I cancers presenting for surgery can be shown to alter the natural history of the disease, by diagnosing it when it is still surgically curable.

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Resumen El cáncer gástrico es responsable de alrededor de 10,000 muertes por año en Inglaterra y Gales y la rata global de sobrevida a 5 años se ha mantenido estática alrededor del 5% en el curso de los últimos 50 años. A pesar de la pobre tasa global de sobrevida, existe un número de factores que tiene influencia en el resultado a largo plazo luego de tratamiento en los pacientes con cáncer del estómago. Esta bien establecido que el estadío del tumor es el más importante factor de pronóstico y que la razón para la no mejoría en la tasa de sobrevida es que la mayoría de los pacientes se presenta en los estados III o IV de la enfermedad; precisamente ésta es un área donde los avances en el diagnóstico precoz pueden resultar en una mejor sobrevida global. En esta revisión se discuten los diversos determinantes principales de pronóstico que tienen relevancia clínica en el cáncer gástrico.

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Résumé Malgré une diminution lente de l'incidence du cancer gastrique des 90 dernières années, 100000 patients vont mourir de cette maladie chaque décennie en Angleterre et au pays de Galles. La survie à 5 ans ne s'est pas beaucoup amélioré au cours de ce siècle, essentiellement parce que le stade au moment du diagnostic n'est pas modifié. II existe bon nombre de facteurs pronostiques cliniquement significatifs. L'âge est un facteur important car les lésions sont fréquemment plus avancées chez le patient de moins de 40 ans si bien qu'il faut avoir une forte suspicion devant un patient jeune chez lequel les symptômes persistent. Il n'est pas clairement établi d'après la littérature que la durée des symptômes soit corrélée au stade tumoral, mais il est évident que le raccouricissement de la période des symptômes par une mise en ocuvre des investigations peut amener à faire un diagnostic rapide et à traiter une plus grande proportion de patients à un stade précoce de la maladie. Le site des lésions est également important: actuellement, l'augmentation de la proportion des cancers du cardia est responsable d'une réduction de la survie globale. La taille de la lésion ne devrait pas intervenir dans la décision de résection car la plupart des études ne montrent pas de rapport entre la taille de la lésion et le stade. Le stade de la tumeur, par contre, est le facteur pronostique le plus important car il est démontré que les efforts pour augmenter la proportion des patients avec une maladie au stade I, stade chirurgicalement curable, modifient l'histoire naturelle de ces tumeurs.

     

Prognostic significance of the histopathologic recognition of low- and high-grade components in stage I-II B-cell gastric lymphomas

The prognostic value of histopathologic features was assessed in 83 patients with stage I-II gastric B-cell lymphomas (PGL). The following histotypes were considered: low-grade mucosa-associated lymphoid tissue (MALT)-type lymphoma (LGML; n = 35), diffuse large B-cell lymphoma with areas of MALT-type lymphoma (DLCLML; n = 20) and diffuse large B-cell lymphoma without areas of MALT-type lymphoma (DLCL; n = 28). Low-grade (LG) and high-grade (HG) components, lymphoepithelial lesions (LEL), size of cells giving rise to LEL, and amount and growth pattern of large cells (LC) were analyzed. Five-year cause-specific survival (CSS) for patients with LGML, DLCLML, and DLCL were 94%, 84%, and 64%, respectively (p = 0.05). LG component or LEL were associated with a significantly longer 5-year CSS, whereas the presence of an HG component, defined as clustered LC greater than 10% of neoplastic population, was significantly related to a shorter survival. Lymphomas with LC disposed in clusters were associated with a worse survival in comparison with cases with scattered LC. The presence of scattered LC 5%-10% appeared irrelevant in LGML. When analysis was limited to DLCLML/ DLCL patients, the presence of LG component or LEL was associated with a significantly longer 5-year CSS, whereas the existence of LEL formed by LC (HG LEL) did not modify survival. Multivariate analysis, adjusted by the main prognostic factors, confirmed the independent and significant association between histopathologic categorization and survival. Age, stage, lactate dehydrogenase (LDH) ratio, thrombocytopenia, and use of chemotherapy had independent prognostic value. In conclusion, histopathologic categorization is an independent prognosticator in PGL. The formation of compact clusters by LC, rather than their amount, is a true prognostic variable. The presence of scattered LC 5%-10% appears irrelevant in LGML. LG component and LEL are favorable predictors in HG lymphomas, helping to identify two subsets of DLCL with different prognosis.     

Prognostic factors in gastric stump carcinoma

OBJECTIVE: To compare prognostic results in patients with gastric stump cancer (GSC) versus those with primary gastric cancer (PGC). SUMMARY BACKGROUND DATA: Gastric stump carcinomas have often been described as having low resectability rates and a poor prognosis. METHODS: Results of surgical treatment of 50 patients with GSC were compared with that of 516 patients with PGC. RESULTS: The resectability rate was 94% for GSC patients and 96.5% for PGC patients, without significant differences in terms of postoperative complications, death rate, and median survival time (31.6 vs. 32.9 months). The multivariate analysis showed an independent prognostic effect for R0 resection, pT1 and pT2 category, and age older than 65 years. CONCLUSION: The prognosis after resection and adequate lymphadenectomy does not differ between patients with GSC and PGC.     

影响胃癌预后因素的研究进展

影响胃癌预后的因素即临床一般因素和病理因素包括性别、年龄、肿瘤部位、肿瘤大小、大体类型、组织学类型、浸润深度、淋巴结转移及其转移率、阴性淋巴结数、远处转移、TNM分期和脉管浸润。笔者就以上影响胃癌预后因素的研究进展作一综述。

     

胃癌组织IFITM1表达与临床及预后价值的探讨

目的 探讨胃癌组织中干扰素诱导跨膜蛋白-1(IFITM1)的表达在胃癌侵袭转移过程中的作用及预测胃癌患者预后的价值.方法 采用免疫组化方法检测68例胃癌组织和27例距癌组织5cm以上胃大部切除黏膜组织中IFITM1的表达情况.同时评估IFITM1表达与临床病理因素(年龄、性别、Lauren's分型、肿瘤分化程度、肿瘤浸润深度、淋巴结转移和临床分期)之间的关系.用Kaplan-Meier法及单因素和多因素分析来评估胃癌患者术后生存率.结果 胃癌组织中IFITM1阳性表达率为85.3%(58/68),与距癌组织5cm以上胃大部切除黏膜组织中的表达阳性率(22.2%)比较,差异有统计学意义(P<0.01).IFITM1阳性表达率与Lauren's分型(P=0.026)、肿瘤分化程度(P=0.033)、淋巴结转移(P=0.001)、肿瘤浸润深度等因素(P=0.041)有关.IFITM1阳性表达率与年龄、性别、肿瘤大小和临床分期无显著性相关.胃癌患者的生存分析显示,IFITM1阴性组,低表达组和高表达组生存率之间差异有统计学意义(P=0.011).结论 IFITM1高表达与胃癌的浸润和转移密切相关,可以作为预测胃癌预后的一个生物学指标.     

The histological expression of prostate-specific antigen and its clinical significance in patients with prostate cancer]

A total of 58 cases with prostatic diseases including benign hypertrophy (BPH) (n = 10) and adenocarcinoma (n = 48) were studied as to prostate-specific antigen (PA) with indirect enzyme immunohistochemistry. The expression of PA in the prostate, as well as the localization of PA in the tissue, was also studied in regard to cell differentiations, clinical stages, serum PA levels, with or without endocrine therapy, and prognosis of prostate cancer. Strong staining of PA was noted in epithelial cells of the gland, particularly on the ductal cavity, except for patients in the poorly differentiated carcinoma group. The overall positive rate for expression of PA was 100% in BPH and 73% (35/48) in prostate cancer. When prostate cancer was classified by cell differentiation, the positive rate was 100% (17/17) in the patients with well, 83% (10/12) moderately, and 42% (8/19) poorly differentiated carcinoma. When divided by clinical stages, the positive rate was 100% (1/1 and 9/9) in stages A and B each, 69% (9/13) in stage C, and 65% (17/26) in stage D. Of 33 cases whose serum PA values were determined, the histochemistry was positive in 67% of 12 patients with normal serum PA levels and in 86% of 21 in the elevated group. The prior to endocrine therapy group showed the presence of PA in 22 of 27 cases (82%) and a positive rate of 62% (13/21) was observed in the group during the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic factors in bronchopulmonary neoplasms]

The paper aims to illustrate the current state of knowledge regarding the prognostic factors of lung cancer. The disappointing results obtained using therapeutic modes (an overall 5-year survival rate of 15%), together with the considerable variability of the natural history of lung cancer, should be attributed to a group of prognostic factors, of varying importance, which can be subdivided into three categories: those concerning the characteristics of cancer, those inherent to the patient's conditions and those related to the type of operation. The paper underlines that histotype, TNM staging, the assessment of the nuclear degree and ploidy class play a correct and real prognostic role, and that only surgical treatment, if indicated, can offer a real life expectancy (40% 5-year survival rate in operated patients).     

Prognostic factors in breast cancer]

Among the various factors reported as having significant prognostic value in primary breast cancers, the author discusses the value of well established "classical" prognostic factors used routinely and "new" prognostic factors developed over recent years as a result of progress in cell and molecular biology. The presence of axillary lymph node metastases remains the most important prognostic factor of recurrence, justifying post-surgical adjuvant therapy. However, in patients with negative axillary nodes (N-), the size of the tumour, Scarff-Bloom-Richardson (SBR and MSBR) histological grade, certain particular histological types (carcinoma in situ and tubular, colloid or pure papillary cancer) and hormone receptors (ER and PR) appear to be well established prognostic factors allowing the identification, within this group of N- patients who generally have a good prognosis, those patients with a low risk of recurrence and therefore not requiring adjuvant therapy. In contrast, the proliferative activity (ploidy and S phase, Thymidine Labeling Index, antibody Ki67), cathepsin D, thymidine kinase, EGF receptors, several genes including oncogene HER-2/neu, are recently developed prognostic factors whose significance needs to be confirmed by further studies.     

Survivin转录变异体在胃癌组织中的表达及其与预后的关系

目的研究survivin各转录变异体在胃癌组织中的表达情况及与其预后的关系。方法采用实时荧光定量RT-PCR技术,对77例胃恶性肿瘤患者的肿瘤组织、正常胃黏膜的成对标本进行mRNA定量检测。结果在检测患者肿瘤组织中野生型survivin、survivin-2B与survivin-△Ex3的表达量均显著高于其对应正常胃黏膜组织中的表达量(P<0.01)。在胃癌组织中,survivin的表达率为100%(77/77),survivin-2B的表达率为79.8%(61/77),survivin-△Ex3的表达率为64.9%(50/77)。survivin高表达组患者的生存率明显低于低表达组(P<0.01)。结论Survivin的3个转录变异体中,野生型survivin对胃癌患者预后具有重要的评估价值。     

Prognostic significance of alarm symptoms in patients with gastric cancer

BACKGROUND: The aim of this study was to determine the incidence and spectrum of alarm symptoms in patients with newly diagnosed gastric cancer, and to examine the relationship between symptoms and outcome. METHODS: Three hundred consecutive patients with gastric adenocarcinoma were studied prospectively. The outcomes of 40 patients (13.3 per cent) without alarm symptoms (21 men; median age 69 years) were compared with those of the 260 patients (86.7 per cent) with alarm symptoms (175 men; median age 72 years). RESULTS: It was possible to perform an R0 gastrectomy more often in patients without alarm symptoms (21 patients; 52 per cent) than in those with alarm symptoms (71 patients; 27.3 per cent) (chi(2) = 10.35, 1 d.f., P = 0.001). The cumulative survival rate at 5 years was 38 per cent for patients without alarm symptoms versus 15.0 per cent for those with alarm symptoms (chi(2) = 10.18, 1 d.f., P = 0.001). In a multivariate analysis, distant metastasis (hazard ratio (HR) 2.73 (95 per cent confidence interval (c.i.) 2.04 to 3.66); P < 0.001), overall stage of cancer (HR 1.83 (95 per cent c.i. 1.53 to 2.19); P < 0.001) and persistent vomiting at diagnosis (HR 1.66 (95 per cent c.i. 1.26 to 2.18); P < 0.001) were independently associated with length of survival. CONCLUSION: Alarm symptoms are absent in a significant minority of patients with gastric cancer at diagnosis; these patients stand a better chance of curative surgery and long-term survival than those with alarm symptoms.     

Heterotopic ossification in Dupuytren's disease: clinical and histological significance

We report the case of an 82-year-old man who underwent fasciectomy for a severe Dupuytren's contracture, during which an ossified lesion was encountered within the contracture and surrounding the neurovascular bundle. The abnormal tissue was removed with difficulty and heterotopic ossification was confirmed histologically. We believe this is the first report of heterotopic ossification in Dupuytren's disease.     

肿瘤大小对T3期胃癌患者预后的影响

目的探讨肿瘤大小对T3期胃癌患者预后的影响。方法对408例L期胃癌患者施行胃癌D2根治术,应用Cox比例风险模型对肿瘤大小进行最佳截点的筛选。对全组T3期胃癌患者的预后因素进行单因素及多因素分析：并对大直径组及小直径组胃癌患者的预后因素进行多因素分析。结果本组408例T3期胃癌患者通过Cox比例风险模型筛选出肿瘤大小的最佳截点为8cm。肿瘤大于或等于8cm的胃癌患者（大直径组）85例．小于8cm的胃癌患者（小直径组）323例：大直径组和小直径组术后5年生存率分别为33．8％和52．2％,差异有统计学意义（P〈0．05）。通过Cox比例风险模型分析显示,肿瘤大小、淋巴结转移、Boi Tmann分型和肿瘤部位是影响全组患者预后的独立因素（均P〈0．01）：进一步按肿瘤大小进行分层预后分析显示,Borrmann分型和淋巴结转移是影响大直径组患者预后的独立因素（均P〈0．05）;淋巴结转移是影响小直径组患者预后的独立因素（P〈0．01）。结论以8cm为界值进行B期胃癌患者的预后判断准确性最高。肿瘤大小是影响B期胃癌患者预后的独立因素。