胃癌术前超声内镜评估TNM分期的临床研究

为了评估超声内镜在胃癌术前分期评估中的作用,83例胃癌患者均于术前行超声内镜检查,并将其内镜分期结果与术后病理学检查分期结果比较.超声内镜分期结果与病理学分期结果比较显示,各期准确率分别为T1期88.9%(8/9),T2期91.2%(21/23),T3期81.5%(31/38),T4期92.3%(12/13);淋巴结转移准确率为78.9%.超声内镜检查可有效进行术前分期,有助于制订合理的治疗方案.     

胃超声造影术前评估胃癌TNM分期47例

[目的]探讨胃超声造影在胃癌术前TNM分期中的应用价值。[方法]47例胃癌患者术前进行胃超声造影检查及TNM分期，并与术后病理作对照分析。[结果]胃超声造影诊断胃癌检出率为95．7％，T、N分期总符合率分别为70．0％和64．0％。对T1、T2、T3、T4期诊断符合率分别为50．0％、53.3％、77．8％、80．1％；对N分期诊断的符合率分别为N085．0％、N1 50．0％、N2 55．6％、N3 50．0％，对M1诊断符合率达80％。[结论]超声造影具有较高的胃癌临床分期符合率，可作为进展期胃癌术前常规筛查手段，但对于早期胃癌、胃大弯和胃底部病灶的TN分期符合率相对偏低。     

DcR3与肿瘤研究新进展

DcR3又称肿瘤坏死因子受体(TNFR)6B，是新近发现的TNFR超家族成员，它具有抗凋亡和细胞调节的生物学特性。DcR3与肿瘤的发生发展密切相关，可为肿瘤的诊断、治疗、疗效观察和预后判断提供一种新的思路。现综述DcR3的生物学特性及其在肿瘤方面的研究进展。     

DcR3与肿瘤研究新进展

DcR3又称肿瘤坏死因子受体(TNFR)6B,是新近发现的TNFR超家族成员,它具有抗凋亡和细胞调节的生物学特性.DcR3与肿瘤的发生发展密切相关,可为肿瘤的诊断、治疗、疗效观察和预后判断提供一种新的思路.现综述DcR3的生物学特性及其在肿瘤方面的研究进展.     

双期动态CT扫描和腹部B超对胃癌术前TNM分期的评价

目的 评价双期动态ＣＴ扫描和腹部Ｂ超以及两者相结合对胃癌术前分期的诊断价值。     

进展期胃癌术前CT分期的临床价值探讨

对 46例进展期胃癌在低张、充盈状态下 ,进行CT分期并与手术对照。 46例胃癌CT扫描准确率为 91.30 % ,对胃周围实质性器官浸润情况有较高敏感性 ;术中摘除淋巴结 67枚 (CT显示 5 6枚 ) ,病理证实转移淋巴结 49枚 (CT显示 41枚 ) ,CT诊断准确率 70 % ( 14 2 0 ) ,直径≤ 0 .5cm者准确率 5 0 % ,直径≥ 1.0cm者准确率 10 0 % ,漏误诊率为5 0 % ( 14 2 8)。N2 站淋巴结敏感性最低为 35 .71% ,N3、N4 站淋巴结敏感性较高 ,分别为 5 4.5 4%、85 .72 %。研究结果提示 ,进展期胃癌术前CT扫描分期对胃癌的手术治疗具有指导意义。     

MSCT双对比剂充盈对胃癌TNM分期的诊断价值

目的:探讨MSCT双对比剂充盈、三期增强结合三维重建在胃癌术前分期及评估中的应用价值.方法:对34例经胃镜活检证实的胃癌患者术前行MSCT平扫、三期动态增强扫描及三维重建扫描,再运用多平面重建、容积重建及CT仿真内窥镜等后处理技术,进行胃癌MSCT-TNM分期,并与手术病理分期结果相比较.结果:1)MSCT表现病灶厚度与手术病理的浆膜侵犯,淋巴结转移均相关(P<0.05);MSCT的强化特点与手术病理的淋巴结转移相关(P<0.05),与浆膜侵犯不相关.2)MSCT-TNM分期:MSCT对胃癌T、N、M分期的判断准确率分别为79.4%、75.6%和100%,其中对淋巴结转移的敏感性和特异性分别为73.9%和88.9%.MSCT对胃癌TNM临床分期判断的准确率为81.8%.结论:MSCT可在很大程度上提高微小病变的检出率,可对癌肿侵犯胃壁的深度、区域淋巴结转移情况、周围脏器浸润以及远处转移情况做出较为准确的判断,较准确的作出TNM分期.MSCT作为一种新型、无创、在体的评价手段,能较准确的对胃癌进行术前分期及评估,对指导临床治疗具有较大的临床应用价值.     

肺癌临床TNM分期与手术病理TNM分期的比较分析

背景与目的　肺癌临床TNM分期准确与否直接关系到患者的处理决策是否恰当。本研究旨 在探讨肺癌临床与手术病理TNM分期的一致性并分析其原因。方法　随机抽取我院2000年以来接受手术 治疗的肺癌患者150例,根据1997年新修订的国际肺癌分期标准分别进行临床和手术病理TNM分期,对两 种分期结果采用Kappa统计量进行一致性分析,同时比较T分期各亚组临床与手术病理分期的符合率。结 果　临床与手术病理T分期的一致性较为满意(Kappa值=0.729),但将病例分层分析后发现,临床T3、临床 T4组与手术病理结果的符合率明显低于临床T1和临床T2组(P<0.01)。临床与手术病理N分期的一致性 不够理想(Kappa值=0.108),两种TNM分期的一致程度也随之降低(Kappa值=0.287)。结论　目前基于 CT的肺癌临床T分期能较为真实地反映肿瘤的部位、大小,但是当原发灶靠近胸壁或者纵隔时,其边界不易 确定,部分临床T4病例仍可获得完全性切除。临床与手术病理N分期的一致程度不够理想,寻找更可靠的 术前诊断淋巴结转移的技术是提高肺癌临床TNM分期准确性的关键。     

DcR3在消化系统肿瘤细胞中的表达

目的：研究诱骗受体3（decoy receptor3，DcR3）在消化系统肿瘤细胞中的表达差异，阐明其与消化系统肿瘤的相关性。方法：体外培养结肠癌细胞（sw480）、胃癌细胞（SGC7901）、肝癌细胞（HepG2）和人成纤维细胞（3T3），采用RT-PCR法检测DcR3 mRNA的表达水平；应用Western印迹法检测DcR3蛋白的表达水平。结果：SW480细胞的DcR3mRNA和蛋白表达水平均高于SGC7901、HepG2和3T3细胞的表达水平，差异有统计学意义（P〈0．05）。结论：DcR3在结肠癌细胞中的高表达可能与结肠癌的发生、发展有关。     

AJCC第7版与第6版胃癌TNM分期的比较:一项基于预后分析的918例中国胃癌人群的回顾性研究

目的:本研究旨在评价美国癌症联合会(American Joint Committee on Cancer,AJCC)第7版胃癌TNM分期系统在判断预后方面是否优于AJCC第6版胃癌TNM分期系统.方法:对2003年1月-2008年12月单一中心的918例胃癌患者分别采用AJCC第6版和第7版胃癌TNM分期系统进行重新分期,采用单因素和多因素分析评价这2种胃癌TNM分期系统在判断预后中的价值.采用Akaike信息标准(Akaike's Information Criterion,AIC)评价这2个分期系统的优劣.结果:AJCC第7版胃癌TNM分期系统中,T、N和M分期亚组的总生存时间差异有统计学意义.对患者进行Ⅰ～Ⅳ期临床分期,则无论是按照AJCC胃癌TNM分期系统第6版还是第7版,Ⅰ～Ⅳ期这4条生存曲线的差异均有统计学意义(P值均为0.000);按照AJCC第7版胃癌TNM分期系统的8个亚分期,ⅠA期和ⅠB期、ⅠB期和Ⅱ A期、Ⅱ B期和Ⅲ A期、Ⅲ A期和Ⅲ B期以及Ⅲ B期和Ⅲ C期的生存曲线差异均无统计学意义(P=0.643、P=0.267、P=0.534、P=0.124、P=0.174).AJCC第7版胃癌TNM分期系统的AIC值小于第6版.结论:AJCC第7版胃癌TNM分期系统在预测预后价值方面要优于第6版,但前者的优势十分有限,且存在一定缺陷.     

诱捕受体3在胃癌中的表达及其临床意义

目的探讨诱捕受体3（DcR3）基因在胃癌组织中的表达及其与胃癌临床病理特征之间的关系。方法采用PT—PCR方法检测41例胃癌组织和41例癌旁正常组织中DcR3的表达，分析其与多种临床病理特征之间的关系。结果41例胃癌组织中DcR3阳性表达率为56％（23／41）。41例癌旁正常胃组织中发现3例DcR3的阳性表达。癌组织DcR3mRNA的表达水平明显高于正常胃黏膜组织（P〈0．01）。DcR3的表达与胃癌的分化程度（X）、淋巴结转移（X2）及TNM分期（X3）显著相关，与患者肿瘤部位及浸润深度等无相关性（P〉0．10）。其多元化线性回归方程为Y=0．432—0．208X1＋0．098X2＋0．086X3。结论DcR3在胃癌组织中具有较高的表达率，其异常表达可促进胃癌的发生、发展。DcR3的基因检测可作为判断胃癌分化、浸润、转移、分期的重要参考指标。     

Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma

BACKGROUND: The lymph node (N) classification in the International Union Against Cancer (UICC) TNM staging system for gastric adenocarcinoma has been revised. The new classification is based on the number of positive regional lymph nodes instead of the anatomic location of the regional lymph node metastasis. Both classification systems were compared for prognostic significance. METHODS: A total of 4362 gastric carcinoma patients who underwent resection between 1969 and 1990 were analyzed. RESULTS: Thirteen percent of patients could not be staged according to the new system. Based on the previous classification, 647 patients were classified as pN1 and 711 patients as pN2. When reclassified, 587 patients remained pN1, 54 patients became pN2, and 6 patients became pN3. Of the 711 pN2 patients, 333 became pN1, 267 remained pN2, and 111 patients became pN3. Both lymph node classification methods defined groups with widely differing prognoses. The prognoses of patients classified as new pN2 were more homogeneous than those of the group classified as old pN2. Survival of new pT4/pN1 patients was significantly better than that of other subgroups in Stage IV. Nine potential prognostic factors, including lymph node metastasis, were studied in multivariate analysis. The hazard ratios were 1.38 (1.16-1.64) for pN1 and 2.55 (2.16-3.01) for pN2, based on the old classification. They were 1.51 (1.29-78) for pN1, 3.11 (2.56-3.78) for pN2, and 3.88 (2.98-5.05) for pN3, based on the new classification. CONCLUSIONS: The new N classification is superior as a prognostic factor to the old N classification, although there is inadequacy in stage grouping. [See editorial on pages 1763-5, this issue.] Copyright 2000 American Cancer Society.     

Correlation between MR imaging-derived nasopharyngeal carcinoma tumor volume and TNM system

PURPOSE: To measure nasopharyngeal carcinoma tumor volume based on magnetic resonance images using a validated semiautomated measurement methodology and correlate tumor volume with TNM T classification. METHODS AND MATERIALS: The study population consisted of 206 consecutive nasopharyngeal carcinoma patients who had magnetic resonance imaging staging scans. Tumor volume was measured using a semisupervised knowledge-based fuzzy clustering algorithm. Patients were divided into 4 groups according to TNM T classification. The difference in tumor volumes among the various TNM T-classification groups was examined. RESULTS: The mean tumor volume in each T-classification group is as follows: T1, 8.6 mL +/- 5.0 (standard deviation [SD]); T2, 18.1 mL +/- 8.1 (SD); T3, 25.8 mL +/- 14.1 (SD); and T4, 36.2 mL +/- 18.9 (SD). The mean tumor volume increased significantly with advancing T classification (p < 0.0001). Tumor volume in a more advanced T group was significantly larger than that in an adjacent early T group (p < 0.01). CONCLUSION: Validated magnetic resonance imaging-based tumor volume shows positive correlation between tumor volume and advancing T-classification groups. It may be possible to incorporate tumor volume as an additional prognostic factor into the existing TNM system.     

胃癌UICC第6与第7版TNM分期对预后预测的对比分析

目的:探讨胃癌第7版UICC分期对判断预后的价值.方法:选择行胃癌根治术、临床病理及随访资料完整的360例胃癌患者为研究对象,按UICC第6版和第7版分别进行TNM分期,Kaplan-Meier生存曲线分析各期5年生存率.结果:360例患者的5年生存率为61.8％,中位生存时间为64.4个月(95％CI:60.6～68.2).第7版Ⅰ、Ⅱ和Ⅲ期患者的5年生存率分别为95.4％、80.1％和37.4％;ⅡA和ⅡB期分别为81.9％和78.9％,ⅢA、ⅢB和ⅢC期分别为59.3％、46.1％和11.7％.与第6版比较,Ⅲ期各亚组间5年生存率差异有统计学意义,P=0.000.结论:第7版TNM分期更注重肿瘤局部浸润深度和淋巴结转移数目对胃癌预后的影响,所以分析预后更精确;同时分期的调整更符合临床实践的预后判断信息,量化复发风险,可指导不同亚期的患者进行个体化综合治疗.     

Primary carcinoma of the gallbladder: TNM staging and prognosis

In order to investigate the lethality of carcinoma of the gallbladder and several of the coexisting features, a retrospective analysis of 53 patients with this disease was undertaken. Abdominal pain, obstructive jaundice, and a right upper quandrant mass were present in approximately one-half of the patients. Laboratory and radiological data were frequently nonspecific and did little to identify the diagnosis. The most common preoperative diagnoses were cholelithiasis or chronic cholecystitis. Cholecystectomy was the most frequently performed procedure. Fifteen wedge liver resections were performed. No radical or extended liver resections were done. Eighty-one percent of the patients had sufficient data for staging. Five patients (11.6%) had stage I lesions, three patients (7.0%) had stage II lesions, while 17 (39.5%) and 18 (41.9%) patients had stage III and IV lesions, respectively. Mean survival was 6.4 months for the entire group. Three patients are still alive (two longer than 5 years and one at 2 years) for an overall survival of 5.7%. Both staging and grading of the tumor correlated well with patient survival. Those patients with stage I lesions survived significantly longer (23 months vs. 3 months) than those with stage IV tumors. Also, those with more favorably graded (well-differentiated) neoplasms lived an average of 13 months longer than patients with poorly differentiated lesions.     

Classification of gastric carcinoma using the Goseki system provides prognostic information additional to TNM staging.

BACKGROUND: Due to the high variability of the epidemiology, genetics, morphology, and biologic behavior of gastric carcinoma, many classification systems are in use, e.g., the World Health Organization (WHO) classification; tumor differentiation; the criteria of Ming, Mulligan, and Laurén; and the recently introduced Goseki classification. In the authors' opinion, the TNM staging is the most valuable classification system, with a prognostic value for survival. METHODS: To assess the reproducibility and usefulness of these systems in clinical practice, material from 285 gastric carcinoma patients entered in the Dutch Gastric Cancer Trial was analyzed by a panel of 5 experienced gastrointestinal pathologists. The presence of eosinophilic and lymphocytic infiltrates was analyzed in addition to the TNM staging. RESULTS: Of the analyzed classification systems, only TNM stage, tumor differentiation, eosinophilic infiltrate, and the Goseki system contained information associated with the survival of patients with gastric carcinoma. The reproducibility was perfect for tumor differentiation (Kappa 1.00), nearly perfect for the WHO and Goseki classifications (Kappa 0.86 and 0.87, respectively), reasonably good for Laurén and lymphocytic infiltrate (Kappa 0.70), and reasonably good for eosinophilic infiltrate (Kappa 0.42). CONCLUSIONS: Of all these systems, the Goseki classification was the only system with prognostic value that is additional to TNM staging.     

Comparison of TNM staging systems for nasopharyngeal carcinoma,and proposal of a new staging system

Background:

There are few systematic evaluations regarding the sixth and seventh editions of the UICC/AJCC TNM Staging System (TNM6th, TNM7th) and Chinese 2008 Staging System (TNMc2008) for nasopharyngeal carcinoma (NPC).

Methods:

We classified 2333 patients into intensity-modulated radiotherapy (IMRT) cohort (n=941) and conventional radiotherapy (CRT) cohort (n=1392). Tumour staging defined by TNM6th, TNM7th and TNMc2008 was compared based on Akaike information criterion (AIC) and Harrell''s concordance index (c-index).

Results:

For T-classification, TNM6th (AIC=2585.367; c-index=0.6390385) had superior prognostic value to TNM7th (AIC=2593.242; c-index=0.6226889) and TNMc2008 (AIC=2593.998; c-index=0.6237146) in the IMRT cohort, whereas TNMc2008 was superior (AIC=5999.054; c-index=0.623547) in the CRT cohort. For N-classification, TNMc2008 had the highest prognostic value in both cohorts (AIC=2577.726, c-index=0.6297874; AIC=5956.339, c-index=0.6533576). Similar results were obtained when patients were stratified by chemotherapy types, age and gender. Using staging models in the IMRT cohort, we failed to identify better stage migrations than TNM6th T-classification and TNMc2008 N-classification. We therefore proposed to combine these categories; resultantly, stage groups of the proposed staging system showed superior prognostic value over TNM6th, TNM7th and TNMc2008.

Conclusion:

TNM6th T-classification and TNMc2008 N-classification have superior prognostic value in the IMRT era. By combining them with slight modifications, TNM criteria can be unified and its prognostic value be improved.