淋巴结转移率在淋巴结转移乳腺癌患者预后中的作用

[目的]评价淋巴结转移率指标预测乳腺癌患者预后的意义.[方法]回顾性分析2004年1月至2010年12月期间149例淋巴结转移乳腺癌患者的临床资料.随访时间为12～60个月.数据分析采用SPSS 16.0软件,生存曲线采用Kaplan-Meier法,并采用Log-rank检验.[结果] 149例患者手术中检出淋巴结数共计3 230枚,平均21.68±6.54枚.经病理学检查证实每例患者转移淋巴结数平均4.50±5.39枚.总的淋巴结转移率为20.7％(670/3230).以淋巴结转移率(LNR)=0.25为界,LNR＜0.25患者的3年生存率为95.7％,而LNR≥0.25患者的3年生存率为87.2％,两组差异有统计学意义(x2=4.441,P=0.035).[结论]LNR能较准确预测淋巴结转移乳腺癌患者的预后.LNR可作为一种潜在的乳腺癌预后指标.     

淋巴结转移率在T3期胃癌预后中的临床意义（附347例）

目的:探讨T3期胃癌患者淋巴结转移率的影响因素及淋巴结转移率对于预后生存的临床意义。方法:回顾性分析2007年1月至2010年12月期间哈尔滨医科大学肿瘤医院347例接受手术治疗的T3期胃癌患者的临床病理资料,通过χ2检验分析淋巴结转移率与相关临床病理因素之间的关系;Logistic回归分析淋巴结转移率的影响因素;利用Kaplan-Meier法绘制生存曲线图以及Log-rank检验比较不同组间患者生存率的差异;采用Cox比例风险回归模型对患者预后进行分析。结果:与淋巴结转移率≤28.66%组相比,淋巴结转移率>28.66%组患者肿瘤病理分型较差［93.3%(127/136) vs 76.8%(162/211),P=0.000］,肿瘤位于全胃的比例较高［12.5%(17/136) vs 3.8%(8/211),P=0.002］,肿瘤直径较大［49.3%(67/136) vs 27.5%(58/211),P=0.000］,血清CEA浓度较高［33.1%(45/136) vs 22.7%(48/211),P=0.034］,远处器官发生转移的几率较大［11.0%(15/136) vs 2.4%(5/211),P=0.001］。Logistic回归分析表明:肿瘤位置(全胃)、肿瘤直径(>6.1 cm)、病理分化类型(分化较差)、血清CEA水平(>5 ng/ml)、血清白蛋白浓度(≤40 g/L)是导致淋巴结转移率较高的危险因素(均P<0.05)。随访期间内有233例(67.1%)患者因肿瘤进展死亡;术后5年生存率为33.1%。单因素分析表明:年龄≤60岁、根治性手术、肿瘤单发、淋巴结转移率≤28.66%、M0、肿瘤直径≤6.1 cm、血清CA19-9≤37 U/ml的T3期胃癌患者预后较好(均P<0.05),而淋巴结的清扫数目并不影响患者的预后生存(P=0.089);多因素分析显示:年龄［HR(95%CI):1.487(1.139~1.941),P=0.004］、手术［HR(95%CI):1.741(1.205~2.515),P=0.003］、淋巴结转移率［HR(95%CI):3.053(2.293~4.065),P=0.000］、是否发生远处转移［HR(95%CI):1.766(1.043~2.991),P=0.034］是T3期胃癌患者的预后独立危险因素。结论:淋巴结转移率是影响T3期胃癌患者预后的独立危险因素,而肿瘤位置、病理分化类型、肿瘤直径、血清CEA浓度、远处器官发生转移是淋巴结转移率的影响因素。因此,对于T3期的胃癌患者,术前可以通过相关血液、影像检查,对患者的淋巴结转移率及预后进行准确而有效的评估。     

T3期胃癌行胃癌根治术淋巴结清扫数目与预后的关系

目的 探讨T3期胃癌行胃癌根治术淋巴结清扫数目与预后的关系.方法 回顾性分析2000年1月～2005年1月在我院接受胃癌根治术的426例T3期胃癌患者的临床资料,比较根治术不同淋巴结清扫数目组别问生存率的差异.结果 426例患者中,无淋巴结转移者154例,其中清扫淋巴结数超出25枚的患者1、3、5年生存率分别为95.8%、87.6%和83.5%,清扫淋巴结数20～25枚者1、3、5年生存率分别为96.7%、86.5%和80.1%,清扫淋巴结数15～19枚者1、3、5年生存率分别为96.3%、83.2%和69.3%;有淋巴结转移者272例,其中清扫淋巴结数目超过25枚的患者1、3、5年生存率分别为87.1%、67.1%和54.7%,清扫淋巴结数20～25枚者1、3、5年生存率分别为85.6%、63.5%和50.2%,清扫淋巴结数15～19枚者1、3、5年生存率分别为86.5%、61.2%和38.4%.清扫淋巴结数20～25枚组与25枚以上组相比,无论有无淋巴结转移,生存率差异均无统计学意义(P>0.05),而与清扫淋巴结数15-19枚组比较,无沦有无淋巴结转移,5年生存率差异均有统计学意义(P<0.05).结论 T3期胃癌行胃癌根治术淋巴结清扫数目应达20枚以上.     

淋巴结转移率为基础的TRM分期在胃癌预后中的价值

  目的  探讨淋巴结转移率（RML）为基础的TRM分期在胃癌预后中价值。  方法  采用Cox回归进行多因素生存分析,通过比较-2log likelihood值和hazard ratio（HR）值,比较TRM分期和TNM分期在胃癌预后评价中的差异。  结果  单因素分析显示年龄,肿瘤大小,肿瘤部位,大体分型,分化类型,肿瘤浸润深度（UICC T分期）,淋巴结转移数目分期（UICC N分期）,淋巴结转移率（RML）分期,TNM分期和TRM分期与胃癌预后相关;相同TRM分期中不同TNM分期预后差异无统计学意义,而TNM分期ⅢB和ⅢC期中不同TRM分期预后差异有统计学意义。Cox多因素分析显示TRM分期与TNM分期相比,HR值较高而-2log likelihood值较小。  结论  TRM分期较TNM分期能更好的预测胃癌患者的预后。      

胃癌淋巴结转移与预后的关系

目的:探讨胃癌淋巴结转移与预后的关系,为胃癌的手术治疗提供依据.方法: 回顾性分析2000年-2004年间住院并行手术治疗的胃癌患者361例,建立数据库用SPSS13.0统计软件分析.结果: Logistic多因素回归分析显示胃癌肿瘤大小、浸润深度与淋巴结转移有关(P<0.01);Kaplan-Meier生存分析显示淋巴结转移与胃癌预后相关(P<0.05);而在相同浸润深度时,淋巴结转移与胃癌预后无关(P>0.05).结论: 对于浸润深度相同,而淋巴结转移程度不同的胃癌,积极手术治疗能取得同样的治疗效果.     

胃癌淋巴结转移与预后的关系

目的：探讨胃癌淋巴结转移与预后的关系,为胃癌的手术治疗提供依据。方法：回顾性分析2000年-2004年间住院并行手术治疗的胃癌患者361例,建立数据库用SPSS13．0统计软件分析。结果：Logistic多因素回归分析显示胃癌肿瘤大小、浸润深度与淋巴结转移有关（P〈0．01）;Kaplan—Meier生存分析显示淋巴结转移与胃癌预后相关（P〈0．05）;而在相同浸润深度时,淋巴结转移与胃癌预后无关（P〉0．05）。结论：对于浸润深度相同,而淋巴结转移程度不同的胃癌,积极手术治疗能取得同样的治疗效果。     

不同分子分型乳腺癌患者预后与淋巴结转移率的相关性分析

[摘要] 目的: 探讨不同分子分型乳腺癌患者预后与Ⅱ、Ⅲ期乳腺癌淋巴结转移率的相关性。方法: 回顾性分析2011 年1 月至2016 年1 月在南京医科大学附属常州第二人民医院311 例确诊为Ⅱ、Ⅲ期乳腺癌并首选手术治疗的乳腺癌患者的临床资料,依据雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（HER2）和Ki-67 增殖指数分为Luminal A型、Luminal B 型、HER2 过表达型和三阴型（TNBC）4 型。通过卡方检验分析不同分组间患者的临床特征;通过Kaplan-Meier 生存曲线评估腋淋巴结转移率（LNR）对各型乳腺癌患者预后的影响,以及相同LNR的不同分子分型的乳腺癌预后的差异,通过Spearman 相关分析LNR与Ki-67 增殖指数的相关性。结果: 不同分子分型在患者年龄、绝经情况、肿瘤大小、淋巴结状态及转移部位等临床特征差异无统计学意义（均P>0.05）。LNR为0 或>0.65 的4 组分子分型的无病生存时间（DFS）差异无统计学意义（χ2=3.581、2.808,均P>0.05）,LNR介于0.01~0.65 的4 组分子分型的DFS差异有统计学意义（χ2=24.366、8.169,均P<0.05）。LNR与Ki-67 增殖指数呈正相关（r=0.125,P<0.05）。多因素Cox 回归分析显示,乳腺癌患者预后与分子分型（RR=1.179,95%CI=1.023~1.358;χ2=5.165,P<0.05）、LNR（RR=1.137,95%CI=0.985~0.999;χ2=5.589,P<0.05）及Ki-67 增殖指数（RR=0.992,95%CI=1.022~1.264;χ2=5.623,P<0.05）有关。结论: LNR是Ⅱ、Ⅲ期乳腺癌预后的重要影响因素,相同LNR的不同分子分型预后差异显著,LNR与Ki-67 增殖指数呈正相关。     

淋巴结转移率对胃癌D2根治术患者的预后分析

摘 要：［目的］ 探讨淋巴结转移比例（MLR）对胃癌D2根治术患者的预后价值。［方法］ 回顾性分析行D2胃癌根治术89例患者的临床和随访资料。以MLR>20%为界,分为高比率组与低比率组,比较这两组患者临床病理特点及预后的差别。并从准确性、均一性2个方面分别比较MLR分期与pN分期的预后价值。［结果］ MLR低比率组患者较高比率组患者的组织分化好且T分期、N分期、TNM分期早。MLR低比率组术后1、3年总生存率分别为87.2%、68.6%,高比率组术后1、3年总体生存率分别为25.6%、20.4%（P<0.001）。不同pN分期及不同MLR分期患者3年累积生存率（3-YCSR）的差异均有统计学意义（P<0.001）;进一步经多因素预后分析显示,pN分期和MLR分期均可作为独立预后因素（P均<0.001）。ROC曲线显示,MLR分期预测结果所对应的曲线下面积大于pN分期,但差异无统计学意义。同一pN分期中不同MLR组间3-YCSR的差异无统计学意义（P>0.05）。［结论］ 胃癌D2根治术后患者MLR受病理类型、T分期、N分期、TNM分期影响,MLR高比率是胃癌D2根治术患者预后不良的重要因素之一;MLR与pN是预测胃癌生存的独立因素,MLR分期评估胃癌预后的准确性、均一性与pN分期相当。     

淋巴结微转移与胃癌预后的关系

目的 分析淋巴结微转移对胃癌预后的影响.方法 对30例胃癌患者共850枚淋巴结采用CK-20 mRNA RT-PCR扩增检测转移.结果 14例(46.7%)患者共77枚(12.5%)淋巴结检出微转移,其中7例TNM分期提高:IB期→Ⅱ期、IB期→ⅢA期、Ⅱ期→ⅢA期、ⅢA期→ⅢB期、ⅢA期→Ⅳ期各1例ⅢB→Ⅳ2例.HE染色法的重新分期率为23.3%(7/30).淋巴结微转移与Lauren分型、浸润深度有关(P<0.05).Kaplan-Meier生存分析显示,淋巴结微转移阳性患者中位生存期为(18.00+7.48)月,明显短于淋巴结微转移阴性者的(22.86+3.17)月两者差异有统计学意义(P<0.05).结论 胃癌淋巴结微转移检测有助于更准确地进行临床病理分期,淋巴结微转移阳性者预后较差.     

淋巴结转移率与乳腺癌预后关系的研究进展

乳腺癌是女性最为常见也是目前治疗效果最好的癌症之一。肿瘤大小、组织学分级、淋巴结转移数（positive lymph node，PLN）、激素受体状态等是评价乳腺癌患者预后的常用指标，其中以PLN最为重要。     

Prognostic Significance of the Number of Negative Lymph Nodes in Postoperative Locally Advanced Gastric Cancer Patients

OBJECTIVE To evaluate the impact of the number of negative lymph nodes on disease free survival (DFS) in patients with locally advanced gastric cancer.METHODS A total of 485 patients who underwent surgery for locally advanced gastric cancer (pT3N0-2M0) and had a DFS at least 6 months were enrolled in this retrospective study. The medical records of the patients were reviewed in detail, and the characteristics of the patients and the findings of pathologic examination were analyzed in order to find the potential association with DFS. Subgroup analysis according to pathologic stage was performed. Multivariate analysis using the COX regression method was also conducted in order to identify the independent prognostic factors. The Kaplan-Meier method was used to plot DFS curves. The DFS rate was compared in each subgroup.RESULTS COX regression analysis showed that the DFS rate of gastric cancer patients with pathologic stage T3N0-2M0 was significantly associated with age, degree of tumor differentiation, tumor location as well as the number of negative lymph nodes. Among patients with stage T3N0M0 disease, who had 1-4 and 5 or more negative lymph nodes, the 2-year DFS rate was 8.3% and 55.6%, respectively. Meanwhile, the 3-year DFS rates of the same group of patients was 0% and 24.9%, respectively (P = 0.025). In the T3N1M0 subgroup, the 2-year DFS rate of patients with 3 or fewer, 4-9, and 10 or more negative lymph nodes was 17.3%, 39.1%, 52.6%, respectively. The 3-year DFS rate in this group was 4.2%, 6.0%, 17.1%, respectively (P < 0.001). In the T3N2M0 subgroup, the 2-year DFS rate of patients with 7 or fewer and 8 or more negative lymph nodes was 11.5% and 35%, respectively. The 3-year DFS rate of the same group of patients with 8 or more negative lymph nodes was also significantly improved (0.8% vs. 5%, respectively; P = 0.015).CONCLUSION For gastric cancer patients with pathologic stage T3N0-2M0, the number of negative lymph nodes is an independent prognostic factor for DFS. The number of negative lymph nodes may reflect the level of regional lymph node dissection or the accuracy of the pathologic staging.     

Lymph Node Ratio Assessment of Brain Metastasis in EarlyBreast Cancer Cases

Background: Ten to 30% of early breast cancer (EBC) patients develop brain metastasis (BM) during theirfollow-up. In this study, we aimed to evaluate importance of the lymph node ratio (LNR) in development ofBM in EBC cases. Materials and Methods: Ninety patients whom had axillary metastases in lymph nodes attheir initial diagnosis and developed BM during 5-year follow-up were detected in 950 EBC patients. LNRvalues were calculated for all patients and after categorization into 4 molecular sub-types as luminal A, luminalB HER-2 (+), HER-2 overexpressing and basal- like. Comparison was with control group patients who hadsimilar characteristics. Results: In the comparison of all molecular sub-types of LNR, 54.9% and 28.4% valueswere found in patients with and without BM respectively (p<0.001). In the comparison of the LNR with controlgroups, a statistically significant differences were found with luminal A with BM (p=0.001), luminal B HER-2(p=0.001), HER-2 overexpressing (p=0.027) and basal-like groups (p<0.001). In the evaluation of patients withBM, the highest ratio was found in the basal-like group (67.9%) and there was a statistically significant differencebetween this group and the others (p=0.048). Conclusions: EBC patients developing BM within 5 years followuphad significantly higher LNRs for all molecular sub-types, especially in the basal-like group. Larger scalestudies are now needed for evaluating LNR prognostic importance for EBC regarding BM development.     

Prognostic Factors in First-Line Chemotherapy Treated Metastatic Gastric Cancer Patients: A Retrospective Study

Background: The majority of patients with gastric cancer in developing countries present with advanceddisease. Systemic chemotherapy therefore has limited impact on overall survival. Patients eligible for chemotherapyshould be selected carefully. The aim of this study was to analyze prognostic factors for survival in advancedgastric cancer patients undergoing first-line palliative chemotherapy. Methods: We retrospectively reviewed107 locally advanced or metastatic gastric cancer patients who were treated with docetaxel and cisplatin plusfluorouracil (DCF) as first-line treatment between June 2007 and August 2011. Twenty-eight potential prognosticvariables were chosen for univariate and multivariate analyses. Results: Among the 28 variables of univariateanalysis, nine variables were identified to have prognostic significance: performance status, histology, locationof primary tumor, lung metastasis, peritoneum metastasis, ascites, hemoglobin, albumin, weight loss and bonemetastasis. Multivariate analysis by Cox proportional hazard model, including nine prognostic significancefactors evident in univariate analysis, revealed weight loss, histology, peritoneum metastasis, ascites and serumhemoglobin level to be independent variables. Conclusion: Performance status, weight loss, histology, peritoneummetastasis, ascites and serum hemoglobin level were identified as important prognostic factors in advancedgastric cancer patients. These findings may facilitate pretreatment prediction of survival and can be used forselecting patients for treatment.     

胃癌前哨淋巴结定位及活检技术

目的：确定胃癌前哨淋巴结定位及活检技术的可行性及其预测各期胃癌淋巴结转移情况的准确性。方法：使用专利蓝染料，对45例胃癌病人进行术中及术后前哨淋巴结定位和活检。结果：在44例（97．78％）中找到前哨淋巴结。有15例前哨淋巴结存在转移，其中10例非前哨淋巴结亦存在转移。5例前哨淋巴结为胃周淋巴结的唯一转移部位。有29例前哨淋巴结无转移，其中4例非前哨淋巴结存在转移。由前哨淋巴结状态预测胃周淋巴结转移情况的敏感性为78．95％，特异性为100％，准确率为90．91％。随着肿瘤增大，浸润程度加深，其特异性不变，但准确率下降。结论：胃癌前哨淋巴结定位及活检技术是可行的，对于早期胃癌，前哨淋巴结的组织学状态可以准确反映胃周其余淋巴结的状况。将来治疗淋巴结转移阴性的胃癌中，这一技术有可能免除常规的淋巴结清扫。     

乳腺癌前哨淋巴结微转移检测在根治术中的应用价值

目的：通过对腑淋巴结阴性乳腺癌行前哨淋巴结（sentinel lymph node,SLN）活检,可推测全腋窝淋巴结受累状况。对常规病理检查阴性的SLN再行连续切片检查,则能更准则查明微转移的有无,以更可靠地评价该项技术作为设计治疗依据的价值。方法：对本组52例采用染料法（1％PatentBlueV）检出SLN,并对阴性的SLN再行连续切片,检查有无常规病理检查未能发现的微转移。结果：52例中检出SLN44例（84．6％）,检出率与肿瘤部位（P＜0．01）相关。常规病理检查是SLN（＋）13例,SLN（－）31例,此31例中有“跳跃转移”2例。总诊断符合率95．5％,假阴性率13．3％。对31例阴性SLN行连续切片测微转移,在无“跳跃转移”的29例中又检出3例阳性,假阴性率降至11．1％。结论：SLN活检对评估全腑淋巴结受累状态有一定价值,可作为选择术式及术后治疗方案的参考。本组常规病理假阴性率为13．3％,与大多数研究结果相符,此为影响该项技术应用于临床的主要障碍。本研究采用连续切片出常规法难以发现的微转移,减少了假阴性。若再结合免疫组化及RT－PCR技术,将能进一步提高SLN勘测技术的可靠性。     

Prognostic Value of Subcarinal Lymph Node Metastasis in Patients with Esophageal Squamous Cell Carcinoma

Purpose: The 7th edition of the American Joint Committee on Cancer Staging Manual for esophagealcancer (EC) categorizes N stage according to the number of metastatic lymph nodes (LNs), irrespective ofthe site. The aim of this study was to determine the prognostic value of subcarinal LN metastasis in patientsundergoing esophagectomy for esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysisof 507 consecutive patients with ESCC was conducted. Potential clinicopathological factors that could influencesubcarinal LN metastasis were statistically analyzed. Univariate and multivariate analyses were also performedto evaluate the prognostic parameters for survival. Results: The frequency of subcarinal LN metastasis was22.9% (116/507). Logistic regression analysis showed that tumor length (>3cm vs ≤3cm; P=0.027), tumor location(lower vs upper/middle; P=0.009), vessel involvement (Yes vs No; P=0.001) and depth of invasion (T3-4a vsT1-2; P=0.012) were associated with 2.085-, 1.810-, 2.535- and 2.201- fold increases, respectively, for risk ofsubcarinal LN metastasis. Multivariate analyses showed that differentiation (poor vs well/moderate; P=0.001),subcarinal LN metastasis (yes vs no; P=0.033), depth of invasion (T3-4a vs T1-2; P=0.014) and N staging (N1-3vs N0; P=0.001) were independent prognostic factors. In addition, patients with subcarinal LN metastasis had asignificantly lower 5-year cumulative survival rate than those without (26.7% vs 60.9%; P<0.001). Conclusions:Subcarinal LN metastasis is a predictive factor for long-term survival in patients with ESCC.     

胃癌前哨淋巴结的检测及其临床意义

目的 研究亚甲蓝术中定位胃癌前哨淋巴结的可行性.方法 使用亚甲蓝对50例胃癌患者行术中前哨淋巴结定位及术中、术后活检.结果 在50例中有49例（98%）找到前哨淋巴结.有15例前哨淋巴结存在转移,其中9例非前哨淋巴结也存在转移,6例前哨淋巴结为胃周淋巴结惟一转移部位.有34例前哨淋巴结无转移,其中8例非前哨淋巴结存在转移.结论 使用亚甲蓝术中定位胃癌前哨淋巴结是确实可行的.在早期胃癌前哨淋巴结能准确预测胃癌淋巴结转移情况,有可能达到对没有淋巴结转移的胃癌患者,使其避免不必要的扩大性淋巴结清扫.     

淋巴结转移度对食管癌患者预后的影响

目的：探讨食管癌患者标准淋巴结清扫术后淋巴结转移度对预后的影响。方法:回顾性分析食管癌患者临床病理因素和随访资料,通过Kaplan-Meier曲线和Cox多因素回归模型分析来评估这些因素与生存期的关系。结果:245例手术患者共切除淋巴结1 758个,病理学报告112例患者共有220个淋巴结发生转移,总体转移率为45.71%,淋巴结转移度为0.13。单因素分析结果显示肿瘤残留状态、淋巴结状态和淋巴结转移度对患者5年生存率差异存在统计学意义(P<0.05）。在排除混杂因素的影响后,Cox多因素回归分析显示组织学类型、肿瘤残留状态、浸润深度、淋巴结状态和淋巴结转移度均可作为影响患者预后的独立危险因素(P<0.05）。结论:食管癌手术采用标准的淋巴结清扫术,淋巴结转移的个数不能明确影响pN1患者的预后,而淋巴结转移度对患者的预后有较强的敏感度,具有一定的参考价值。