大肠癌淋巴结转移的风险因素与预后分析

CXCR2与人体免疫关系密切,多项研究表明CXCR2及其配体在结肠癌、乳腺癌、肝癌、肾细胞癌、黑色素瘤、胰腺癌、卵巢癌等多种肿瘤细胞中呈高表达,在促进肿瘤生长、转移、血管生成等肿瘤进展过程中发挥重要作用。CXCR2在多种肿瘤的诊断以及预后的判断上具有重要价值。包括CXCR2拮抗剂SB225002在内的多种趋化因子拮抗剂在多项研究中都表现出了抑制血管生成及抑制肿瘤细胞生长、转移等作用。文章对CXCR2及其配体在肿瘤进展中的作用进行综述,为肿瘤的靶向治疗提供新的思路。     

淋巴结转移阴性大肠癌的临床病理特点及预后分析

目的探讨常规病理检查淋巴结转移阴性(pN0)大肠癌患者的预后因素。方法回顾性分析57例pN0大肠癌患者的临床病理特点及其与预后的关系。结果淋巴结转移阴性大肠癌浸润深度较浅、很少浸透浆膜,限局型、高分化腺癌较多;术后5年生存率为83.1%。结论淋巴结转移阴性大肠癌施行根治术后预后较好,浸润深度和大体类型是其独立预后因素。     

Relation Between Tumor Size and Lymph Node Metastasis According to Subtypes of Breast Cancer

PurposeTumor size and lymph node metastasis are important factors that contribute to the progression of breast cancer. We aimed to analyze the relationship between tumor size and lymph node metastasis molecular subtype and examine the effects of nodal metastasis on overall survival (OS).MethodsWe retrospectively reviewed the data of 16,552 patients who underwent breast surgery in Samsung Medical Center between 2000 and 2015. Information on tumor size (largest diameter of the invasive component), number of positive lymph nodes, and molecular subtype were obtained. We constructed a linear regression model to evaluate the relationship between tumor size and lymph node metastasis. To determine the effect of nodal metastasis on OS, we performed a Cox proportional regression analysis with Np/T (number of metastatic lymph nodes [n]/tumor size [cm]).ResultsThis study included 12,007 patients with a median follow-up of 62 months. The linear regression coefficients were 1.043 for luminal A, 1.024 for luminal B, 0.656 for HER2, and 0.435 for triple-negative breast cancer (TNBC) subtypes. No significant difference was observed in the coefficients between the luminal A and B subtypes (p = 0.797), while all other coefficients showed significant difference. After adjusting for other risk factors, the hazard ratio (HR) of Np/T for each subtype was significant for OS: luminal A (HR, 1.134; 95% confidence interval [CI], 1.097–1.171; p < 0.001), luminal B (HR, 1.049; 95% CI, 1.013–1.086; p = 0.007), HER2 (HR, 1.069; 95% CI, 1.014–1.126; p = 0.013), and TNBC (HR, 1.038; 95% CI, 1.01–1.067; p = 0.008).ConclusionThe incidence of lymph node metastasis differed according to molecular subtype. Luminal types have higher incidence of nodal metastasis than HER2 and TNBC. The HR of Np/T was highest in luminal A subtypes and lowest in TNBC subtypes.     

C-erbB-2在乳腺癌中表达及与淋巴结转移的关系

目的 探讨C-erbB-2在乳腺癌中的表达及与淋巴结转移的关系。方法 用免疫组织化学ABC法检测48例乳腺癌和10例乳腺良性疾病组织中C-erbB-2的表达。结果 1O例乳腺良性疾病有1例表达阳性(10.00％),而48例乳腺癌中有32例表达阳性(66.67％)。C-erbB-2的表达与淋巴结转移与否无明显相关性,而与肿瘤病理组织类型显著相关。结论 C-erbB-2过表达在乳腺癌发生发展中起一定作用,并可作为判断乳腺癌生物行为的一个有用指标。     

直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素分析

摘 要：［目的］ 探讨直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素。［方法］ 60例直肠NET患者进行手术治疗,其中行肠镜下电灼术3例,行经肛根治术15例,行经肛局部切除术41例,另1例肝转移患者行姑息性直肠病灶切除术。分析患者淋巴结转移情况及其预后的影响因素。［结果］ 直肠NET的淋巴结转移受肿瘤G分级、T分期以及肿瘤大小影响（P＜0.01）。多因素分析显示T分期为影响淋巴结转移的独立因素（OR=45.997,95%CI：4.032~526.128,P=0.001）。肿瘤G分级、T分期、N分期、M分期以及肿瘤大小均与直肠NET患者的预后相关（P＜0.05）,M分期是直肠NET患者预后的独立影响因素（OR=2.895,95%CI：1.482~3.528,P＜0.001）。［结论］ NET的淋巴结转移情况与T分期密切相关,预后受肿瘤的M分期影响。     

肿瘤位置等临床病理特征与分化型甲状腺癌淋巴结转移的关系

目的 探讨肿瘤位置、体积及甲状腺被膜浸润情况等临床病理特征与分化型甲状腺癌颈淋巴结转移的关系。方法 回顾性分析2010年7月至2013年7月四川省肿瘤医院头颈外科收治的初次手术治疗的248例患者临床及病理资料。结果 肿块位置、最大直径、数量、浸出腺体外膜及受累腺叶数等特征对Ⅵ区和Ⅱ~Ⅴ区淋巴结状态均有影响;低龄与Ⅵ区淋巴结转移有关。肿块位于下极时,Ⅵ区阳转率最高达74.29%,Ⅱ~Ⅴ区仅45.00%,而当肿块位于上极时Ⅵ区为58.33%,Ⅱ~Ⅴ区却高达84.21%。肿块直径＞1 cm和2 cm分别为中央区和颈侧区阳转率上升的临界值。结论 肿块位于下极、直径>1 cm、多发、多叶受累、浸出被膜、低龄这些特征可作为中央区淋巴结转移的高危因素;而肿块处于上极、直径＞2 cm、多发、多叶受累、浸出被膜等特征可能为颈侧区淋巴结转移的高危因素;应当尤其注意肿块位置与不同区域淋巴结状态的关系以及肿块体积作为区域淋巴结转移的高危因素时其临界值可能不同。     

PET/CT对cT1-2N0M0期乳腺癌腋窝淋巴结转移的诊断价值

目的探讨PET/CT检查对cT1-2N0M0期乳腺癌腋窝淋巴结转移情况的诊断价值。方法 40例cT1-2N0M0乳腺癌患者,在PET检查医师和患者双盲的情况下行PET/CT检查,以术后病理检查结果为金标准,对PET检查的漏诊率、误诊率、灵敏度、特异度等指标进行分析。结果 40例乳腺癌患者腋窝淋巴结转移误诊率为18.18%,漏诊率为27.78%,灵敏度为78.26%,特异度为76.47%;PET/CT对腋窝淋巴结定性诊断的灵敏度和特异性优于单纯CT检查（P〈0.05）。结论 PET/CT检查对乳腺癌腋窝淋巴结转移定性诊断的误诊率低,特异性较好;可为术式选择和腋窝淋巴结清扫术的取舍提供参考。对于不愿接受腋窝前哨淋巴结活检的患者,先行PET/CT检查是比较理想的选择。     

结肠癌淋巴结转移的风险基因及列线图预测模型的构建

目的 寻找结肠癌淋巴结转移的相关风险基因,并构建由基因组成的列线图（nomogram）预测模型。 方法 从TCGA和GEO数据库下载基因测序数据,利用差异分析和LASSO回归方法筛选基因。利用赤池信息准则确定最优的nomogram模型,ROC曲线、校准曲线及拟合优度检验评估模型预测的准确性,决策曲线分析评估临床应用价值。 结果 通过筛选得到11个有效预测结肠癌淋巴结转移的基因。由年龄、病理T分期、TH、CDH4、PNMA6A、TNNC1、KIR2DL4、STUM、SFTA2构成的nomogram模型具有最小的AIC值（440.4）。内部评估模型AUC值为0.800,外部验证AUC值为0.664,校准度及拟合优度均较佳。临床决策曲线分析法评估基于nomogram模型的风险判断可以带来临床获益。结论 共筛选出11个结肠癌淋巴结转移的风险基因。构建的nomogram预测模型的一致性和区分度良好,可帮助评估患者淋巴结转移状态。     

术前使用列线图预测胃癌患者淋巴结转移

摘 要：［目的］ 拟构建列线图预测术前胃癌淋巴结转移情况。［方法］ 回顾性分析接受胃癌根治术患者170例,按照病理结果将患者分为淋巴结转移组110例和无淋巴结转移组60例。采用Logistic回归分析筛选出胃癌淋巴结转移的独立危险因素,建立预测模型,并用1 000个bootstrap样本进行校正以减少过拟合偏差。［结果］ 通过单因素和多因素Logistic回归分析,显示与胃癌淋巴结转移相关的因素有CA72-4、PLR、CT影像学T分期、N分期,结合这4个因素构建的列线图在预测胃癌淋巴结转移风险方面表现出良好的准确性,C统计量为 0.87（95% CI：0.81～0.93）,内部验证校正后的C统计量为0.86,具有良好的拟合校准曲线。当列线图评分≥110分的胃癌患者高度怀疑有淋巴结转移。［结论］ 列线图提供了较准确的胃癌患者术前淋巴结转移预测。     

LCN2 Promoter Methylation Status as Novel Predictive Marker for Microvessel Density and Aggressive Tumor Phenotype in Breast Cancer Patients

LCN2 (Lipocalin 2) is a 25 KD secreted acute phase protein, reported to be a novel regulator of angiogenesis inbreast cancer. Up regulation of LCN2 had been observed in multiple cancers including breast cancer, pancreaticcancer and ovarian cancer. However, the role of LCN2 promoter methylation in the formation of microvesselsis poorly understood. The aim of this study was to analyze the association of LCN 2 promoter methylation withmicrovessel formation and tumor cell proliferation in breast cancer patients. The LCN2 promoter methylationstatus was studied in 64 breast cancer tumors by methylation specific PCR (MSP). Evaluation of microvesseldensity (MVD) and Ki67 cell proliferation index was achieved by immunohistochemical staining using CD34and MIB-1 antibodies, respectively. LCN2 promoter unmethylation status was observed in 43 (67.2%) of breastcancer patients whereas LCN2 methylation status was seen in 21 (32.8%). Further, LCN2 promoter unmethylationstatus was associated with aggressive tumor phenotype and elevated mean MVD in breast cancer patients.     

肺癌淋巴结转移标志物研究进展

肺癌转移是众多患者预后欠佳的基本原因,在肺癌治疗过程中存在局部及远处转移是很常见的临床问题.相当数量的肺癌患者死于转移的相关并发症[1,2].因此可以准确评价肺癌转移的因子是很重要的.而淋巴结作为转移的常见位置,决定着肺癌的分期和预后,目前有许多种研究检测出多种因子与肺癌淋巴结转移很关.以分子生物学方法 检测肺癌淋巴结转移主要分为以下两类,一类为检测肿瘤特异性基因改变,另一类为检测肺癌起源组织的特异性蛋白类标记物,可以在不含此类物质的淋巴结或血液中检测出而对肿瘤的转移做出预示,此文将分别综述如下.     

胃癌原发灶和淋巴结转移灶HER2表达的临床意义

目的 观察HER2在胃癌原发灶和淋巴结转移灶中的表达及其临床意义.方法 选取胃癌患者140例,其中淋巴结转移94例.采集胃癌患者的原发灶、淋巴结转移灶及癌旁组织,采用免疫组织化学法(Elivision)方法检测3种组织中HER2蛋白表达情况.结果 140例胃癌原发灶组织中HER2蛋白阳性表达与胃癌TNM分期、浸润深度及淋巴结转移有关(P<0.05),而与患者性别、年龄和分化程度无关(P>0.05),癌旁组织中HER2表达与性别、年龄、分化程度、TNM分期、浸润深度及淋巴结转移均无关(P>0.05);HER2蛋白在胃癌原发灶、淋巴结转移灶中表达水平均高于癌旁组织,差异有统计学意义,而94例淋巴结转移灶和对应的胃癌原发灶中HER2表达的差异无统计学意义;94例有淋巴结转移的患者淋巴结转移灶与原发灶HER2表达一致率为89.4%,两类标本HER2表达状态具有一致性(Z=6.386,P<0.001).结论 胃癌HER2蛋白的阳性表达与胃癌TNM分期、浸润深度及淋巴结转移有关,提示HER2的表达与胃癌的浸润转移有关;胃癌原发灶和淋巴结转移灶HER2的表达具有较好的一致性,患者在不能获取原发病灶的情况下,检测转移灶中HER-2可能为靶向治疗的选择提供依据,为晚期胃癌患者带来希望.     

Primary Tumor Location Is a Useful Predictor for Lymph Node Metastasis and Prognosis in Lung Adenocarcinoma

Introduction

We examined the value of tumor location in predicting the clinicopathologic features, survival, and metastases of pulmonary adenocarcinoma.

High Expression of Claudin-1 Protein in Papillary Thyroid Tumor and its Regional Lymph Node Metastasis

Claudins, known as major contributors in the formation of the tight junction, are differentially expressed in malignant tumors as compared to the corresponding healthy tissues. Therefore, they are thought to play a role in carcinogenesis and tumor progression. Altered expression of claudin-1 has been reported in several tumor types including endometrial, papillary renal cell and colonic carcinoma, and increased claudin-1 mRNA levels have been observed in papillary thyroid carcinoma (PTC). In this study, we aimed at determining the pattern of claudin-1 expression in various types of thyroid lesions at the protein level and investigating the immunolocalization of β-catenin reported to regulate claudin-1 expression. Samples included 19 PTCs, ten cases of corresponding regional lymph node metastasis, eight papillary microcarcinomas (PMC), 17 follicular thyroid carcinomas (FTC) and 19 follicular adenomas (FA). All cases were evaluated by quantitative immunohistochemistry. Conspicuous claudin-1 immunostaining was detected in the majority of PTC/PMC primary tumors and lymph node metastases (19/27 and 9/10, respectively). On the other hand, we found weak or no claudin-1 expression in any of the FA and FTC cases or peritumoral non-malignant thyroid tissues. Our data prove that high claudin-1 protein expression is specific for PTC and its regional lymph node metastases, while we failed to verify that claudin-1 is regulated by β-catenin in thyroid tumors. Based on these results, claudin-1 may be a useful tumor marker for PTC.     

T1期非小细胞肺癌纵隔淋巴结转移规律及清扫方式研究进展

肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer,NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。     

大肠癌中nm23-H1的表达与淋巴结转移的关系

 目的　探讨大肠癌中nm23-H1的表达与淋巴转移的关系。方法　应用免疫组化方法研究96例大肠癌中nm23-H1蛋白的表达。结果　nm23-H1蛋白低表达与淋巴结或远处转移显著相关(P<0.05);nm23-H1蛋白低表达预测大肠癌转移的灵敏性为88.4%,特异性为79.3%。结论　检测nm23-H1蛋白可以预测大肠癌淋巴结或远处转移,从而可能成为临床治疗的判断依据。