残胃癌的淋巴结转移规律与外科治疗特点

回顾近年文献，综述残胃癌淋巴结转移规律及其合理的根治术式，认为残胃癌的淋巴结清除范围应为：（1）B－I式重建残胃癌切除范围为1、2、3、4sa、4sb、7、8a、9、10、11组淋巴结，必要时清除第12、14、13、8p淋巴结；（2）B－Ⅱ式重建残胃癌切除范围为胃肠吻合口附近口侧及肛侧空肠各10cm，同时清除空肠系膜淋巴结；（3）食管受累有望根治性切除病例应开胸并清除第19、20、111、110及108组淋巴结。残胃癌施行治愈性切除可获得较高生存率。     

残胃癌及残胃再发癌再手术及淋巴结转移的临床分析

我院外科自１９８３年－１９９４年收治残胃癌、残胃再发癌４９例，其中残胃癌２０例，残胃再发癌２９例，残胃癌切除率为７０％，残胃再发癌为３７．９％，总切除率为５１％。首次术式ＢⅡ式切除率为７８．６％，ＢⅠ式为６０％，ＢⅡ式较ＢⅠ式切除率有明显差异，残胃再发癌首次手术未淋巴结清扫者，淋巴结转移组明显增加，阳性率在２３％以上，术式的选择及早期诊断对再次切除成功率极为重要。     

远端胃癌淋巴结转移规律及临床意义*

目的：探讨远端胃癌各组淋巴结转移的特点,指导远端胃癌根治手术中淋巴结清扫的范围。方法：回顾性分析2010年2 月至2014年9 月天津医科大学肿瘤医院远端胃癌患者773 例接受D 2（D 2 +）胃次全切除术的临床病理资料,分析其淋巴结转移特点。结果：773 例远端胃癌患者术后病理证实淋巴结转移为423 例（54.72%）,各组淋巴结中发生转移的患者所占比例由高至低依次为NO.6、NO.3、NO.4sb 、NO.5 组淋巴结。N 1 淋巴结转移率由高至低依次为NO.3、NO.6、NO.5、NO.4d 组淋巴结;N 2 淋巴结转移率由高至低依次为NO.8a 、NO.7、NO.1 组淋巴结。50.68% 的患者出现NO.8a 组淋巴结跳跃性转移。结论：远端胃癌根治性手术应注意NO.8a 淋巴结转移的可能性,必要时应适当扩大淋巴结的清扫范围。     

残胃癌及残胃再发癌再手术及淋巴结转移的临床分析

我院外科自1983年～1994年收治残胃癌、残胃再发癌49例．其中残胃癌20例，残胃再发癌29倒．死胃癌切除率为70％（14／20），残胃再发癌为37．9％（11／29），总切除率为51％．首次术式BI式切除率为78.6％，BI式为60％，BI式较BI式切除率有明显差异P<0.01，残胃再发癌首次手术未淋巴结清扫者，淋巴结转移组明显增加，阳性率在23％以上．术式的选择及早期诊断对再次切除成功率极为重要。     

胃癌淋巴结转移规律的临床研究

目的：探讨胃癌淋巴结转移规律和胃癌根治术的淋巴结清扫范围。方法：将采集不同部位的淋巴结,依据国际TNM分期标准和组站分类法,全部数据进行统计学处理。结果：本组胃癌淋巴结转移率67．3％,早期和进展期胃癌转移率分别为14．3％和79．8％。肿瘤浸润深度T1者,淋巴结转移主要局限于N1,T2者淋巴结转移N3者5．4％,T3者淋巴结转移N3的9．5％。结论：胃癌淋巴结转移通常从原发病灶开始,通过淋巴网沿着淋巴管由近及远地向外扩散,肿瘤的大小或浸润深度不同,淋巴结转移的差异性有显著意义（P＜0．01）。     

淋巴结转移阴性胃癌的临床病理特点及预后多因素分析

目的：探讨淋巴结转移阴性胃癌的临床病理特点及其预后因素，为临床治疗提供依据：方法：以本院1980～1990年间施行胃癌根治手术，检取10个以上淋巴结均无转移者104例为研究对象，总结临床病理特点；采用Kaplan—Meier法进行单因素分析，COX比例风险模型进行多因素分析，判定淋巴结转移阴性胃癌的独立预后因素。结果：淋巴结转移阴性胃癌浸润深度较浅，其中近29．8％为早期胃癌(31／104)。5年生存率为76．0％(79／104)。结论：淋巴结转移阴性胃癌施行根治术后预后较好，浸润深度是其独立预后因素。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的：探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义。方法：收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系。结果：103例患者胃癌淋巴结转移率为68.9%（71/103）。随着肿瘤直径的增加,淋巴结转移率（度）也增高（P〈0.05）;临床分期中,胃癌的淋巴结转移率（度）随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率（度）均低于其它期（P〈0.01）;Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%（40/49）,高于其它型（P〈0.05）,而Ⅳ型患者淋巴结转移度32.4%（161/497）最高。结论：淋巴结转移率和转移度随着胃癌的临床进展而增高。合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的:探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义.方法:收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系.结果:103例患者胃癌淋巴结转移率为68.9%(71/103).随着肿瘤直径的增加,淋巴结转移率(度)也增高(P<0.05);临床分期中,胃癌的淋巴结转移率(度)随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率(度)均低于其它期 (P<0.01);Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%(40/49),高于其它型(P<0.05),而Ⅳ型患者淋巴结转移度32.4%(161/497)最高.结论:淋巴结转移率和转移度随着胃癌的临床进展而增高.合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性.     

残胃癌的早期诊断与外科治疗

1930年Eicheller报道了第1例残胃癌，到目前为止对残胃癌的定义、分类等仍未取得完全一致的意见。我们参考有关文献资料规定：残胃癌指因良性胃十二指肠病变行胃大部切除术、迷走神经切断术和胃空肠吻合术后5年以上发生的癌。近年来，残胃癌的病例报道逐年增多。由于本病早期往往无症状，缺乏特征性临床表现，大多数患者就诊时已属晚期。因此，本病早期诊断率、手术切除率和长期生存率均较低。     

胃癌的淋巴结转移规律及其意义

目的：探讨胃癌淋巴结转移规律及合理淋巴结清除术的原则和适应证。方法：采用病理组织不学、免疫组织化学法研究转移淋巴结分型、分期、分级和计量学及淋巴结的检出率。结果：全组淋巴结转移率为74.8%，以No3、No7为高；不同病期的转移率有明显差别；转移淋巴结数量、级别和类型是反映胃癌生物行为和预后的重要指标。胃癌组织中淋巴管癌栓（ ）、FDP、TPA高表达，E-cd低表达和DNA含量增高与淋巴结转移密切相关。术中胃壁内注射CH40，认识淋巴结跳跃性转移规律，切除标本美蓝染色结合淋巴结连续切片，对提高淋巴结清除率和检出率有一定的应用价值。结论：针对胃癌淋巴结清除率、分型、分期、分级和计量学，以及淋巴结转移率、检出率和分子标志物研究，对选择合理根治术式、提高生存率具有重要的临床意义。     

Metastatic pattern of lymph node and surgery for gastric stump cancer

BACKGROUND AND OBJECTIVES: Metastatic pattern of lymph node (LN) and surgery options for gastric stump cancer (GSC) remain controversial. The aim of this study was to investigate LN metastasis and lymphadenectomy for GSC for curative purposes. METHODS: Sixty-seven patients with GSC were analyzed retrospectively. RESULTS: The metastatic rates of LN were as follows: 63.3% in right cardia (No. 1), 33.3% in left cardia (No. 2), 75.0% in lesser curvature (No. 3), 53.3% in greater curvature (No. 4), 40.0% in celiac artery (No. 9), 60.0% in splenic hilus (No. 10), 72.7% in splenic artery (No. 11), 36.1% in hepatoduodenal ligament (No. 12), 8.3% in retropancreatic (No. 13), 21.4% in para-aortic (No. 16), 50% in supra-diaphragm (No. 111), 16.7% in LN within jejunal mesentery, respectively. All nine patients who only received simple laparotomy died within 1 year. The overall 5-year survival rate of GSC was 17.9% (12/67), including 100% for stage I, 80.0% for stage II, 12.1% for stage III, and 0% for stage IV. Moreover, the 5-year survival rate (36.7%, 11/30) for curative patients was significantly better than that (3.6%, 1/28) of non-curative patients (chi(2) = 7.76, P < 0.01). CONCLUSIONS: Our results imply that GSC has a wide range of LN metastases, including LN within jejunal mesentery in B-II reconstruction cases, and curable resection may obtain better results. Therefore, we suggest that radical operation for B-I patients needs removal of gastroduodenectomy anastomosis and the above LNs, and that B-II patients need removal of 10 cm of jejunum besides gastrojejunostomy anastomosis, and clearance of LN within its mesentery, in addition to B-I GSC.     

Protein predictive signatures for lymph node metastasis of gastric cancer

Lymph node status remains one of most crucial indicators of gastric cancer prognosis and treatment planning. Current imaging methods have limited accuracy in predicting lymph node metastasis. We sought to identify protein markers in primary gastric cancer and to define a risk model to predict lymph node metastasis. The Protein Pathway Array (PPA) (initial selection) and Western blot (confirmation) were used to assess the protein expression in a total of 190 freshly frozen gastric cancer samples. The protein expression levels were compared between samples with lymph node metastasis (n = 73) and those without lymph node metastasis (n = 57) using PPA. There were 27 proteins differentially expressed between lymph node positive samples and lymph node negative samples. Five proteins (Factor XIII B, TFIIH p89, ADAM8, COX‐2 and CUL‐1) were identified as independent predictors of lymph node metastasis. Together with vascular/lymphatic invasion status, a risk score model was established to determine the risk of lymph node metastasis for each individual gastric cancer patient. The ability of this model to predict lymph node metastasis was further confirmed in a second cohort of gastric cancer patients (33 with and 27 without lymph node metastasis) using Western blot. This study indicated that some proteins differentially expressed in gastric cancer can be selected as clinically useful biomarkers. The risk score model is useful for determining patients' risk of lymph node metastasis and prognosis.     

口底鳞状细胞癌颈淋巴结转移规律及处理的探讨

背景与目的：口底癌颈淋巴结转移规律方面的研究较少,本研究探讨口底癌颈淋巴结转移的分布特点和合理的治疗方法。方法：回顾性分析经根治性治疗的79例口底鳞癌病例,比较其临床和病理阳性淋巴结分布差异;比较临床淋巴结阳性组经根治性颈清扫术,上半颈清扫术术后颈部的复发率和临床淋巴结阴性组经根治性颈清扫术,上半颈清扫术,颌下三角清扫术的复发率,及临床观察组颈部的复发率。结果：临床和病理阳性淋巴结分布都以Ⅱ区为主,分别占61.8%和40.0%。其次是Ⅰ区和/或Ⅲ区,而Ⅳ,Ⅴ,Ⅵ区则极少;临床淋巴结阳性组中根治性颈清扫术术后颈部的复发率低于上半颈清扫术者,但无统计学意义（X^2=3.403,P=0.065);临床颈淋巴结阴性组中上半颈清扫术,颌下三角清扫术,临床观察等方法处理的颈部复发率分别是11.1%(1/9),40.0%(2/5)和23.5%(4/17),组间差异无统计学意义（X^2=1.554,P=0.46)。结论：口底鳞癌颈淋巴结转移的分布主要在Ⅰ、Ⅱ、Ⅲ区;临床颈淋巴结阴性者宜进行Ⅰ、Ⅱ、Ⅲ区（上半颈）淋巴结清扫术。     

Preoperative predicting score of lymph node metastasis for gastric cancer

The aim of our study was to develop a new score system that might predict the probability of lymph node of gastric carcinoma. We studied the clinicopathological variables of 932 patients with gastric carcinoma admitted to the Department of Surgical Oncology at the First Hospital of China Medical University. Logistic analysis was performed to identify predictors. The hazard risk (HR) of variables obtained from logistic regression was used to construct a simple scoring system determined by an aggregate of the points assigned for each selected variable. Receiver operator characteristic (ROC) curve was created to analyze the specificity. Lymph node metastases were found in 644 (69.1 %) of 932 patients. After multivariate logistic regression analysis, tumor size, depth of invasion, and macroscopic types (P?相似文献   

Risk factors for lymph node metastasis and endoscopic treatment strategies of undifferentiated early gastric cancer

Objective  

To discuss the effects of clinico-pathological features on lymph node metastasis (LNM) in undifferentiated EGC (early gastric cancer), as well as identify the appropriate medical management.     

淋巴结转移对早期胃癌预后的影响

目的建立一种简单、有效的方法用以评估早期胃癌伴淋巴结转移患者的预后，为术后个体化的辅助治疗与随访提供依据。方法150例行胃癌根治术，术中清扫淋巴结≥15枚且术后病理诊断淋巴结转移的早期胃癌患者为研究对象，用单因素和多因素法回顾性分析各种临床病理参数和预后的关系。结果多因素分析中的Cox比例风险模型显示，在判断患者无瘤生存期时阳性淋巴结个数是最有效的预测指标。单因素分析阳性淋巴结个数n≥3的早期胃癌患者无瘤5年生存率远低于阳性淋巴结个数n≤2的患者（71．8％vs96．3％，P〈0．01）。23例（15．3％）复发患者中以血道转移为主占52．2％，多数在术后2年内复发（68．2％）。结论阳性淋巴结个数n≥3的早期胃癌患者是复发的高危人群，术后要加强随访同时可考虑给予适当的辅助化疗，以降低其复发率。     

预防性治疗食管癌淋巴结转移

目的：评价化疗及放疗预防食管癌淋巴结转移的疗效。方法：70例食管癌患者随机分为化疗预防组（A组）35例，放射预防组（B组）35例。结果：治疗后2年，总的淋巴结转移率A组34．29％，B组48．57％（χ^2=1.472,P=0.225).锁骨上颈部、纵隔、贲门胃左动脉旁、腹腔淋巴结转移率A组分别为8．57％，11．43％，8．57％，5．71％，B组分别为5．71％，31．43％，5．71％，5．71％χ^2与P值分别为：χ^2＝0．215，P＝0．643；χ^2＝4．158，P＝0．041；χ^2＝0．215，P＝0．643；χ^2＝0，P＝1．00。A组（CR＋PR）91．43％，B组为71．43％（χ^2＝4．629，P＝0．031），两组生存率差异有显著意义（χ^2＝4．629，P＝0．031）。结论：食管癌淋巴结转移预防性治疗，以化疗放疗合并预防优于单独放疗预防。     

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。     

Recurrence in early gastric cancer with lymph node metastasis

Background  Early gastric cancer (EGC) has an excellent prognosis, but some patients with lymph node-positive disease will develop recurrence. In this study we investigated the risk factors for recurrence in this selected group of patients. Methods  The clinical and pathological records of 2368 patients who underwent gastrectomy for solitary EGC between 1980 and 1999 at the National Cancer Center Hospital, Tokyo, were examined. Two hundred and thirty-eight patients (10%) were lymph node-positive (positive for lymph node metastasis) and form the population of this study. Results  Nineteen (8%) of the 238 patients with lymph nodepositive disease developed recurrence. The most common site of recurrence was lymph node (37%), followed by liver (21%). The interval between surgery and the detection of recurrence ranged from 3 to 98 months, with a median of 26 months. Multivariate analysis demonstrated that the number of metastatic nodes was an independent risk factor for recurrence. Patients with seven or more metastatic nodes had the highest rate of recurrence, at 38%. Conclusion  The number of nodes positive for metastasis was the only independent risk factor for recurrence after curative surgery in patients with lymph node-positive early gastric cancer. These high-risk patients may obtain additional survival benefit if targeted with adjuvant chemotherapy.