p53,p16,PCNA蛋白在食管癌中的表达及其临床意义

目的探讨p53,p16,PCNA蛋白在食管癌中的表达及临床意义。方法用免疫组织化学染色SP法对62例食管癌标本进行p53,p16,PCNA蛋白测定。结果62例食管癌中,p53,PCNA蛋白阳性表达均为71.0%(44/62),p16缺失率48.4%(30/62)。p16缺失与肿瘤浸润深度、淋巴结转移密切相关(P<0.05、P<0.01)。而p53,PCNA蛋白同时表达56.5%(35/62),亦与肿瘤浸润深度、淋巴结转移密切相关(P<0.05、P<0.01)。结论食管癌p53,PCNA蛋白同时表达及p16缺失可视为危险预后因素。     

食管癌及癌旁组织p53蛋白、VEGF及MVD联合检测的临床意义

目的讨论食管癌及癌旁组织中MVD、VEGF和p53蛋白表达与食管癌临床、病理因素之间的关系,探讨其表达在食管癌患者转移、预后中的作用,并为以食管癌血管生成为靶点的靶向治疗提供理论基础。方法采用免疫组织化学方法,检测30例食管癌患者手术切除标本中癌灶、癌近旁、癌远旁组织的p53蛋白、VEGF的表达,并用FⅧ相关抗原标记、检测MVD。进行统计学分析,探讨其在性别、年龄、临床分期、淋巴结转移、生存率中的关系。结果①癌灶内VEGF阳性染色主要位于癌细胞胞浆内,癌灶p53蛋白阳性染色主要位于癌细胞胞核内,呈棕褐色。肿瘤内血管分布呈明显异质性,在癌组织浸润的边缘较密集,p53蛋白、VEGF、MVD与食管鳞癌关系在性别、年龄、TNM中无显著性差异。但在不同部位、有无淋巴结转移和5年生存率中有显著的统计学差异。②p53蛋白与VEGF表达有显著相关性（P〈0．05）。③p53、VEGF表达与MVD相关性具有显著统计学差异。结论在食管鳞癌组织及癌近旁、癌远旁组织中p53蛋白、VEGF、MVD均有不同程度表达,阳性表达率有显著性差异。联合检测可作为食管鳞癌恶性潜能的重要生物学指标．并为食管癌手术切除长度从一个新的角度提供参考及理论基础,并可作为其判断预后的重要生物学指标,并为以血管生成为靶点的靶向治疗提供参考。     

鼻咽癌T分期及淋巴结转移的MRI表现与p53蛋白的关系

目的探讨鼻咽癌T分期、淋巴结转移的MRI表现与p53蛋白表达的关系。方法搜集首次放疗前行MR检查且临床资料完整的患者104例，用链霉菌抗生物蛋白-过氧化酶免疫组织化学（SP）法检测p53蛋白的表达，分析T分期、淋巴结转移的MRI表现与p53的关系。结果影像学表现：104例中，经MRI分析T1、T2期各32例，T3、T4期各20例；颈部淋巴结转移49例，咽后外侧淋巴结转移34例。鼻咽癌中的p53蛋白的阳性表达率为82．7％（86／104）。T3＋T4组p53蛋白的阳性表达率92．5％（37／40），T1＋T2组p53蛋白阳性表达率为76．6％（49／64），2组之间差异有统计学意义（x^2=4．37，P=0．037）。T1、T2、T3、T4期高表达率分别为81．3％（26／32）、59．4％（19／32）、95．0％（19／20）、85．0％（17／20），p53蛋白表达强度随着MRI的T分期升高而有增加趋势（x^2=10．57，P=0．014）。颈部淋巴结转移和咽后外侧淋巴结转移的p53蛋白阳性表达率分别为77．6％（38／49）、76．5％（26／34），淋巴结的转移与p53蛋白的表达情况无关联（x^2值分别为0．591、0．795，P值均〉0．05）；颈部淋巴结直径≥4cm组p53蛋白的阳性表达率81．8％（9／11），〈4cm组阳性表达率76．3％（29／38），二者之间的差异无统计学意义（x^2=0．005，P=0．944）。结论鼻咽癌中有较高的p53表达，p53蛋白的过度表达可能与鼻咽癌的发生有关；p53蛋白的表达强度随着MRIT分期升高有增强的趋势；淋巴结的肿大与否及大小与p53蛋白的表达无关。     

非小细胞肺癌中血管内皮生长因子和p53的表达及其与血管生成的关系

目的:探索血管内皮生长因子(VEGF)在非小细胞肺癌(NSCLC)组织中的表达及其与微血管密度(MVD)和p53之间的关系。方法:利用免疫组织化学技术对65例非小细胞肺癌组织进行VEGF、p53表达和肿瘤组织微血管密度检测。结果:65例NSCLC患者癌组织平均MYD为31.44±15.79,VEGF蛋白阳性表达率为83.1％,p53蛋白阳性表达率55.4％。10例正常肺组织平均MVD为13.71±4.12,明显低于癌组织,P<0.01。在转移癌组织中MVD显著性高于无转移癌组,P<0.01;ⅢA-B期癌组织中MVD也显著高于Ⅰ期和Ⅱ期,P<0.01。NSCLC中。VEGF、p53蛋白表达显著高于正常肺组织,P<0.05。两者阳性表达都与患者的NSCLC淋巴结转移、TNM分期呈正相关,P<0.01,与年龄、肿瘤大小无关,P>0.05。结论:在组织血管生成过程中,突变的p53可能通过调节VEGF的表达发挥作用。     

结直肠癌中组织因子和p53蛋白表达的相关性及其意义

目的 研究组织因子（TF）和p53蛋白在结直肠癌组织中表达的相关性并探讨其意义。方法 应用免疫组织化学方法检测43例结直肠癌标本中TF和p53蛋白的表达情况。结果 43例结直肠癌组织中19例（44．2％）TF表达阳性,21例（48．8％）p53蛋白表达阳性;TF表达阳性者中78．9％（15／19）淋巴结转移阳性,p53蛋白表达阳性者中85．7％（18／21）淋巴结转移阳性,两者的表达均与淋巴结转移密切相关（r=0.414和0．588,P〈O．01）;p53蛋白阳性表达组TF阳性率为66．7％（14／21）,而p53蛋白阴性表达组TF阳性率为22.7％（5／22）,二者呈正相关（r=0.442,P=0.003）。结论 结直肠癌组织中TF和p53蛋白表达与肿瘤淋巴转移密切相关,TF的表达与p53蛋白的表达具有显著相关性。     

肝细胞癌螺旋CT征象与MVD及VEGF表达间关系的研究

目的探讨肝细胞癌(HCC)的螺旋CT征象与瘤内微血管密度(MVD)及血管内皮生长因子(VEGF)表达之间的关系。资料与方法运用免疫组织化学SP法,检测45例经手术切除并病理证实的HCC瘤内MVD及VEGF的表达,所有病例术前均行CT平扫及增强扫描。结果CT征象与MVD、VEGF表达之间的关系:(1)瘤体边缘模糊组和清晰组的HCCMVD分别为50.3±16.2和38.7±13.4,VEGF阳性表达率分别为90.0%(19/21)和54.1%(13/24),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(2)瘤内有坏死不强化组和无坏死组的HCCMVD分别为65.3±17.6和38.2±13.0,VEGF阳性表达率分别为77.8%(7/9)和69.4%(25/36),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(3)有扩散转移组和无扩散转移组的HCCMVD分别为73.9±20.4和40.6±17.1,VEGF阳性表达率分别为100.0%(18/18)和51.8%(14/27),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(4)瘤体直径>5cm和直径≤5cm的HCC...     

肺癌的早期诊断一CT与p53、p16对比研究

目的研究非小细胞肺癌(NSCLC)的CT征象与p53、p16基因蛋白异常表达之间的相关性.方法应用免疫组化SABC法检测52例经手术病理证实的周围型非小细胞肺癌(NSCLC)石蜡包埋标本p53、p16基因蛋白表达,并与相应的CT征象作对比研究.结果(1)正常肺组织、癌旁肺组织和肺癌组织中,p53基因蛋白阳性表达率分别为0.0%、45.0%、63.5%;p16基因蛋白阳性表达率分别为85.7%、55.0%、45.0%.(2)CT显示NSCLC肿块轮廓出现深分叶征、棘状突起征,边缘出现短毛刺征组p53蛋白表达率高,p16蛋白表达率低.结论CT征象与p53、p16等分子生物学指标对比观察,有助于提高肺癌的早期诊断水平.     

中心型肺癌P53蛋白的表达与其MSCT征象的相关性分析

目的:本研究将肺癌影像学表现征象同病理特征及P53蛋白表达相对照,探究肺癌MSCT表现的分子病理学基础,寻找中心型肺癌浸润转移的相关生物学标志。方法:对58例中心型肺癌患者行MSCT平扫及双期动态增强扫描,将容积扫描数据传至AW4.2工作站进行图像分析。所取手术标本切片进行免疫组织化学染色分析,测定不同分化程度肺癌组织中P53蛋白含量,同所得CT图像进行相关性研究。统计学分析用SPSS10.0软件包进行数据处理,以P<0.05为有统计学意义。结果:58例中心型肺癌中P53蛋白表达率为65.5%,高分化癌P53蛋白表达率为33.3%,低分化癌中表达率为76.7%,其结果有统计学意义(P<0.05)。58例患者CT影像中,淋巴结转移36例,P53蛋白阳性表达率为77.8%,阳性表达率在淋巴结转移组和非转移组中有显著性差异?P<0.05?。结论:肺癌组织中P53蛋白的阳性表达同肿瘤分化程度及是否有淋巴结转移、远处侵袭密切相关,根据MSCT征象可推断出P53蛋白的表达情况。     

CT增强扫描在评价NSCLC血管生成中的临床意义

目的　探讨非小细胞肺癌 (NSCLC)血管内皮生长因子 (VEGF)的表达水平与CT增强程度的关系 ,从影像学角度评价肿瘤血管生成在肺癌诊断、治疗及淋巴结转移中的临床价值。方法　对 30例NSCLC病人进行动态螺旋CT扫描 (SCT) ,测量病灶增强幅度 ,并利用免疫组化技术检测VEGF。对病灶增强值、VEGF阳性表达及淋巴结转移情况进行统计学分析。结果　 30例肺癌病人CT增强值均数为 (36 .2 8± 6 .41 )HU ,VEGF阳性表达 2 1例 ,阴性表达 9例。VEGF在中晚期的阳性表达高于早期病人 (Ρ<0 .0 5) ,淋巴结转移组高于非淋巴结转移组 (Ρ <0 .0 5) ;癌灶增强值与VEGF阳性表达、肿瘤分期及淋巴结转移亦呈正相关。结论　NSCLC的CT增强程度能够反映肿瘤的血管生成 ,并与淋巴结转移密切相关 ,有助于肺癌的诊断、TNM分期 ,而且可以从肿瘤分子生物学行为方面补充目前肺癌分期方法的不足     

胃癌多层CT增强征象与组织分化及p53、P-糖蛋白表达相关性初步探讨

目的 初步研究进展期胃癌的多层CT增强征象与肿瘤组织分化及p53、P-糖蛋白(P-gp)表达的关系.资料与方法 手术切除且资料完整的胃癌患者66例.所有病例术前均行上腹部多层CT常规及双期增强检查,观察内容包括肿瘤部位、最大直径、胃壁浸润厚度、双期强化率、淋巴结转移等.术后标本经10%甲醛固定、石蜡包埋、组织切片,采用常规HE染色确定组织分化和免疫组织化学检测p53、P-gp在胃癌中表达.比较胃癌的多层CT增强征象与组织分化及p53、P-gp在胃癌表达间的关系.结果 73.1%(19/26)均匀强化的胃癌为高/中分化腺癌,75%(30/40)分层强化或不均匀强化的胃癌为低分化腺癌,两者比较差异有统计学意义(P=0.000).CT双期增强的强化率与胃癌组织分化无关(P＞0.05);p53、P-gp在分层强化或不均匀强化的胃癌中阳性表达率显著高于在均匀强化的胃癌中阳性表达(P＜0.05).p53阳性表达还与动脉期强化率、肿瘤大小和淋巴结转移有关(P＜0.05),与胃壁浸润厚度、门静脉期强化率无关(P＞0.05);而P-gp表达与门静脉期强化率有关(P=0.005),与动脉期强化率、胃壁浸润厚度、肿瘤大小和淋巴结转移无关(P＞0.05).结论 胃癌不同的强化方式和双期强化率反映了胃癌的不同组织分化和p53、P-gp阳性表达,提示胃癌的多层CT增强征象与其组织分化及p53、P-gp表达有较密切的相关性.     

CT在食管癌诊疗中的应用

目的评价CT检查在食管癌诊疗中的价值。方法回顾性分析65例经手术病理或内镜活检证实的食管癌CT及临床资料。结果65例食管癌CT表现均呈阳性，表现为食管管壁增厚，管腔狭窄，腔内肿块。部分病例侵及周围器官，或伴发肝脏纵隔及腹腔淋巴结转移。结论CT检查可为食管癌的诊断、手术评估及放化治疗跟踪提供可靠的依据。     

食管癌术前CT检查对淋巴结转移的研究及分期的评估

目的为了准确地预测食管癌术前淋巴结转移情况,并对食管癌术前CT分期及术后TNM分期对比。方法60例经病理学证实的食管癌病人行术前CT检查（平扫加增强扫描56例）,并与手术及术后病理结果相对比。结果术前CT检查对淋巴结转移的敏感性、特异性及准确性分别为48.00%、81.48%及65.38%。按术前CT的Moss法分期Ⅰ期,0;Ⅱ期39;Ⅲ期18;Ⅳ期3。与术后的国际TNM分期符合49例,符合率为81.67%。结论食管癌术前CT检查对淋巴结转移的预测是较有价值和重要的,还可协助制定治疗方案等。     

Imaging techniques in the staging of carcinoma of the esophagus

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CT findings with intraoperative macroscopic ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. Thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines, especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic (local: 66.6%, distant: 64.2%) and hepatic metastases. Combined thoraco-abdominal CT, tracheobronchoscopy and liver US, besides MR imaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas.     

CT判别食管癌外侵主动脉的探索

目的探讨术前CT检查“夹角法”+“厚度法”判断食管癌外侵主动脉的价值。方法65例经病理学检查确诊的食管癌患者进行术前的CT检查及分析,用“夹角法”+“厚度法”相结合的方法进行判断,所有患者均有CT检查及分析并与手术及术后病理学结果相对比。结果按照“夹角法”与“厚度法”相结合的判别方法,本组65例病人主动脉受侵的敏感性、特异性及准确性分别为87.50%、87.76%及87.69%。结论“夹角法”+“厚度法”判断食管癌外侵主动脉价值较大。     

3D CT protocol in the assessment of the esophageal neoplastic lesions: can it improve TNM staging?

The purpose of this prospective observational study was the evaluation of the usefulness of MPR reconstructions and virtual endoscopy in the study of the esophageal carcinoma. Thirty-nine patients with esophageal cancer proved by means of endoscopy, underwent preoperative TNM staging with dynamic CT of the chest and abdomen with the aid of 3D rendering. Twenty-six patients underwent surgery, and the CT results were compared with histopathologic findings. In staging the T parameter, the CT with 3D reconstructions and virtual endoscopy, showed a sensitivity of 92% and an accuracy of 88%. In staging lymph nodes, the sensitivity in our study was 85%, the specificity 58%, and the accuracy 69%. Our protocol of the study of the esophageal cancer with 3D CT and virtual endoscopy, demonstrated a high concordance with the surgical and pathologic findings. The 3D reconstructed images were very helpful to the surgeons regarding preoperative planning. We performed an observational enquiry, and although this was a small study, it has, however, confirmed that the 3D imaging of the esophagus represents a valuable advantage to conventional imaging. Further studies with a larger number of patients are needed to prove its superiority to traditional CT imaging of the esophagus.     

Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET.

Because both the number and location of metastatic lymph nodes and the N stage influence survival in esophageal cancer, accurate noninvasive evaluation of individual lymph node groups for the presence of metastasis is essential for therapeutic planning. Therefore, we investigated the accuracy of FDG PET for evaluating individual lymph groups in esophageal cancer patients and compared the results with those of CT and endoscopic sonography (ES). METHODS: Sixty-one consecutive patients with histologically proven primary esophageal carcinoma were studied prospectively with FDG PET. Thirteen patients who were treated nonsurgically were excluded from data analysis. The remaining 48 patients underwent esophagectomy and lymph node dissection. All 48 patients underwent CT scanning, including the lower neck, thorax, and upper abdomen, with intravenous administration of contrast medium. ES was performed in 45 of the patients but was incomplete in 12 patients because of esophageal stenosis. The accuracies of FDG PET, CT, and ES were compared with histologic findings. RESULTS: During surgery, a total of 382 lymph node groups were dissected in 48 patients, of which 100 node groups in 32 patients were malignant on histologic examination. For assessing metastasis to individual groups, FDG PET showed 57% sensitivity, 97% specificity, and 86% accuracy, whereas CT showed 18% sensitivity (P < 0.0001), 99% specificity (P = 0.033), and 78% accuracy (P = 0.003). For N staging, FDG PET was correct in 83% (40/48) of the patients, whereas CT and ES were correct in 60% (29/48; P = 0.006) and 58% (26/45; P = 0.003), respectively. CONCLUSION: FDG PET is more accurate than is CT or ES for evaluating metastasis to individual lymph node groups and for N staging in esophageal cancer and thus may be helpful in determining the therapeutic plan.     

18F-FLT和18F-FDG PET/CT对胸段食管癌淋巴结分期诊断的对比研究

目的 评价18F-脱氧胸苷（FLT）PET/CT对未经治疗的胸段食管癌淋巴结分期诊断的价值,并与18F-脱氧葡萄糖（FDG）PET/CT进行比较.方法 选择22例拟行手术治疗的胸段食管癌患者,术前行双显像剂PET/CT检查及淋巴结分期诊断,术后以病理学诊断为＂金标准＂,比较18F-FLT和18F-FDG PET/CT对胸段食管癌淋巴结分期的灵敏度、特异性、准确性、阳性预测值和阴性预测值.应用SPSS 13.0软件进行x2检验.结果 患者均行食管癌切除和淋巴结清扫术,病理检查结果显示16例患者存在淋巴结转移,N0期7例,N1期15例,M1a期6例（其中1例为N0M1a,另外5例为N1M1a）,全组均无M1b期.共检出424枚淋巴结,其中47枚为转移淋巴结.18F-FDG PET/CT诊断呈假阳性的淋巴结14枚,而18F-FLT诊断呈假阳性的淋巴结为3枚;18F-FDG假阴性的淋巴结8枚,18F-FLT假阴性的淋巴结12枚.18F-FLT PET/CT的诊断灵敏度、特异性、准确性、阴性预测值和阳性预测值分别为74.47%（35/47）、99.20%（374/377）、96.46%（409/424）、96.89%（374/386）和92.11%（35/38）,18F-FDG分别为82.98%（39/47）、96.29%（363/377）、94.81%（402/424）、97.84%（363/371）和73.58%（39/53）;两者比较的x2值分别为0.572,6.018,1.017,0.348,3.852,P值分别＞0.05,＜0.05、＞0.05、＞0.05和＞0.05.结论 18F-FLT对食管癌区域淋巴结的诊断灵敏度与18F-FDG显像接近,特异性高于18F-FDG,但仍存在一定的局限性.     

Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer.

The aim of this study was to compare the value of reviewing combined 18F-FDG PET/CT images with that of reviewing side-by-side PET and CT images in the diagnosis of locoregional lymph node metastases in patients with esophageal squamous cell cancer. METHODS: From November 2003 to December 2005, 45 patients with thoracic esophageal squamous cell cancer underwent 18F-FDG PET/CT before surgery. The results of reviewing combined PET/CT images and side-by-side PET and CT images for the diagnosis of locoregional lymph node metastases were compared prospectively in relation to pathologic findings. RESULTS: All patients underwent successful surgery, and pathologic examination confirmed nodes positive for metastasis in 32 patients and 82 of 397 excised nodal groups. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 93.90% (77/82 nodal groups), 92.06% (290/315), 92.44% (367/397), 75.49% (77/102), and 98.31% (290/295), respectively, whereas those of PET were 81.71% (67/82), 87.30% (275/315), 86.15% (342/397), 62.62% (67/107), and 94.83% (275/290), respectively. P values were 0.032, 0.067, 0.006, 0.063, and 0.037, respectively. The differences in sensitivity, accuracy, and negative predictive value between PET and PET/CT were statistically significant. CONCLUSION: PET/CT improves the sensitivity, accuracy, and negative predictive value of 18F-FDG imaging in the assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer and provides data of diagnostic significance.     

对转移性肝癌CT表现的分析(附23例报告)

目的:分析CT扫描对转移性肝癌的诊断价值。材料与方法:23例转移性肝癌经手术和/或病理证实,其原发灶有肺癌7例,胃癌6例,乳腺癌4例,胰腺癌2例,结肠癌2例,食管癌1例,以及子宫内膜癌1例。全部病例均经CT平扫和增强扫描。11例还于增强后1、3、5分钟做了延迟扫描。结果:CT平扫准确证实了多数病例(19/23)为多发性病灶且大多病灶(13/19)能被清楚辩认。增强扫描后可见如下CT表现:1.病灶整体轻度强化,2.病灶边缘轻度强化,3.病灶不强化,4.病灶缩小乃至消失,5.出现平扫时未检出的病灶。延迟扫描后,未见比增强扫描时更有意义的CT表现。结论:CT平扫和增强扫描对转移性肝癌的诊断具有重要实用价值。     

食管高密度异物(鱼刺)的CT诊断

目的探讨CT在食管异物诊断中的应用价值方法食管异物10例(均为鱼刺),均行常规CT平扫,必要时加CT薄层扫描,再将CT征象与手术及内镜结果比较结果10例食管异物(鱼刺)均为CT所显示,呈大小、形态不一的稍高或高密度影,其中合并食管出血2例,黏膜下血肿1例,脓肿3例及脓胸1例结论常规CT扫描及薄层扫描在食管异物检查中具有重要意义