胃和结直肠肿瘤脉管浸润特点及其临床意义的研究

目的:研究胃和结直肠肿瘤血管浸润(BVI)和淋巴管浸润(LVI)的检测方法及其临床意义。方法:应用免疫组化法检测95例胃和结直肠肿瘤组织中CD34和D2-40的表达,根据HE染色和免疫组化染色结果判断BVI和LVI,并分析其临床意义。结果:淋巴管浸润与血管浸润显著相关,P<0.001。免疫组化法发现的脉管浸润显著高于HE法发现的脉管浸润,P<0.001。肿瘤浸润深度与BVI(1.5%vs33.3%,P<0.001)和LVI(7.7%vs40.0%,P<0.001)显著相关。淋巴结转移状态与BVI(6.9%vs26.1%,P=0.022)和LVI(6.9%vs52.2%,P<0.001)显著相关。结论:免疫组化法比常规HE法有更高的特异性和敏感性;BVI和LVI可能是胃癌和结直肠癌重要的预测预后因子。     

血管内皮生长因子在睾丸生殖细胞肿瘤中的表达

 目的 探讨血管内皮生长因子（VEGF）表达及微血管计数与睾丸生殖细胞肿瘤（TGCT）临床病理特征的关系。方法 42例睾丸生殖细胞肿瘤和10例对照（无肿瘤浸润的去势睾丸组织）标本取自武汉大学人民医院病理科。应用免疫组化方法检测标本q-血管内皮生长因子的表达及微血管计数（MVC），HE染色显示脉管（血管或淋巴管）浸润。结果 肿瘤组VEGF阳性表达率及MVC均显著高于对照组。VEGF表达在各病理类型组间无显著差别（P〉0．05）；随临床分期的进展VEGF表达增强（P〈0．001）。Ⅲ期肿瘤的MVC分别显著高于Ⅰ、Ⅱ期。VEGF表达与MVC之间呈较强正相关（r=0．675）。脉管浸润率随临床分期的增加而增加。但多因素分析显示仅VEGF表达与临床分期相关。结论 血管生成与TGCT的转移相关。VEGF在调节TGCT的血管生成及促进TGCT的临床进展方面可能发挥着重要作用，VEGF可作为反映TCK2T生物学行为的客观指标。     

结直肠癌中Galectin-9的表达及其意义

目的：探讨Galectin-9基因和蛋白在结直肠癌中的表达及其临床意义。方法：运用荧光实时定量PCR及免疫组织化学染色方法检测45例手术切除的结直肠癌标本和20例正常结直肠上皮组织中Galectin-9基因和蛋白的表达，分析Galectin-9的表达与结直肠癌临床病理特征的关系。结果：Galectin-9基因在结直肠癌组织中表达低于正常结直肠上皮组织（P〈0．05），Galectin-9蛋白在结直肠癌组织中表达阳性率为62％，在正常结直肠上皮组织中表达阳性率为90％，差异具有统计学意义（P〈0．05）。Galectin-9的低表达与结直肠癌的远处转移相关（P〈0．05），与患者的年龄、性别、肿瘤浸润深度、淋巴结转移、肿瘤分化程度、肿瘤分期及肿瘤部位无显著相关。结论：Galectin-9在结直肠癌中低表达，并且与肿瘤的远处转移相关，有可能成为结直肠癌判断预后的标志物以及基因治疗的潜在靶点。     

Ⅰ期、Ⅱ期非小细胞肺癌中血管和淋巴管浸润与预后的关系

 为评价Ⅰ、Ⅱ期非小细胞肺癌(NSCLC)中血管浸润(BVI)和淋巴管浸润(LVI)的预后意义,随访76例Ⅰ、Ⅱ期NSCLC病人,HE切片中组织学观察各例NSCLC中的BVI和LVI,Pearsonx²检验分析组间差异,Kaplan－Meier乘积限法和Cox比例风险模型用于生存分析。病人平均年龄56.0岁±8.2岁,中位随访时间为51个月,3年、5年总体生存率分别为68％和64％;BVI(＋)占28％,LVI(＋)占0.7％,BVI(＋)/或LVI(十)占34％;单变量生存分析显示:BVI而非LVI与生存差显著相关(x²=8.66,p=0.003);Cox回归多变量分析显示:脉管浸润(p=0.003)和淋巴结状况(p=0.01)是影响总体生存的独立预后因素。本研究提示:脉管浸润是评价Ⅰ、Ⅱ期NSCLC病人预后重要的病理因素。     

食管-胃结合部腺癌淋巴管侵犯与相关病理学因素关系研究

目的：探计食管-胃结合部腺癌淋巴管侵犯与相关病理学因素之间的关系。方法：对156例根治性手术切除的食管-胃结合部腺癌的病理资料进行分析，按照有无淋巴管侵犯分为两组（LVI（＋）组89例，LVI（-）组67例），比较不同N分期、T分期、肿瘤大体类型、组织学类型、分化程度、肿瘤大小及淋巴结转移个数等情况下，淋巴管侵犯的发生情况（采用卡方检验，P〈0．05差异具有统计学意义），并比较LVI（＋）组与LVI（-）组肿瘤分化程度的差别（采用非参数Mann—Whitney U检验）以及肿瘤大小和淋巴结转移个数的情况（采用两个独立样本的t检验，P〈0．05差异具有统计学意义）。结果：1）LVI（-）组与LVI（＋）组，LN（＋）发生率分剐为61．2％和95．5％。LVI（＋）者淋巴结转移率高，差异具有统计学意义；LN（-）者与LN（＋）者，LVI（＋）发生率分别为13．3％和67．5％，LN（＋）者发生淋巴管侵犯的几率较大。差异具有统计学意义，2）T1期均为LVI（-）；T2及T3期LVI发生率无统计学差异；T4期LVI（＋）者显著高于LVI（-）者。3）分化好组与分化差组的LVI发生率有统计学差异，分化差组中低分化腺癌LVI（＋）明显高于LVI（-）。4）LVI（＋）组平均肿瘤大小和平均淋巴结转移个数分别为（6．09＋3．40）cm和（9．75＋7．82）枚，LVI（-）组分别为（4．34＋2．07）cm和（2．63＋2．00）枚，两组间差异具有统计学意义。结论：食管-胃结合部腺癌的淋巴管侵犯发生与N分期、T分期、组织学类型、分化程度、肿瘤大小及淋巴结转移个数等多种病理学因素显著相关。     

结直肠癌组织淋巴管密度和淋巴管内癌栓及VEGF-C表达的意义

目的:检测并比较结直肠癌及结直肠正常组织内淋巴管密度(LVD)和血管内皮生长因子(VEGF-C)的表达,并计数结直肠癌组织中淋巴管内癌栓(LVI),探讨其意义。方法:免疫组化法检测结直肠癌及相应的正常结直肠组织中LVD及VEGF-C的表达,计数结直肠癌组织LVI。结果:结直肠癌组织中的LVD明显高于正常结直肠组织,P=0.000。结直肠癌的LVD与LVI(P=0.001)及淋巴结转移(P=0.047)密切相关。LVI与TNM分期(P=0.017)及淋巴结转移(P=0.006)密切相关。结直肠癌组织中VEGF-C表达显著高于正常结直肠组织(P=0.000),且与肿瘤的TNM分期(P=0.029)及淋巴结转移(P=0.023)密切相关。结论:淋巴管的形成在结直肠癌的发生发展过程中起重要的作用。LVI及VEGF-C的表达可预测结直肠癌的侵袭性。     

NGAL在83例结、直肠癌中的表达及其临床意义

[目的]探讨NGAL在结、直肠癌组织中的表达及其临床意义。[方法]应用免疫组化法检测NGAL在83例结、直肠癌及癌旁正常组织中的表达,分析其与结、直肠癌临床病理特征及预后的关系。[结果]NGAL在结、直肠癌组织中的阳性表达率为55．4％,明显高于在相应癌旁正常组织中的表达（P〈0．001）,NGAL表达与结、直肠癌分化程度、Dukes分期、淋巴结转移、脉管侵犯（P〈0．05）有关,而与患者年龄、性别、部位、肿瘤直径、肿瘤大体形态、病理类型、癌性肠梗阻无关（P〉0．05）。单因素生存分析显示NGAL阳性表达组5年无复发生存率低于阴性组,差异有统计学意义（P=0．022）。[结论]NGAL阳性表达与结、直肠癌浸润、转移、预后不良有关,NGAL可能是结、直肠癌早期诊断、监测复发的潜在生物学参考指标。     

膀胱癌组织VEGF-C表达与淋巴管生成和淋巴结转移之间关系的研究

目的：应用特异的淋巴管内皮标志物podoplanin检测膀胱移行细胞癌（BTCC）组织中淋巴管，用淋巴管密度（LVD）表示淋巴管生成情况，探讨BTCC内VEGF-C表达与淋巴管生成和淋巴结转移的关系。方法：收集45例BTCC和10例正常膀胱组织标本，应用免疫组化检测VEGF-C、podoplanin的表达，计算VEGF-C阳性表达率及淋巴管密度值，分析两者的关系。结果：BTCC组织内VEGF-C阳性表达率显著高于正常膀胱组织（71．1％vs．10．0％，P〈0．01）；BTCC高中分化和低分化之间VEGF-C阳性表达率无显著性差异（70．6％US．72．7％，P〉0．05），而淋巴结阳性组显著高于淋巴结阴性组（81．3％vs．65．5％，P〈0．05）.BTCC组织内LVD显著高于正常膀胱组织（6．8±1．3vs．1．2±0．3，P〈0．01）；BTCC中，VEGF-C阳性组LVD显著高于VEGF-C阴性组（7．6±1．5vs．4．7±0．9，P〈0．05），而淋巴结阳性组显著高于淋巴结阴性组（8．3±1．4vs．5．1±1．1，P〈0．05）。结论：淋巴管生成可能是BTCC淋巴结转移的重要因素，VEGF-C参与BTCC淋巴管生成，从而促进淋巴结转移。     

胃癌组织Ki-67表达与复发转移相关性分析

目的：探讨进展期胃癌根治术后早期发生复发转移的影响因素,以及Ki-67表达与临床病理参数间相关性及对预后的影响。方法：回顾性分析2007-01—01—2011-08-31中国医科大学附属第四医院行根治术的128例胃癌患者临床资料,分为早期复发组（62例）和对照组（66例）,进行临床病理参数比较,应用Cox模型分析独立影响因素。分析Ki-67与各临床病理参数关系,运用Kaplan-Meier法分析其与患者生存时间关系。结果：128例患者中,早期复发组与对照组肿瘤病理分级（χ^2=11．170,P=0．004）、大体分型（χ^2=7．049,P=0．008）、浆膜浸透（χ^2=9．372,P=0．009）、淋巴结转移（χ^2=16．516,P〈0．001）、pTNM分期（χ^2=40．911,P〈0．001）、脉管癌栓（χ^2=23．944,P〈0．001）以及Ki-67表达（χ^2=18．011,P〈0．001）差异有统计学意义。Ki-67表达与肿瘤大小（χ^2=10．383,P=0．016）、浸润深度（χ^2=12．674,P=0．049）及淋巴结转移阳性率（P〈0．001）存在明显相关性。单因素分析显示,肿瘤的病理分级（χ^2=10．013,P=0．007）、浆膜浸润（χ^2=11．632,P=0．003）、是否有淋巴结转移（χ^2=14．197,P〈0．001）、脉管癌栓（χ^2=37．532,P〈0．001）、pTNM分期（χ^2=58．200,P〈0．001）、大体分型（χ^2=6．251,P=0．012）以及Ki-67表达（χ^2=18．961,P〈0．001）对肿瘤术后复发时间有影响。多因素分析显示,脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。随着淋巴结转移阳性率增加,其Ki-67的阳性表达率也增加,P〈0．001;当Ki-67阳性表达〉50％时,患者预后差。结论：脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。Ki-67对于判断胃癌肿瘤生物学行为有一定价值,可作为临床参考?     

直肠良恶性肿瘤中肿瘤相关巨噬细胞和微血管及淋巴管生成的关系

目的：探讨直肠良恶性肿瘤组织中微血管密度（MVD）及淋巴管密度（LVD）与肿瘤相关巨噬细胞（TAMs）数量的相关性。方法：采用免疫组化的方法,用CD68标记TAMs,分别用CD31和D2-40标记微血管和淋巴管,光镜下对TAMs,MVD及LVD进行计数,分析。结果：直肠腺癌组织中的TAMs,MVD及LVD计数明显高于直肠腺瘤型息肉组织（P〈0.01）;在直肠腺癌组中,TAMs与MVD和LVD有明显相关性（TAMs与MVD：P〈0.01;TAMs与LVD：P〈0.01）,且MVD与直肠癌淋巴结转移（P〈0.01）和分化程度（P〈0.05）密切相关;而TAMs和LVD仅与淋巴结转移有显著相关性（P〈0.01,P〈0.05）。结论：TAMs,MVD及LVD可能是反映直肠腺癌发生、发展、转移及侵袭能力的生物学指标,TAMs在肿瘤中的浸润可能与肿瘤血管及淋巴管的生成有关。     

A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.     

Twinning and the Incidence of Breast and Gynecological Cancers (United States)

Increasing epidemiological and experimental evidence indicates that the carcinogenic pathway in the breast and female reproductive organs is driven, at least in part, by factors associated with reproduction. We conducted a retrospective cohort study, comparing the risk of ovarian, breast, endometrial, and cervical cancers among women who had records of at least one twin pregnancy, compared with women who had given birth to only single children. Subjects were selected from the Utah Population Database, which consists of multiple linked datasets including genealogy, births and deaths and cancer registries. We used Poisson regression to calculate relative risks, adjusted for the number of pregnancies and the age of the mother at the birth of first and last children, with singleton mothers as the reference group in each case. The risks of breast and ovarian cancers did not differ between mothers of twins and mothers of single children. The risk of endometrial cancer was slightly lower in mothers of twins than in mothers of singleton children (RR = 0.90, 95% CI 0.67-1.21). Conversely the risk of cervical cancer was higher among twin mothers (RR = 1.78, 95% CI 0.88-3.52). This latter finding supports previous data suggesting that reproductive hormones act as cofactors in the etiology of cervical cancer.     

Risk factors for colorectal cancer following breast cancer

Objective. To investigate risk factors for colorectal cancer following breast cancer. Methods. In this nested case-control study, all women (n=14,900) with a first primary breast cancer (1978–1992) were identified from the western Washington population-based Surveillance, Epidemiology, and End Results Cancer Registry. Cases (n=160) developed a second primary colorectal cancer before 1995, at least 6 months after the first cancer diagnosis. Controls (n=310, matched to the cases on calendar year, age and breast cancer stage) were randomly selected from those who did not develop a second primary cancer and who survived to the case's colorectal cancer diagnosis date. Characteristics of the cases and controls at initial diagnosis were compared using conditional logistic regression. Results. The incidence of colorectal cancer was associated with a family history of breast cancer (v.s. no family history, matched odds ratio (mOR)=2.1, 95% confidence interval (CI): 1.1–4.1), high body mass index (30 kg/m² v.s. <30 kg/m², mOR=2.2, CI: 1.2–3.9), and lobular breast cancer histology (v.s. ductal, mOR=2.0, CI: 0.9–4.4). Risk was unrelated to menopausal status, prior hormone replacement therapy and estrogen/progesterone receptor status of the breast tumors. Conclusions. The risk of developing a second primary colorectal cancer may be elevated among certain subsets of breast cancer patients.     

结直肠神经内分泌肿瘤的研究进展

结直肠神经内分泌肿瘤来源于结直肠神经内分泌细胞,发病率较低,但近年有上升趋势.WHO病理学将结直肠神经内分泌肿瘤分为神经内分泌瘤、神经内分泌癌、混合型腺-神经内分泌癌和增生性及肿瘤前病变.结直肠神经内分泌肿瘤细胞具有激素合成及分泌功能,但不一定都出现相应的临床症状.不同分类、分期的结直肠神经内分泌肿瘤的诊断及治疗方法也...     

Neoplasms in skin and subcutis over the breast, simulating breast neoplasms: case reports and literature review

Twenty cases of neoplasms in skin and subcutaneous tissue over the breast were reviewed. There were 17 women, from 15 to 70 years of age, and three men, from 25 to 66 years of age. Among the benign skin neoplasms, superficial leiomyoma, granular cell tumor, and eccrine acrospiroma were misdiagnosed clinically as primary breast carcinoma. Among the malignant neoplasms in subcutaneous tissue, there were three metastatic malignant melanomas, one metastatic epidermoid bronchogenic carcinoma, and two malignant lymphomas. It is interesting that four of these six patients had no prior history of malignant lesion, the subcutaneous nodule presenting as the first manifestation of an occult primary. It is concluded that histological diagnosis of such tumors may lead to avoidance of unnecessary radical surgery.     

Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening

Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates from the National Health Interview Survey, and select issues related to cancer screening. In this 2018 update, we also summarize the new American Cancer Society colorectal cancer screening guideline and include a clarification in the language of the 2013 lung cancer screening guideline. CA Cancer J Clin 2018;68:297–316 . © 2018 American Cancer Society .     

从高发现场视角看食管癌和贲门癌的临床研究趋势

我院流行病室开展食管癌和贲门癌高发现场研究已历30余年,所取得的最显著成绩主要有以下4个方面：（1）对食管癌癌前病变（即鳞状上皮不典型增生）及其逐级发展和演变规律的确认,以及对各级不典型增生诊断及处理的经验;（2）对食管癌早诊早治方法的探索,以及实践所得的优异效果;（3）食管鳞状细胞癌易发部位的发现及其对食管癌早期诊断的贡献;（4）胃贲门癌高发位点的发现及其对贲门癌早诊早治的贡献。在此基础上,结合我们长期在高发现场的实际工作经验,展望今后食管癌和贲门癌临床研究的趋势。     

Metastatic Breast Cancer Presenting as a Subconjunctival Mass

Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.