微波消融治疗甲状腺乳头状癌术后淋巴结转移的临床研究和疗效观察

目的 为了提高对超声引导下经皮微波消融术治疗甲状腺乳头状癌术后颈部淋巴结转移癌的认识,并评价其疗效性和安全性。方法 选择84例甲状腺乳头状癌术后复发的患者,接受微波消融治疗后,通过超声造影增强检查,评估消融区内的肿瘤活性,在1、3、6个月以及12个月对患者进行肿瘤大小、体积和血清甲状腺球蛋白的测量临床评估。结果 103个颈部淋巴结转移癌全部成功接受了微波消融治疗,治疗后超声造影增强检查未检测到不完全消融,在最后一次随访中,平均最大直径从10.5±5.7mm减小到0.8±1.5mm(P＜0.05),平均体积从285.9±245.7mm³减小到4.0±8.0mm³(P＜0.05)。治疗后既未检测到已治疗的肿瘤发生进展,也没有新增可疑的淋巴结。结论 超声引导下经皮微波消融术可能成为某些不适合或拒绝进行手术治疗的甲状腺乳头状癌术后淋巴结转移患者的替代疗法,这种手术安全有效,并发症发生率低。     

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival.

Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test.

Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3?cm (p?=?0.002), the number of pulmonary metastases ≤3 (p?=?0.014), serum AFP level ≤400?ng/mL (p?=?0.003), and the controlled status of intrahepatic tumour after lung RFA (p?=?0.001) were favourable prognostic factors for overall survival.

Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.     

Magnetic Resonance Evaluation of Transplanted Endometrial Carcinoma and Its Lymph Node Metastasis in Rabbits

Objective： To establish a rabbit model of transplanted endometrial carcinoma with lymph node metastasis and observe its magnetic resonance imaging （MRI） features. Methods： VX2 tumor grafts were orthotopically embedded in the endometrium of rabbits, and 3 weeks after the transplantation, thetumor and its metastasis to the retroperitoneal lymph nodes were examined by MRI, and the signal intensities and size of the lymph nodes were compared with those of normal rabbits. Results： The orthotopic transplantation of the tumor grafts resulted in tumor growth in all the 12 recipient rabbits. The tumors infiltrated the serosa of the uterus and metastasized to the retroperitoneal lymph nodes 3 w after transplantation. MRI demonstrated that the lymph nodes of the tumor-bearing rabbits were larger in size than those of normal control rabbits, but the signal intensity of the lymph nodes was not significantly different between them. Conclusion： This transplanted endometrial carcinoma model is characterized by high success rate and similar tumor metastasis behaviors with human endometrial carcinoma, therefore may serve as a good model for testing the efficacy of contrast agents for MR lymphography.     

Prognostic value of lymph node metastases and lymph node ratio in esophageal squamous cell carcinoma

Aims

Although the positive lymph node (LN) metastasis in patients with thoracic esophageal squamous cell carcinoma carcinoma (SCC) has been reported to be a risk factor to reduce long-term survival, only a few studies have so far evaluated the lymph node metastasis among this group of patients. The purpose of this study was to evaluate the impact of lymph node positivity and ratio on survival of esophageal SCC.

Methods

All patients undergoing esophagectomy at the Forth Hospital of Hebei Medical University between January 1986 and December 2002 were reviewed. Survival curves were estimated using the Kaplan-Meier method.

Results

Of 1325 patients with invasive cancer, had squamous cell cancer of the esophagus. Median overall survival (OS) of the entire group was 36.7 months and 5-year OS was 39.3%. The most significant prognostic factor for overall survival was the presence of positive LN (P < 0.01). Additionally, patients with zero involved LN had a 5-year survival of 49.1%, while patients with 1–3 positive LN and >3 positive LN had 5-year survival of 19.5% and 11.0%, respectively (P < 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, patients with <25%, 25%–50% and >50% positive LN had 5-year survival of 47.53%, 14.6% and 8.9%, respectively (P < 0.01).

Conclusion

Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examine LN portend a poor prognosis. These factors should play an important role in predicting prognosis of patients.     

Comparison of percutaneous 915 MHz microwave ablation and 2450 MHz microwave ablation in large hepatocellular carcinoma

Purpose: To compare the effectiveness of ultrasound (US)-guided percutaneous 915 MHz microwave (MW) ablation with the 2450 MHz MW ablation for large hepatocellular carcinoma (HCC) (>4 cm in diameter).

Materials and methods: Patients with HCC >4 cm in diameter who underwent US-guided percutaneous MW ablation with curative intention between March 2007 and December 2008 (39) were randomly divided into two groups, 915 MHz MW group and 2450 MHz MW group. We compared the results of ablation between the two groups.

Results: Fewer antenna insertions for each tumour were required in the 915 MHz MW group (3.69 ± 0.6) than in the 2450 MHz MW group (4.71 ± 1.61) (p = 0.01). According to the follow-up contrast-enhanced imagings, technique effectiveness rate was 85.7% (18/21) and 73.7% (14/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). The rate of local tumour progression (LTP) was 14.3% (3/21) and 26.3% (5/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). There were no deaths and no thrombosis of major vessels in any patient.

Conclusions: Compared with 2450 MHz MW ablation, our initial experience showed that percutaneous 915 MHz MW ablation with cooled-shaft antennae was safe and could achieve a high technique effectiveness rate with fewer insertion numbers in the treatment of large HCC. Therefore, percutaneous 915 MHz MW ablation may provide a new method for the treatment of large HCC.     

Percutaneous thermal ablation for the treatment of colorectal liver metastases and hepatocellular carcinoma: a comparison of local therapeutic efficacy

Aim: This study aimed to compare the local therapeutic efficacy of percutaneous thermal ablation for colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC).

Methods: One hundred sixty-one CRLM nodules in 101 patients and 122 HCC nodules in 97 patients were treated with thermal ablation. Complications and local efficacy were retrospectively compared.

Results: Major complications were observed in two (2.0%) patients in the CRLM group and one (1.0%) in the HCC group (p?=?1.000). The complete ablation (CA) rate of lesions ≤?3?cm was lower in the CRLM group than in the HCC group (p?=?0.018). After a mean follow-up period of 21.1?±?20.7 months in the CRLM group and 22.1?±?17.6 months in the HCC group, the local tumour progression (LTP) rate of lesions >?3?cm was higher in the CRLM group than in the HCC group (p?=?0.036). The multivariate analysis revealed that only safety margin (≤?0.5?cm/>?0.5?cm) was a significant predictor of LTP in both CRLM and HCC.

Conclusions: To achieve better local tumour control, thermal ablation should be more aggressive for CRLM than for HCC, especially for large tumours in clinical.     

RELATIONSHIP BETWEEN LYMPH NODE METASTASES IN ESOPHAGEAL CARCINOMA AND ITS PROGNOSIS

The prognosis of patients with respectable esophageal carcinoma still remains poor. The 5-year survival rates range from 20% to 36% after intentionally curative surgery[1-3]. Early metastatic relapse after complete resection of an apparently localized primary tumor indicates that micro- metastastic tumor cells spread at the time of surgery, undetected by current staging methods and by routine histopathology. The lymph node metastases play a pivotal role in patients with esophageal cancer. It i…     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

子宫颈癌盆腔淋巴结转移的术前CT评价

目的：探讨螺旋CT检查对子宫颈癌盆腔淋巴结转移的诊断价值。方法：60例经临床及病理诊断为子宫颈癌的患者，做子宫颈癌根治术之前行盆腔螺旋CT检查，并以术后病理检查为金标准进行对照，按病例数和盆腔淋巴结部位(粒)数分别计算CT检查的灵敏度、特异度、Youden指数。结果：术前盆腔淋巴结螺旋CT检查的病例对照和部位对照的灵敏度分别为33．3％、28．6％，特异度分别为100％、98．8％，Youden指数分别为0．333、0．274。结论：螺旋CT检查对诊断子宫颈癌盆腔淋巴结转移的特异度较高，具有一定的参考价值；但灵敏度偏低，有待改进。     

经皮微波消融治疗鼻咽癌局限肝转移的疗效分析

背景与目的：局限性肝转移瘤由于数目、大小可控,局部微创治疗可以有效提高患者的生存期,微波消融已经成为肝转移瘤的重要治疗手段。该研究旨在探讨经皮肝穿刺微波消融治疗局限性鼻咽癌肝转移瘤的应用价值。方法：收集湖南省肿瘤医院自2011年9月—2014年10月共26例晚期放化疗失败的鼻咽癌肝脏转移患者的临床资料。患者肿瘤病灶数目小于等于3个,直径小于等于5 cm,且无其他远处转移病灶。在B超引导下行经皮肝穿刺微波消融治疗,26例患者共完成43次消融治疗,术后1个月复查肝功能、增强CT或者MRI,在mRECIST标准评价肿瘤治疗疗效。观察患者术后并发症,统计患者无疾病进展时间(progression-free survival,PFS)及总生存期(overall survival,OS)。结果：26例患者共53个病灶,其中完全消融(complete ablation,CA)20例(20/26,77.0%),部分消融(part ablation,PA)3例(3/26,11.5%),整体有效率(CA+PA)为88.5%,无严重并发症出现,26例患者0.5、1和2年生存率分别为96.1%、65.3%和23.0%,PFS为11.4个月,中位生存期(median survival time,MST)为17.8个月,OS为23.7个月。结论：经皮肝穿刺微波消融治疗局限性鼻咽癌肝转移瘤是微创、安全、有效的治疗方法。     

Surgery for lymph node metastases of medullary thyroid carcinoma: A review

Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells that occurs in hereditary and sporadic clinical settings. Metastatic spread commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the most effective option for curative therapy, reduction in tumor burden, or effective palliation. In patients undergoing preventative surgery for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is elevated. Preservation of parathyroid function in these young patients is of paramount importance. In patients with established primary tumors, systematic surgical removal of lymph node basins (compartmental dissection) should be guided by ultrasound mapping of lymph node metastases and level of serum calcitonin. A “berry‐picking” approach is discouraged. Newly approved targeted molecular therapies offer wider treatment options for patients with progressive or metastatic disease. Cancer 2016;122:358–366. © 2015 American Cancer Society.     

基于MRI的3100例鼻咽癌淋巴结转移规律分析

目的 应用MRI研究鼻咽癌淋巴结转移规律,为IMRT提供颈部照射范围依据。方法 前瞻分析2010—2013年间具有MRI检查的 3100例初治鼻咽癌患者资料。由鼻咽癌多学科综合治疗组阅片,分析淋巴结转移。淋巴结位置按RTOG分区2003版评判。结果 全组淋巴结转移占86.42%(2679/3100),其中分布在咽后外侧组 2012例 (64.90%,其中 6例 同时位于中央组), Ⅱ341例 (75.52%,其中 492例 淋巴结上界至C1一半水平、115例 到达颅底水平), Ⅱ798例 (58.00%),Ⅲ区 1184例 (38.19%),Ⅳ区 350例 (11.29%,其中 28例 下界超出RTOG规定的范围),Ⅴ区 995例 (32.10%,其中 91例 超出规定范围),Ⅰb 区 115例 (3.71%),腮腺区域 40例 (1.29%,均伴随同侧广泛淋巴结转移,且淋巴结总数≥6个)。只 6例 发生跳跃性转移(0.19%)。结论 ①鼻咽癌中央组咽后淋巴结转移较为罕见;②Ⅱ区淋巴结上界为颅底水平更合适;③鼻咽癌淋巴结转移从上至下规律性发展;④Ⅳ、Ⅴ区有转移时淋巴结可能超出RTOG规定范围;⑤同侧淋巴结广泛转移时可能出现腮腺区累及。     

甲状腺乳头状癌颈部淋巴结转移特点及清扫策略

背景与目的：目前,在甲状腺癌颈淋巴结清扫方面存有较大分歧。该研究总结甲状腺乳头状癌淋巴结转移的特点,为择区淋巴结清扫提供理论依据。方法：回顾性分析2006年7月—2014年8月收治的462例甲状腺乳头状癌患者病历资料,分析其淋巴结转移规律及其影响因素,评判cN0标准的准确性。结果：全组患者均行患侧中央区(Ⅵ区)淋巴结清扫,320例行侧颈区淋巴结清扫术(Ⅱ～Ⅴ区)或择区淋巴结清扫(Ⅱ～Ⅳ区中的部分或全部),90例行对侧中央区淋巴结活检。73.2%(338/462)符合cN0标准,病理证实其中有184例淋巴结转移,cN0标准误诊率达60.9%。颈部淋巴结总转移率为65.4%(302/462),侧颈区淋巴结转移率为42.6%(197/462),“跳跃转移”率为13.1%(42/320),对侧中央区淋巴结转移率为50%(45/90)。男性、肿瘤累及腺叶上1/3、肿瘤T3或T4、多中心病灶是淋巴结转移的危险因素。肿瘤累及腺叶上1/3是喉前淋巴结转移及“跳跃转移”的危险因素。喉前淋巴结转移及中央区淋巴结2个以上转移者侧颈区淋巴结转移率显著增加(分别为85.7%和83.3%, P＜0.05)。结论：现行cN0标准不能作为确定淋巴结清扫范围的依据;甲状腺乳头状癌易发生淋巴结转移,其中Ⅵ区淋巴结转移率最高,依次为Ⅲ区、Ⅱ区、Ⅳ区、Ⅴ区;初次手术应常规清扫患侧中央区淋巴结,建议将Ⅵ区淋巴结送冰冻病理;当喉前淋巴结有转移或Ⅵ区2个以上淋巴结转移时,或肿瘤累及腺叶上1/3者,有必要行侧颈区(或择区)淋巴结清扫;对侧中央区淋巴结转移率较高,需予以重视;中央区淋巴结再分亚区具有重要意义,应深入研究。     

Long-term survival in a patient with hepatocellular carcinoma with resection of a metastatic lymph node after percutaneous ethanol injection therapy

Lymph node (LN) metastases during operation for hepatocellular carcinoma (HCC), but not during operations for other cancer, as many surgeons can attest. We performed partial hepatectomy with LN dissection in a man with LN metstasis from HCC, and long-term survival was achieved. In December 1993, at another hospital, a tumor, 4.2cm in diameter, in this 73-year-old patient had been diagnosed as HCC. Transcatheter arterial embolization (TAE) was performed three times Eighteen months after the operation, a swollen LN was discovered at the hepatic hilum and was treated by TAE once and by transcatheter arterial infusion (TAI) twice. However, the level of alpha-fetoprotein gradually increased and so percutaneous ethanol injection therapy (PEIT) was performed. Nevertheless, serum PIVKA-II (protein induced by vitamin K absence or antagonist II) continued to rise. The patient was referred to our hospital for further treatment. He underwent S5 subsegmentectomy with LN dissection. Histologically, the primary lesion consisted entirely of necrotic tissue. However, in the resected LN, there was residual cancer tissue near its periphery. We concluded that dissection of the affected LN offered the only chance for long-term survival, and that PEIT should be avoided for a metastatic lymph node.     

Parotid lymph node metastases from squamous cell carcinoma of the skin

Nineteen parotid lymph node metastases from squamous cell carcinoma of the skin were treated, seven with irradiation and 12 with surgery and postoperative irradiation. In the group treated with combined therapy, size of nodal metastasis and extent were strong predictors of relapse. Further postoperative irradiation with 60 Gy is not adequate to control extensive parotid nodal disease. Finally, elective treatment of clinically negative parotid nodes is not necessary in patients who can be closely followed, since early nodal disease can be controlled readily.     

Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches.

Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA.

Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring ≥3?cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16–4.02, p?=?.01 for LR; OR 0.21, 95% CI 0.04–1.03, p?=?.05 for major complication rate). CA, DFS, and OS were similar between the two groups.

Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.