肝门淋巴结清扫术在原发性肝癌治疗中的价值

目的探讨原发性肝癌患者肝门淋巴结转移的相关因素、转移规律以及肝门淋巴结清扫对其预后的影响。方法对113例原发性肝癌患者在肝脏切除前常规进行肝门区域淋巴结清扫;对淋巴结转移的发生率、部位、术前术后诊断符合率以及对预后的影响进行分析。结果原发性肝癌113例中18例（15.93%）患者有淋巴结转移,其中肝细胞肝癌10例,胆管细胞癌7例,混合型肝癌1例。术中门静脉、胆总管及肝动脉周围的淋巴结均被清扫,清扫的淋巴结平均数为（3.8±1.6）个。有肝门淋巴结转移者中位生存时间为13个月,而无肝门淋巴结转移者中位生存时间为25个月,两者2年生存率分别为17.12%和49.83%,差异有统计学意义。结论淋巴结状态是肿瘤患者1个重要的预后因素,显著影响患者生存率。肝门淋巴结清扫是安全的,对没有慢性肝病的胆管细胞性肝癌患者应常规应用。     

125例三阴性复发转移乳腺癌首发转移模式的分析

目的：分析三阴性乳腺癌（TNBC）首次复发转移部位的特征,以指导复发转移性TNBC患者的治疗选择及管理。方法回顾性分析125例复发转移性TNBC患者的临床资料,对术后常见的复发转移部位和复发转移时间进行描述和统计,归纳其首次复发转移的模式。结果125例复发转移性TNBC患者中,首次单发转移部位以淋巴结和肺最为常见,分别占11.2%和5.6%;首发即为多发转移的比例高达79.2%,其中,含淋巴结、肺、骨、肝和脑转移的比例分别为52.8%、34.4%、27.1%、14.4%和6.4%,其他特殊部位（包含肾上腺等）转移32例（25.6%）。首发内脏转移（仅包含肝和肺）63例,占50.4%,其中6例同时有肝和肺转移;淋巴结转移比例最高,为64.0%;合并肺转移（40.0%）的患者明显多于肝转移（15.2%）的患者（P=0.000）。复发转移的时间多在术后2～3年,2年内复发者52例（41.6%）,2～3年复发者23例（18.4%）,3年以上复发者50例（40.0%）。结论 TNBC淋巴结、肺转移多见;脑转移作为首发部位也值得关注;TNBC多发转移比例高;多数在2～3年内复发。建议在辅助治疗后的随访中,除了关注淋巴结的检查外,还需关注肺部和颅脑的检查,以早期发现复发征象。     

An orthotopic mouse model of remetastasis of human colon cancer liver metastasis.

Whether liver metastases from colon cancer are capable of metastasizing to other sites is an important question in surgical oncology. To answer this question, we have developed a highly metastatic orthotopic transplant model of a liver metastasis from a human colon cancer patient in nude mice that targets the liver and lymph nodes. The metastatic human tumor was transplanted in athymic nude mice by surgical orthotopic implantation (SOI) of a liver metastasis from a colon cancer patient. The human colon tumor was then subsequently implanted in the colon by SOI or, in an additional series of nude mice, in the liver by surgical hepatic implantation (SHI). The mice were then explored over time for lymph node involvement beginning 10 days after implantation. After SOI, 100% of the animals had liver metastasis within 10 days, and subsequently, 19 days after SOI, all lymph nodes draining the liver were involved with metastasis without any retroperitoneal or lung tissue involvement. After SHI, all sites of lymphatic drainage of the liver, including portal, celiac, and mediastinal lymph nodes, were massively involved by metastasis in 100% of the animals as early as 10 days after tumor implantation on the liver. The results of this study demonstrate that liver metastases from colon cancer are capable of remetastasizing to other sites. This study thus suggests that in colon cancer patients with liver metastasis, mediastinal, celiac, and portal lymph node metastases originate from the liver metastasis and not, as previously thought, from primary colon cancer.     

肺癌伴腋窝淋巴结转移患者临床特点分析

  目的  总结肺癌伴腋窝淋巴结转移（axillary lymph node metastasis,ALNM）的临床特点。  方法  回顾性分析2007年1月至2013年12月浙江省肿瘤医院收治的91例肺癌ALNM的患者资料。采用列联表分析原发灶、颈部和锁骨上区淋巴结、纵隔淋巴结与腋窝淋巴结位置相关性,采用Kaplan-Meier法计算总生存,以及不同时期发现ALNM患者的生存情况,并行Log-rank检验,进一步进行Cox回归分析。  结果  肺癌伴ALNM发生率为0.63%;常见于腺癌患者,以周围型病灶多见,常累及胸膜并伴胸水,或发生胸壁转移。原发灶、颈部和锁骨上区淋巴结、纵隔淋巴结与腋窝淋巴结位置存在相关性。肺癌伴ALNM的患者中位生存时间为19.02个月,2年生存率为62.64%。首诊伴ALNM患者生存情况差于首诊无腋窝淋巴结患者,且为独立预后因子（P=0.003,RR=2.18,95%CI:1.330~3.572）。  结论  肺癌伴ALNM发生率低,其可能的转移途径为胸壁、淋巴引流及血行转移,首诊发现ALNM的患者生存情况更差。      

黏膜黑色素瘤原发部位与转移部位相关性分析

目的:探讨黏膜黑色素瘤的原发部位与转移部位的相关性及基因组学特征。方法:对经病理确诊为黏膜黑色素瘤的92例患者进行流行病学调查,对肿瘤原发部位及转移部位的相关因素进行总结分析。结果:头颈部为黏膜黑色素瘤高发部位46人（50%）,其次为泌尿生殖系统25人（27.17%）,肛管直肠21人（22.83%）。最常见转移部位均为区域淋巴结,头颈部、肛管直肠、泌尿生殖系统分别为63.04%、57.14%、32.00%;其次为肺转移,头颈部、肛管直肠、泌尿生殖系统分别为23.91%、19.05%、32.00%;肛管直肠和泌尿生殖系统来源黑色素瘤还易出现肝转移,分别为28.57%和20.00%。进行基因检测的33人中,BRAF V600E突变2例（6.06%）,CKIT突变1例（3.03%）,NRAS突变4例（12.12%）。结论:淋巴结转移最常见于头颈部黑色素瘤,其次为肛管直肠黑色素瘤,泌尿生殖系统来源黑色素瘤淋巴结转移比例较低;局部复发伴淋巴结转移在头颈部黑色素瘤约占1/3。基因检测及靶向治疗为更多患者带来生存获益。     

176例HER2阳性乳腺癌首发转移部位的分析

目的：分析176例HER2阳性乳腺癌患者首发转移部位与分子类型的关系,帮助判断HER2阳性乳腺癌治疗和随访策略。方法回顾性分析176例HER2阳性复发转移乳腺癌患者的临床资料,HER2阳性定义为免疫组化+++,或FISH扩增,病理为浸润性导管癌,分析术后首次复发转移的分布情况。结果176例患者中,中位年龄50岁（范围31~76岁）;首发肝转移占38.1%,其中单发肝转移占18.8%;肺转移29.0%,其中单发肺转移11.4%;肝和肺转移之间差异有统计学意义（P=0.045）;淋巴结转移42.6%（包括锁骨上下淋巴结、腹腔淋巴结、纵隔淋巴结等）,其中单发淋巴结转移19.9%;骨转移25.1%,其中单发骨转移6.3%;胸壁复发14.3%,包括仅胸壁复发的8.0%;含脑转移的4例（2.3%）;还有一些少见部位转移：卵巢转移1例,子宫转移1例。首发内脏转移占59.7%,首发即多部位转移的占34.7%。结论 HER2阳性乳腺癌转移有其特殊性,内脏和淋巴结转移多见,内脏转移中肝转移更常见。所以在辅助治疗后的随访中,除了要关注淋巴结的状况外,还要关注内脏的检查,尤其是肝和肺。同时也间接地说明不同的分子类型转移的方式是不同的,所以术后辅助化疗也应该考虑器官转移的特殊性,采取相对应的药物。     

Causes of oral tongue cancer treatment failures. Analysis of autopsy cases.

Eighty-three autopsy cases of squamous cell carcinoma of the oral tongue were reviewed to identify retrospectively the causes of treatment failure. The cure rate for the primary cancers at autopsy was 48.2% (40 of 83). Regional lymph node metastases were found in 71.1% (59 of 83). Regional metastases and/or juxtaprimary recurrence frequently spread continuously and diffusely, forming bulky neck tumors in 38.6% (32 of 83). The incidence of distant lymph node metastasis (below the clavicle) and hematogenous metastasis was 35.4% (29 of 82) and 58.5% (48 of 82), respectively. The lung was the most common site of hematogenous metastases (52.4%, 43 of 82). Hematogenous metastasis occurred more frequently in the younger age group (less than 40 years of age; P = 0.03). Distant lymph node metastases were identified in the lung hilar, bifurcation, and paratracheal nodes in 89.7% (26 of 29) and had a statistically significant association with lung hematogenous metastasis. Univariate analysis revealed that gross appearance, tumor stage, clinical stage, presence of cervical lymph node metastasis, and interval from N0 to NX were significant predictors of survival time (duration from initial treatment to death). Rupture of the neck vessels was fatal in eight patients (9.6%), and hypercalcemia was seen in six (7.2%). Pulmonary infection was the direct cause of death in 33.7% of patients (28 of 83). Secondary malignant lesions occurred in 22.9% (19 of 83).     

Metastatic patterns in adenocarcinoma

BACKGROUND: Unique metastatic patterns cited in the literature often arise from anecdotal clinical observations and autopsy reports. The authors analyzed clinical data from a large number of patients with histologically confirmed, distant-stage adenocarcinoma to evaluate metastatic patterns. METHODS: Tumor registry data were collected between 1994-1996 on 11 primary tumor sites and 15 metastatic sites from 4399 patients. The primary and metastatic sites were cross-tabulated in various ways to identify patterns, and the authors developed algorithms by using multinomial logistic regression analysis to predict the locations of primary tumors based on metastatic patterns. RESULTS: Three primary tumors had single, dominant metastatic sites: ovary to abdominal cavity (91%), prostate to bone (90%), and pancreas to liver (85%). The liver was the dominant metastatic site for gastrointestinal (GI) primary tumors (71% of patients), whereas bone and lung metastases were noted most frequently in non-GI primary tumors (43% and 29%, respectively). In a study of combinations of liver, abdominal cavity, and bone metastases, 86% of prostate primary tumors had only bone metastases, 80% of ovarian primary tumors had only abdominal cavity metastases, and 74% of pancreas primary tumors had only liver metastases. A single organ was the dominant source of metastases in 7 sites: axillary lymph node from the breast (97%), intestinal lymph node from the colon (84%), thoracic lymph node from the lung (66%), brain from the lung (64%), mediastinal lymph node from the lung (62%), supraclavicular lymph node from the breast (51%), and adrenal gland from the lung (51%). CONCLUSIONS: The algorithms that the authors developed achieved a cross-validated accuracy of 64% and an accuracy of 64% on an 1851-patient independent test set, compared with 9% accuracy when a random classifier was used.     

胃癌术后复发转移的超声检查

目的探讨超声检查在胃癌术后随访中的临床意义.方法回顾分析251例胃癌根治术后1个月至10年胃内外复发和转移者的随访性超声检查资料.结果残胃复发56例(22.3%),腹腔淋巴结转移59例(23.5%),浅表淋巴结转移11例(4.4%),腹水64例(25.5%),腹壁转移9例(3.6%),肝转移61例(24.3%),卵巢转移7例(2.8%),胰腺及后腹膜转移32例(12.7%),脾转移3例(1.2%),门静脉癌栓3例(1.2%),下腔静脉癌栓2例(0.8%),肾转移1例(0.4%),甲状腺转移1例(0.4%).结论超声检查在胃癌术后随访中能比较及时发现胃内外复发和转移病灶,为胃癌术后抗复发治疗提供影像学依据.     

以医院登记为基础的初诊未转移肺癌患者的转移部位分布及生存分析

背景与目的：通过分析以医院登记为基础的肺癌转移患者的转移部位分布和转移后生存状况,为肺癌患者的治疗和生存管理提供真实世界数据支持。方法：纳入2008—2017年于复旦大学附属肿瘤医院初诊未发生转移但在随访过程中发生转移的1 490例肺癌患者。通过患者复诊病史资料、电话随访及死因数据链接等方式收集生存随访信息。研究诊断时年龄、性别和组织学亚型对转移分布的影响。应用Kaplan-Meier法估计不同转移部位的转移后总生存（overall survival,OS）率。结果：中位随访时间为40.8个月,随访期间全死因死亡937例。67.7%的患者仅发生单部位转移,而32.3%的患者有多部位转移。常见的转移部位依次为骨（33.8%）、脑（33.6%）、肺（22.8%）、肝（12.0%）和肾上腺（3.7%）。女性患者更容易发生脑转移（37.8% vs 31.4%）,年轻患者更容易发生多部位转移,小细胞癌容易发生脑转移（47.2%）和肝转移（20.9%）。肺癌肺转移患者生存相对最好（1、3和5年OS率分别为78.3%、47.1%和29.5%）,肝转移患者生存相对最差（1、3和5年OS率分别为46.4%、15.2%和3.6%）。结论：肺癌转移患者骨、脑转移比例较高,转移部位分布与性别、诊断时年龄和组织学亚型相关,不同转移部位的预后具有差异性。未来可针对不同转移部位进行机制或临床治疗方案研究,以改善晚期肺癌患者的预后。     

Patterns of metastasis in uterine sarcoma. An autopsy study

The autopsy findings of 73 patients with uterine sarcoma were studied to determine the sites and possible modes of metastasis. Homologous mixed mesodermal tumors were the most frequent (41%) followed by leiomyosarcoma (26%), heterologous mixed mesodermal tumor (18.3%), stromal sarcoma (12%), and endolymphatic stromal myosis (3%). The peritoneal cavity and omentum were the most frequently involved sites (59%), followed by the lung (52%), pelvic lymph nodes (41%), paraaortic lymph nodes (38%), and liver parenchyma (34%). The presence of lung metastasis was not associated with pelvic or paraaortic node metastasis or intraperitoneal disease. Metastasis to other distant sites including the brain, heart, kidney, and bone were independent of pelvic and paraaortic nodal metastasis or intraperitoneal disease. Metastatic sites were not different among various histologic types. Distant metastatic sites were statistically associated with lung metastasis. Hematogenous metastasis best explains this metastatic pattern and adjuvant systemic therapy seems indicated.     

非小细胞肺癌淋巴结转移与临床病理特征及预后的相关性分析

目的 探讨非小细胞肺癌（NSCLC）患者淋巴结转移与临床病理特征及预后的相关性。方法 回顾性分析2010年1月至2013年8月福建省立医院收治的154例接受肺叶或全肺切除+系统性淋巴结清扫术的NSCLC患者的临床资料,探讨肺癌患者胸内各组淋巴结转移频度,分析淋巴结转移与肺癌类型、原发部位、临床病理特征以及预后的相关性。结果 154例肺癌患者中,共清扫胸内淋巴结748组,其中有133组淋巴结存在转移癌,74例发生胸内淋巴结转移,转移率为48.1％。第4、5、6、10、11组淋巴结转移频度高于第1、2、3、7、8、9组淋巴结。中央型肺癌患者第10组淋巴结转移率明显高于周围型肺癌患者（51.2% vs. 28.4%,P＜0.05）。肺下叶癌患者第7组淋巴结转移率明显高于肺上（中）叶癌患者。Ⅲ期肺癌患者总淋巴结转移率、跳跃性N2转移率明显高于Ⅰ、Ⅱ期肺癌患者,中央型肺癌患者总淋巴结转移率明显高于周围型肺癌患者。将淋巴结转移分为3组：无淋巴结转移（Ng0）,1～3组淋巴结转移（Ng1）,4～6组淋巴结转移（Ng2）。生存分析提示淋巴结分组、淋巴结分期、T分期、肺癌类型与肺癌预后显著相关。Cox回归分析显示淋巴结分组、淋巴结分期及T分期为影响肺癌患者预后的独立因素。结论 肺癌淋巴结转移多以肺叶、肺门或肺根部淋巴结转移频度高;肺癌淋巴结转移率与TNM分期、肺癌类型相关;淋巴结转移组数、淋巴结分期及T分期与肺癌患者预后密切相关。     

Clinical characteristics of hepatocellular carcinoma with an extensive lymph node metastasis at diagnosis

Lymph node metastasis is reported to occur only rarely in patients with hepatocellular carcinoma (HCC). However, we have encountered patients with HCC with extensive lymph node metastases. Here we report the clinical characteristics of HCC associated with extensive lymph node metastasis at diagnosis. Ten patients with HCC in whom extensive lymph node metastases were observed at the initial medical examination were studied. The degree of disease progression was documented with ultrasonography and dynamic computed tomography. Primary liver lesions were classified in the following three types according to imaging characteristics: type A, massive type with portal vein tumor thrombus; type B, multinodular, nonencapsulated type; and type C: multinodular, encapsulated type. In patients with types A and B HCC, a large number of lymph node metastases was observed, whereas a small number of isolated metastases was observed in patients with type C. All patients with types A and B HCC died within 7 months (median survival, 4 months), whereas those with type C survived for 4 years or more after treatment with transcatheter arterial chemoembolization and surgery. A relationship exists between the type of primary HCC lesions and the pattern of lymph node metastasis. Long-term survival may be expected for patients with isolated lymph node metastases.     

非小细胞肺癌淋巴结转移规律分析

背景与目的:淋巴结转移是肺癌最常见的转移途径,影响分期和预后,胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在对非小细胞肺癌(non-small cell lung cancer,NSCLC)术后淋巴结转移特点进行分析,为手术选择淋巴结清扫范围提供参考依据。方法:205例NSCLC手术病例,比较胸内各组淋巴结转移情况,从肿瘤原发部位和肿瘤组织类型两方面比较各分组之间淋巴结转移率及跳跃性转移率的差异。结果:205例NSCLC术中共清扫胸内淋巴结977组共3 577枚,平均每例17.4枚。其中220组共508个淋巴结存在转移,有胸内淋巴结转移病例98例,转移率为47.8%。发生跳跃性转移35例,转移率为17.1%。第4、5、7、10、11组淋巴结转移频度较高。肺上叶癌比肺下(中)叶癌更容易发生跳跃性转移。腺癌的淋巴结转移率明显高于鳞癌。结论:NSCLC的淋巴结转移多数是按肺内淋巴结到肺门淋巴结再到纵隔淋巴结的顺序进行逐级转移,纵隔淋巴结的跳跃性转移比较常见。NSCLC的淋巴结转移特点与肿瘤的原发部位、肿瘤组织类型有密切关系。手术应根据淋巴结转移规律对胸内淋巴结进行系统性清扫,特别注意转移频率较高的第4、5、7、10、11组淋巴结。     

Exploring the role of resection of extrahepatic metastases from hepatocellular carcinoma

The role of hepatic resection, taking into consideration the functional status of the liver, for localized hepatocellular carcinoma (HCC) is an established curative treatment. In advance disease, a variety of interventional-based liver-directed therapies and more recently systemic therapy with sorafenib are available to treat unresectable tumors. Extrahepatic Metastasis (EHM) of HCC may occur at initial diagnosis or during recurrence following treatment. This may occur with or without concurrent intrahepatic disease. We reviewed the published works on surgical metastasectomy for common sites of EHM of HCC metastases. It appears from the studies reported in the literature that from selected cases reported, long-term survival may be achieved from resecting metastasis at sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. The encouraging results presented demonstrate that highly selected fit patients may be suitable candidates for these radical curative pursuits. It is likely that indications for resection of EHM HCC may benefit patients with limited isolated metastasis, who have a preserved liver function, and whose primary tumor has been adequately controlled. A registry study to pull the results of case reports and institutional experiences may be useful in cumulating evidence of this practice.     

Risk of prostate carcinoma death in patients with lymph node metastasis

BACKGROUND: The presence of lymph node metastasis is a poor prognostic sign for patients with prostate carcinoma. Results of published reports on survival among patients with lymph node metastasis are difficult to assess because of treatment selections. The extent to which lymph node status will have an impact on a patient's survival is uncertain. METHODS: The authors analyzed 3463 consecutive Mayo Clinic patients who underwent radical prostatectomy and bilateral pelvic lymphadenectomy for prostate carcinoma between 1987 and 1993. Of these patients, 322 had lymph node metastasis at the time of surgery, and 297 lymph node positive patients also received adjuvant hormonal therapy within 90 days of surgery. The progression free rate and the cancer specific survival rate were used as outcome endpoints in univariate and multivariate Cox proportional hazards models. The median follow-up was 6.3 years. Progression was defined by elevation of serum prostate specific antigen (PSA) > or = 0.4 ng/mL after surgery, development of local recurrence, or distant metastasis documented by biopsy or radiographic examination. RESULTS: The 5-year and 10-year progression free survival rates (+/- standard error [SE]) for patients with lymph node metastasis were 74% +/- 2% and 64% +/- 3%, respectively, compared with 77% +/- 1% and 59% +/- 2%, respectively, for patients without lymph node metastasis. The 5-year and 10-year cancer specific survival rates were 94% +/- 1% and 83% +/- 4%, respectively, compared with 99% +/- 0.1% and 97% +/- 0.5%, respectively, for patients without lymph node metastasis. Among patients with a single lymph node metastasis, the 5-year and 10-year cancer specific survival rates were 99% +/- 1% and 94% +/- 3%, respectively. After adjustment for extraprostatic extension, seminal vesicle invasion, Gleason grade, surgical margins, DNA ploidy, preoperative serum PSA concentration, and adjuvant therapy, the hazard ratio for death from prostate carcinoma among patients with a single lymph node metastasis compared with patients who were without lymph node metastasis was 1.5 (95% confidence interval, 0.5-5.0; P = 0.478), whereas the hazard ratio for death from prostate carcinoma was 6.1 (95% confidence interval, 1.9-19.6; P = 0.002) for those with two positive lymph nodes and 4.3 (95% confidence interval, 1.4-13.0; P = 0.009) for those with three or more positive lymph nodes. There was no significant difference in the progression free survival rate among patients with or without lymph node metastasis in multivariate analysis after controlling for all relevant variables, including treatments (hazard ratio,1.0; 95% CI, 0.7-1.3; P = 0.90). CONCLUSIONS: Patients with prostate carcinoma who have multiple regional lymph node metastases had increased risk of death from disease, whereas patients with single lymph node involvement appeared to have a more favorable prognosis after radical prostatectomy and immediate adjuvant hormonal therapy. Excellent local disease control was achieved by using combined surgery and adjuvant hormonal therapy in patients with positive lymph nodes.     

178例三阴性乳腺癌的临床病理特征及生存分析

 目的
探讨三阴性乳腺癌(TNBC)患者的临床病理特点、生存情况和预后影响因素。方法收集雌激素受体(ER)、孕激素受体
(PR)和人表皮生长因子受体2(HER2)均阴性的178例乳腺癌患者的临床病理资料,观察其长期生存状况。分析其临床
特点及影响预后的因素。结果有乳腺癌家族史的患者4例。主要病理类型为浸润性导管癌(155/178,87.1%）。组织
学分级多为Ⅲ级(53.1%）。中位肿瘤最大径2.8 cm(0.2～12 cm）,T1、T2期患者160例占89.9%。108例(61.7%）
患者无淋巴结转移。分期为Ⅰ、Ⅱ、Ⅲ期的患者分别有60例(33.7％)、81例(45.5％)、31例(17.4％)。58例(48.3
％)患者p53阳性。中位随访时间74月(10～156月）,5年
无病生存(DFS)和总生存(OS)率分别是76.9%和86.1%。单因素分析显示T分期、临床分期及淋巴结转移对DFS和OS
均有显著影响。多因素分析显示,淋巴结转移是DFS及OS的独立影响因素。而术后分期是OS的影响因素。共有41例
患者出现复发转移及第二原发肿瘤,常见转移部位依次为骨转移、局部复发或同侧锁骨上淋巴结转移、肺或胸膜转
移、肝转移及脑转移。结论 本组TNBC肿瘤直径较小,组织学分级低分化比例较高(53.1%）。复发转移以骨转移、
局部复发及肺转移为主。淋巴结转移及术后分期是总生存的独立危险因素。     

不同影像学检查对胰腺癌血管浸润及淋巴结转移的前瞻性评估

目的 评价超声(US)、螺旋CT(HCT)、核磁共振成像(MRI)和内镜超声(EUS)等4种影像学检查,对胰腺癌肿瘤局部血管浸润及淋巴结转移的预测价值.方法 对68例胰腺癌患者术前分别进行US、HCT、MRI和EUS检查,记录其肿瘤局部血管浸润及淋巴结转移的手术病理结果,对影像学检查与手术病理结果的一致性和相关性进行分析.结果 (1)US对于肿瘤侵犯下腔静脉、脾动脉、脾静脉的评估与手术病理结果中度一致,HCT对肿瘤侵犯肠系膜上静脉、门静脉、脾静脉的评估结果与手术病理结果高度一致,对肠系膜上动脉、下腔静脉、脾动脉、肝总动脉、肝固有动脉、腹腔动脉干、腹主动脉的评估结果与手术病理结果中度一致.MRI对肿瘤侵犯肠系膜上动脉、肠系膜上静脉、脾动脉、脾静脉的评估结果与手术病理结果中度一致.EUS对肿瘤侵犯脾静脉的评估结果与手术病理结果高度一致,对肿瘤侵犯肠系膜上静脉的评估结果与手术病理结果中度一致.(2)对淋巴结转移的评估,EUS具有最高的敏感性(75.0%)、准确性(87.5%)和阴性预测值(91.7%).HCT和MRI的敏感性明显低于EUS,分别为37.5%和35.3%,US敏感性最低,仅为18.7%.多因素Logistic回归分析结果显示,EUS对淋巴结转移具有独立预测价值(OR=34.50,95%CI:6.54～182.09).结论 HCT评估胰腺癌肿瘤局部血管浸润与手术发现一致性最好,EUS对胰腺癌淋巴结转移具有独立预测价值.     

Childhood and adolescent thyroid carcinoma

OBJECTIVES: This analysis was performed to evaluate the influence of clinical and treatment factors on local tumor control, control of distant metastasis, survival, and complications in children and adolescents with thyroid carcinoma. METHODS: The records of 56 children and adolescents with papillary and follicular carcinoma of the thyroid were reviewed. They ranged in age from 4 to 20 years. There were 43 females and 13 males. At diagnosis, 15 (27%) patients had disease confined to the thyroid, 34 (60%) had additional lymph node metastasis to the neck or upper mediastinum, and 7 (13%) also had lung metastasis. Treatment consisted of a total thyroidectomy in 48 patients, a subtotal thyroidectomy in 4 patients, and a lobectomy in 4 patients. All 56 patients received postoperative thyroid hormone suppressive therapy. (131)I was administered to 82% (46 of 56) of patients after their initial surgery. RESULTS: The overall survival rate was 98% with a follow-up of 0.6-30.7 years (with a median follow-up of 11.0 years). The one death that occurred in this patient population was the result of a congenital heart defect and was unrelated to thyroid carcinoma. The 10-year progression-free survival rate was 61%. Nineteen patients (34%) experienced a recurrence of their thyroid carcinoma. The time to first recurrence of disease ranged from 8 months to 14.8 years (mean, 5.3 years). None of those with disease confined to the thyroid developed recurrent disease. The recurrence rate was 50% (17 of 34) in patients with lymph node metastasis and 29% (2 of 7) in patients with lung metastasis (P = 0.02). Tumor characteristics were evaluated for time to first recurrence utilizing the logistic likelihood ratio test to predict disease recurrence. Thyroid capsule invasion (P = 0.02), soft tissue invasion (P = 0.03), positive margins (P = 0.006), and tumor location at diagnosis (thyroid only vs. thyroid and lymph nodes vs. thyroid, lymph nodes, and lung metastasis, P = 0.02) were significant for developing recurrent disease. Patients younger than 15 years old at diagnosis were more likely to have more extensive tumor at diagnosis than patients who were 15 years and older (thyroid only vs. thyroid and lymph nodes vs. thyroid, lymph nodes, and lung metastasis, P = 0.02). CONCLUSION: Carcinoma of the thyroid in children and adolescents has little risk of mortality but a high risk of recurrence. Younger patients present with a more advanced stage of disease and are more likely to have disease recurrence. Total thyroidectomy and lymph node dissection, followed by postoperative (131)I therapy, thyroid hormone replacement (suppressive) administration, and diligent surveillance are warranted.     

Evaluation of hepatic resection for metachronous liver metastases from gastric cancer

To evaluate the effect of hepatic resection for metachronous liver metastases after resection of gastric cancer, the clinicopathological factors of gastric cancer, state of liver metastasis, surgical procedures for liver metastasis, and remote survival were studied. Between 1989 and 2001, 30 consecutive patients underwent hepatic resections (36 resections) for metachronous liver metastases. The patients included 25 men and 5 women, and the median age was 60 years old (range 46-86 years old). As for curability, curative A/curative B was 10/20, and H0/H1/H2 was 25/3/2. The mean period from initial surgery to the liver resection was 19.3 months (range 6.3-65.2 months), and the liver metastatic conditions were H1 for 27 patients and H2 for 9 patients. By number of liver metastases, 27 patients had 1 lesion, 24 patients had 2, and 5 patients had more than 3 lesions. Twenty-nine patients were negative and 7 were positive for lymph node metastasis. A partial resection was performed for 13 patients, a subsegmentectomy for 3 patients, a segmentectomy for 7 patients, a lobectomy for 8 patients, and an extended lobectomy for 5 patients. For all patients except those who had other causes of death, the overall mean survival time was 702 days and the 5-year survival rate was 26.4%. There were four 5-year survivors after hepatic resection. In conclusion, the main prognostic factor after resection of metachronous liver metastases was the existence of lymph node metastasis, and the remote survival of patients with abdominal para-aortic lymph node recurrence was poor. The type of liver resection was not a predictor of survival. The resection of liver recurrence was evaluated clinically, but we should maintain strict criteria and select adequate surgical procedures.