乳腺癌骨转移患者生存分析

目的 提高对乳腺癌骨转移患者预后影-向因素的进一步认识，指导临床个体化治疗。方法 回顾分析有完整病例资料的乳腺癌骨转移患者68例。结果 68例患者的中位生存期20个月，乳腺癌骨转移合并肝脏和/或肺转移同时存在时，患者的中位生存期13．5个月；乳腺癌骨转移不合并肝脏和/或肺转移患者的中位生存期为26个月；仅有骨转移而不合并其他脏器转移的患者的平均生存时间为44.2个月。结论 乳腺癌转移患者中肝脏和/或肺转移是预后不良指标。骨转移而不合并其他转移的患者生存期较长，其次是骨转移合并肺转移者、合并淋巴结转移、骨转移合并多个脏器转移者及合并肝脏转移者。     

食管鳞癌患者远处转移部位与预后的相关性及生存分析

目的:探讨食管鳞癌患者远处转移部位与预后的相关性及生存分析。方法:从SEER数据库中提取2010年至2015年共439例食管鳞癌伴远处转移患者的临床资料,回顾性分析比较食管鳞癌远处转移部位与预后的相关性,通过χ2检验比较两组变量的差异,采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行单因素分析,COX回归进行多因素分析。结果:肺转移、骨+肺转移、肝+肺转移患者预后较好;骨转移、脑转移、骨+脑转移、骨+脑+肝+肺转移患者预后较差。单因素分析显示:年龄、原发灶部位、T分期、手术情况、多器官转移情况与食管鳞癌远处转移患者的预后有关（P＜0.05）;多因素分析显示:年龄、手术情况与多器官转移情况是影响食管鳞癌远处转移患者总生存时间（OS）的独立危险因素。结论:食管鳞癌伴远处转移的患者整体预后较差,但年龄在60~69岁区间、接受手术治疗与较好的预后相关。仅单器官转移的食管鳞癌患者中,骨转移、脑转移患者预后较差;合并多器官转移的患者中,骨+脑转移、骨+脑+肝+肺转移患者预后较差。     

甲状腺球蛋白与分化型甲状腺癌转移灶的关系分析

目的：探讨甲状腺球蛋白与分化型甲状腺癌转移灶的关联性。方法选取分化型甲状腺癌患者212例,根据患者在第三次131 I治疗时是否出现转移及转移灶的不同将其分为无转移组、淋巴结转移组、肺部转移组、骨转移组、颈部转移组及其它转移组。比较各组患者血清中甲状腺球蛋白水平。结果淋巴结转移组、肺部转移组、骨转移组、颈部转移组及其它转移组患者血清中甲状腺球蛋白水平要高于无转移组（ P＜0．05）。 Spearman秩相关分析显示,甲状腺球蛋白水平与转移灶大小和数目呈明显正相关性,且差异均有统计学意义（R＝2．317,P＜0．05;R＝3．018,P＜0．05）。结论甲状腺球蛋白在判断分化型甲状腺癌患者是否出现转移灶及转移灶大小和数目等方面具有一定的参考价值。     

基于CT图像的非小细胞肺癌锁骨上淋巴结转移规律及放疗靶区探讨

目的:探寻未手术及放疗的肺癌行根治性或预防性放疗锁骨上淋巴结靶区勾画的范围。方法:将锁骨上区域按主要解剖转移途径分区,回顾性分析肺癌在锁骨上淋巴结的转移分布特点,进一步精确肺癌在锁骨上淋巴结靶区勾画范围。结果:锁骨上淋巴结转移的肺癌病例中有双侧锁骨上淋巴结的占31%;锁骨上淋巴结转移在Ⅰ区出现的占22%,多数与其他区（如Ⅱ区及Ⅳ区）同时出现;锁骨上Ⅱ区淋巴结转移占绝大部分,为99%,与他区一同出现或单独出现。锁骨上Ⅲ区出现淋巴结转移的约3.9%,且全部合并有Ⅱ区淋巴结转移,多伴有大的肿瘤负荷,纵隔及锁骨上广泛的淋巴结转移。Ⅳ区出现淋巴结转移的占16%,均合并有Ⅰ区或Ⅱ区淋巴结转移。结论:Ⅰ区及Ⅱ区是肺癌锁骨上淋巴结转移的主要集中区,临床上考虑进行锁骨上预防性照射时建议包括Ⅰ、Ⅱ区;当Ⅱ区存在淋巴结转移时,结合患者耐受性,考虑Ⅳ区照射。     

乳腺癌移植转移模型的建立与应用

乳腺癌是女性最常见的恶性肿瘤之一,而转移是乳腺癌患者死亡的主要原因。乳腺癌转移模型是筛选乳腺癌转移相关基因、探讨肿瘤转移分子机制和评价抗转移实验性治疗疗效的重要工具。乳腺癌转移模型主要包括自发性转移模型、诱发性转移模型、转基因肿瘤转移模型和移植性转移模型。移植性肿瘤转移模型以其操作简单、重复性好和生物学性状稳定等优点应用最为广泛。乳腺癌移植性转移模型按建立方法可分为实验性转移模型和自发性转移模型。乳腺癌实验性转移模型是直接将瘤细胞注入血液循环系统后在远处驻留增殖形成转移灶,实验周期短、转移发生率高,费用低,但缺少原发灶的形成和肿瘤细胞从原发灶逃逸的过程。乳腺癌自发性转移模型是将瘤细胞或瘤块接种于皮下、肌肉和乳腺脂肪垫组织,在局部形成原发癌后自发转移,涉及了从原发灶产生到转移灶形成的乳腺癌转移的完整过程,是较好的研究乳腺癌转移机制的工具。近年来对移植转移模型转移灶的检测有了较大进展,采用活体动物成像技术不但能在肿瘤发生早期探测到各组织器官内的微小转移灶,还可以动态监测肿瘤细胞在动物体内的转移状态。本文对乳腺癌移植性转移模型的分类、模型建立方法、转移灶的检测,以及该类模型在乳腺癌转移分子机制和抗转移治疗研究中的应用进行综述。     

浸润性宫颈癌治疗后淋巴道转移的临床分析

背景与目的:淋巴道转移是宫颈癌治疗后的主要复发方式.本研究探讨浸润性宫颈癌治疗后出现淋巴道转移的特点、治疗及预后.方法:回顾性分析1990～2000年间浙江省肿瘤医院收治的123例治疗后出现淋巴转移的浸润性宫颈癌患者,初治以单纯手术治疗5例,手术辅以放射治疗45例,单纯放射治疗73例.所有患者接受了以局部放疗和/或全身化疗为主的挽救性治疗.结果:治疗后出现淋巴转移的部位依次为锁骨上淋巴结95例(77.2%).腹主动脉旁淋巴结62例(50.4%),腹股沟淋巴结12例(9.8%),腋窝淋巴结3例(2.4%).首次治疗至出现淋巴转移的中位时间间隔为14个月,间隔≤6个月及＞6个月的患者分别为36例及87例.本组总的3年生存率为15.0%.5年生存率为1.5%.单纯淋巴结转移者76例,淋巴结转移伴血道转移和/或盆腔复发者47例,3年生存率分别为23.1%和4.7%.多因素分析显示,首次治疗至出现转移的时间间隔及有无伴随血道转移和/或盆腔复发为预后因素.结论:宫颈癌治疗后出现单纯淋巴道转移者再治疗可获得较好的疗效.     

Clinical significance of skip metastasis in patients with gastric cancer

Background Metastasis appearing to bypass or skip tiers of lymph nodes (LNs) has been referred to as skip metastasis. The clinical impact of skip metastasis in gastric cancer remains unclear. Methods In patients with gastric cancer, the clinicopathological features and postoperative prognoses of 21 patients with skip metastasis were evaluated and compared with findings in patients with group 1 (N1) or group 2 (N2) LN metastasis. Results Of the 21 patients with skip metastasis, 9 patients had metastasis in the LN along the common hepatic artery (No. 8a), 8 patients had metastasis in the LN along the left gastric artery (No. 7), 2 patients had metastasis in LNs No. 7 and No. 8a, 1 patient had metastasis in the LN at the splenic hilum (No. 10), and 1 patient had metastasis in LN No. 10 and the LN along the splenic artery (No. 11). The mean diameter of the tumors in the patients with skip metastasis was 5.7 ± 2.4 cm, which was significantly smaller than those in the N1 patients (7.9 ± 4.1 cm) and N2 patients (9.3 ± 4.6 cm). The incidence of serosal invasion, lymphatic vessel invasion, and peritoneal metastasis was lower in patients with skip metastasis compared with N2 patients. The 5-year survival rates were 70.2%, 62.0%, and 31.2% in patients with skip metastasis, patients with metastasis in group 1 LNs, and those with metastasis in group 2 LNs, respectively. The prognosis of patients with metastasis in group 2 LNs was significantly worse than that of patients with either skip metastasis (P = 0.0029) or metastasis in group 1 LNs (P < 0.0001). Conclusion Our data indicate that both the clinicopathological characteristics and the prognoses of patients with skip metastasis were similar to those of patients with N1 LN metastasis, but these features were not similar to those in patients with N2 LN metastasis. The sites of skip metastasis presented in the current study may be the key for applying the concept of the sentinel node in gastric cancer.     

KRAS 基因突变与结直肠癌转移模式相关性的研究简

目的：研究结直肠癌患者KRAS基因突变与根治后转移的相关性。方法：检测132例结直肠癌根治术患者石蜡组织中的KRAS基因,回顾性分析患者根治术后3年内转移、复发情况,采用单因素及多因素分析KRAS突变与转移的相关性。结果：各转移组KRAS基因突变率分别为：肺（63．2％）、脑（66．7％）、肝（30．4％）及无转移组（34．7％）。单因素分析提示肺、脑转移组KRAS基因突变率显著高于肝转移组及无转移组（P〈0．05）。纳入年龄和性别校正后采用Logistic回归分析提示KRAS突变显著增加肺转移及脑转移风险（P〈0．05）,而肝转移风险无显著升高（P〉0．05）。结论：结直肠癌转移模式与KRAS突变有关,检测KRAS突变状态有助于更加有效地制定复发监视策略。     

Increased rate of brain metastasis with trastuzumab therapy not associated with impaired survival

Trastuzumab is important for treatment of metastatic breast cancer patients with tumors that overexpress HER2/neu, but its penetration to the brain is poor. The aims of this study are to determine the prevalence of bone and brain metastasis during therapy, to compare the survival of breast cancer patients with brain metastasis who received trastuzumab to those patients not receiving trastuzumab, and to assess the impact of brain metastasis on the overall survival of trastuzumab patients. Of 103 patients treated with trastuzumab, 16 had brain metastasis and 43 had bone metastasis at the beginning of trastuzumab. The control group consisted of 196 patients with metastatic breast cancer who had never received trastuzumab. Six had brain metastasis and 75 had bone metastasis at the beginning of therapy. During therapy, only 9 of 60 trastuzumab patients (15%) developed bone metastasis, while 170 of 186 control patients (91%; c2 = 129.8, P < 0.0001) developed bone metastasis. In addition, 22 of 87 trastuzumab patients (25%) and 58 of 190 control patients (31%) subsequently developed brain metastasis. Control patients without brain metastasis experienced significantly better survival (median survival = 928 days) than those with brain metastasis (median survival = 639 days, c2 = 8.34, P < 0.005). There was no difference in survival for trastuzumab-treated patients if they acquired brain metastasis (median survival = 1400 days) or no brain metastasis (median survival > 2000 days, c2 = 0.12, P > 0.05). Patients receiving trastuzumab were unlikely to develop new bone metastasis but were as likely as control patients to develop brain metastasis. However, patients who developed brain metastasis experienced better survival compared with those patients with brain metastasis who never received trastuzumab.     

食管癌纵隔喉返神经旁淋巴结转移对颈部淋巴结转移的影响

目的 探讨食管癌术后颈部淋巴结转移的危险因素。方法 用Logistic法回归分析本院胸段食管鳞癌术后区域淋巴结转移患者 126例的临床资料,探寻食管癌术后颈部淋巴结转移的危险因素。结果 全组颈部淋巴结转移比例为43.7%(55/126)。Logistic回归分析显示原发部位、T分期、N分期、病理分级、淋巴结转移率、淋巴结转移度、淋巴结转移区域数与颈部淋巴结转移均无关。上纵隔右、左1区淋巴结转移是颈部右、左Ⅰ区淋巴结转移的高危因素(χ²=12.14、9.27,P=0.000、0.002),左纵隔喉返神经区淋巴结转移可降低右颈部Ⅰ区淋巴结转移风险(χ²=6.04,P=0.014),颈部Ⅲ区和上纵隔2区淋巴结转移是颈部 Ⅱ_a区淋巴结转移的高危因素(χ²=14.56、8.27、8.02、3.93,P=0.000、0.004、0.005、0.047)。     

Ⅲa-N2非小细胞肺癌纵隔淋巴结转移综合模式的预后价值

  目的  研究跳跃转移与肺叶特异性转移对Ⅲa-N2非小细胞肺癌（non small cell lung cancer,NSCLC）的预后意义。  方法  天津医科大学肿瘤医院2008年1月至2009年12月行完全切除和系统淋巴结清扫的218例pN2期NSCLC被纳入本研究。根据有无N1区淋巴结转移将分为连续转移与跳跃性转移;根据纵隔淋巴结转移范围是否超出肺叶特异性区域分为纵隔广泛转移与肺叶特异性转移。对各组的总生存（overall survival,OS）和无病生存（disease free survival,DFS）进行了比较。  结果  全组患者的5年OS为21.6%,5年DFS为16.8%。跳跃性转移及连续转移病例的5年OS分别为37.6%和22.0%（P =0.008）;DFS分别为29.1%和15.0%（P =0.022）。肺叶特异性转移和广泛转移的5年OS分别为38.3%和20.4%（P =0.005）;DFS分别为28.4%和15.1%（P =0.009）。根据两者的组合将所有患者进一步分为3组:仅有跳跃性转移和肺叶特异性转移（A组）,发生连续转移或者纵隔广泛转移中的一项（B组）;既有连续转移又有纵隔广泛转移（C组）。3组的5年OS分别为47.1%,28.1%和16.6%（P =0.001）;5年DFS分别为35.2%,20.8%和11.2%（P =0.002）。多因素分析表明,这种综合转移模式是OS和DFS的独立预后因素。  结论  淋巴结转移的综合模式是Ⅲa-N2的一种独立的预后因素,在评价患者预后及筛选术后治疗患者时应该将这种综合模式考虑在内。      

A rare case Of gastric cancer: Isolated vaginal metastasis

Gastric cancer is one of the most common cancers worldwide. The vast majority of gastric cancer is adenocarcinoma histologically. The majority of gastric cancer patients show distant metastasis at the time of diagnosis. Because they are diagnosed with metastatic disease, most often they are inoperable ovarian metastasis is a well-known metastasis of gastric cancer. Vaginal metastasis happens by the local spreading of ovarian or uterine metastasis. This study reports a gastric cancer case that presented with isolated vaginal metastasis in the absence of ovarian or uterine metastasis     

Splenic metastasis of lung cancer

Splenic metastasis from a lung cancer is infrequently noted, however, the pattern of the metastasis has not been studied, thus we conducted a retrospective study. Twelve of the consecutive 997 patients with lung cancer, who were admitted to our division, developed splenic metastasis. The pattern of splenic metastasis involved solitary nodule in 7 patients (58.3%); multiple nodules in 4, and microscopic metastasis in 1. All of the 12 patients had other abdominal organ metastasis. Splenic mass accompanying metastasis to other abdominal organs in a patient with a known lung cancer should be regarded as a metastasis.     

A case with a single liver metastasis from pancreatic cancer surviving for 29 months

We report a 62-year-old man with advanced pancreatic cancer who underwent pancreatoduodenectomy and was then found to have a single hepatic metastasis. Hepatic resection was performed after 19 months of systemic chemotherapy. The patient survived for 29 months after diagnosis of the hepatic metastasis without occurrence of further metastatic lesions. The patient was given a diagnosis of pancreatic head cancer and underwent pancreatoduodenectomy in September 2001. A single hepatic metastasis was found in July 2002. No local recurrence, lymph node metastasis, distant metastasis or peritoneal metastasis were noted on imaging studies. Chemotherapy with S-1 was performed. The hepatic metastasis remained single and there were no other metastatic lesions for 19 months. A metastasis was found in the right lung in May 2004. The patient died in December 2004 without local recurrence, lymph node metastasis or new hepatic metastasis.     

c-met蛋白在大肠癌组织的表达及其与肿瘤肝转移的关系

目的：探讨c—met蛋白在癌旁正常大肠黏膜，大肠腺瘤，大肠癌组织中的表达及其与大肠癌发生、发展、肝转移的关系。方法：免疫组化法检测癌旁正常大肠黏膜，大肠腺瘤，大肠癌组织与肝转移灶组织中c—met蛋白表达水平，分析其与大肠癌病理分化程度，淋巴结转移及肝转移的关系，并比较同期切除的肝转移灶与原发灶表达水平的差异。结果：c—met蛋白在正常大肠黏膜，大肠腺瘤中表达明显低于大肠癌；有淋巴结转移的大肠癌组织中，c—met蛋白表达明显高于无淋巴结转移者；有肝转移的大肠癌组织中c—met蛋白明显高于无肝转移者。结论：c—met在大肠癌发生、发展、转移中起重要作用；c—met蛋白对大肠癌肝转移有一定的预测作用。     

腹膜转移胃癌中GST-π的表达与预后

目的探讨腹膜转移胃癌中谷胱甘肽-S-转移酶(GST-π)的表达及临床意义。方法 应用免疫组化S-P 法检测56例有腹膜转移胃癌原发灶和24例腹膜转移灶的手术标本中GST-π的蛋白表达情况,以40例非腹膜转移胃癌原发灶作对照,并结合临床病理资料进行分析。结果 GST-π在癌旁正常组织、非腹膜转移胃癌原发灶、腹膜转移胃癌原发灶和腹膜转移灶中阳性表达率分别为30.0%(6/20)、72.5%(29/40)、89.3%(50/56)、66.7%(16/24)。GST-π在非腹膜转移组的阳性表达率低于腹膜转移组,差异有统计学意义(P＜0.05)。GST-π在腹膜转移灶中阳性表达率低于其在相应原发灶中的阳性表达率,差异有统计学意义(P＜0.05)。GST-π蛋白表达与胃癌腹膜转移患者的组织学类型相关(P＜0.05),而与年龄、性别、脏器侵犯、Borrmann分型、浆膜浸润、淋巴结转移、腹膜转移程度无关(P＞0.05)。Kaplan-Meier生存统计结果显示腹膜转移胃癌患者GST-π的高表达与否与其生存期有关(P＜0.05)。结论 GST-π蛋白表达与腹膜转移胃癌原发灶的组织学类型有关,应用免疫组化法检测其表达情况对腹膜转移胃癌患者的化疗药物选择及提示预后有一定的意义,GST-π的高表达可能与胃癌的腹膜转移发生有关。     

鼻咽癌骨转移(附136例临床分析)

目的探讨鼻咽癌骨转移临床特点,寻找有效防治措施.方法回顾性调查136例鼻咽癌骨转移临床状况及诊治疗效.结果鼻咽癌骨转移90%发生于治疗后2年内(或88.7%发生于颈淋巴结转移后3年内).常见转移部位有脊柱(41.3%)、骨性胸廓(28%)、盆骨(18.2%)、四肢长骨(12.5%)及颅骨等.同侧颈淋巴结转移40%骨转移在同侧,双侧颈淋巴结转移约20%有双侧骨转移.治疗采用放疗或放疗加化疗,CR分别为64.5%及53.3%.结论鼻咽癌为亲骨转移性肿瘤,骨转移侧别似与颈淋巴结转移侧别有关.骨转移后采用放疗或放、化疗综合治疗为宜.     

１３１Ⅰ治疗分化型甲状腺癌颈部软组织转移的临床分析

目的　分析分化型甲状腺癌（ＤＴＣ）术后患者颈部软组织转移特点及大剂量１３１Ⅰ治疗效果。方法　回顾１９９７年至２００８年在本科接受１３１Ⅰ治疗的８５６例ＤＴＣ术后患者,其中２３例（２７％）合并颈部软组织转移灶。结果　２３例颈部软组织转移与８３３例无颈部软组织转移患者存在远处转移的比例分别为４７.８％和２６.９％（Ｐ＜０.０５）;大剂量^１３１Ⅰ 治疗颈部软组织转移治愈率、有效率和无效率分别为３９.２％、５６.５％和４.３％;单纯颈部软组织转移与合并远处转移患者颈部软组织转移灶治愈率、有效率、无效率分别为４８.３％、５１.７％、０和１８.２％、７２.７％、９.１％（Ｐ＞０.０５）。结论　ＤＴＣ术后颈部软组织转移合并远处转移的可能性较高;大剂量^１３１Ⅰ 治疗颈部软组织转移疗效显著。     

Clinicopathological and molecular features between synchronous and metachronous metastases in colorectal cancer

The molecular difference between synchronous and metachronous metastases in colorectal cancer (CRC) remains unclear. Between 2000 and 2010, a total of 492 CRC patients were enrolled, including 280 with synchronous metastasis and 212 with metachronous metastasis. Clinicopathological and molecular features were compared between the two groups. Patients with synchronous metastasis were more likely to have right-sided CRC, poorly differentiated tumors, lymphovascular invasion, advanced pathological tumor (T) and node (N) categories, and liver metastases than those with metachronous metastasis. For right-sided CRC, patients with synchronous metastasis had more lymphovascular invasion and liver metastases than those with metachronous metastasis. For left-sided CRC, patients with synchronous metastasis were more likely to have poorly differentiated tumors, lymphovascular invasion, advanced pathological T and N categories, and liver metastases than those with metachronous metastasis. Regarding the genetic mutations, patients with metachronous metastasis had more mutations in TP53, NRAS, and HRAS and fewer mutations in APC than those with synchronous metastasis; for right-sided CRC, synchronous metastasis was associated with more APC mutations than metachronous metastasis, while for left-sided CRC, metachronous metastasis was associated with more TP53 and NRAS mutations than synchronous metastasis. The 5-year overall survival (OS) rates were significantly higher in metachronous metastasis patients than in synchronous metastasis patients, especially those with left-sided CRC. Multivariate analysis showed that age, sex, lymphovascular invasion, pathological N category, metachronous metastasis, and BRAF and NRAS mutations were independent prognostic factors affecting OS. CRC patients with synchronous metastasis had a worse OS than those with metachronous metastasis and exhibited distinct genetic mutations.     

贲门癌淋巴结转移规律的研究

目的研究贲门癌淋巴结分组分站转移规律。方法统计217例贲门癌手术病例各组淋巴结的转移率及转移度,总结其规律。结果第一站转移率、转移度均为最高,并呈现逐站下降趋势,同时第7、9组也具有较高转移率。结论贲门癌淋巴结转移重点在腹腔;逐站转移与跳跃式转移并存;第7组具有高转移特性。