低分化型黏膜内胃癌淋巴结转移的危险因素与腹腔镜手术探讨

  目的  探讨低分化型黏膜内胃癌淋巴结转移的危险因素, 从而对低分化型黏膜内胃癌患者, 制定合理腹腔镜术式提供理论依据。  方法  回顾性分析60例低分化型黏膜内胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。  结果  通过多因素分析, 多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性对淋巴结转移差异具有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素均有者, 淋巴结转移率高达66.7%。  结论  多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性是低分化型分化型黏膜内胃癌淋巴结转移的独立危险因素。对于无危险因素的患者, 行腹腔镜下胃局部切除术是可行的; 对于具有危险因素的患者, 可以实施腹腔镜下胃癌根治术治疗。      

内镜下治疗未分化型早期胃癌的临床研究

目的:探讨未分化型早期胃癌淋巴结转移的危险因素,从而对未分化型早期胃癌患者行内镜下治疗提供理论依据。方法:回顾性分析河北医科大学附属邢台市人民医院肿瘤外科1996年1 月至2008年12月90例未分化型早期胃癌的临床病理资料,按照临床病理特征与淋巴结转移的关系进行统计学分析。结果:通过多因素分析,肿瘤大小> 2 cm,淋巴管癌栓和黏膜下癌对淋巴结转移的差异具有统计学意义（P < 0.05）。 无危险因素的患者,淋巴结转移率为0;3 个危险因素均有者,淋巴结转移率高达57.1% 。结论:肿瘤大小> 2 cm,存在淋巴管癌栓和黏膜下癌是未分化型早期胃癌淋巴结转移的独立危险因素。对于无危险因素的患者,行内镜下切除是可行的。      

黏膜内早期胃癌青年患者临床病理特征及内镜下治疗适应证的探讨

  目的  探讨青年患者黏膜内早期胃癌临床病理特征、淋巴结转移风险及内镜黏膜下剥离术（endoscopic submucosal dissec? tion，ESD）适应证。  方法  回顾性选取2009年3月至2016年12月在安徽省立医院行胃癌根治术、临床病理资料完整的325例早期胃癌患者，所有患者均经术后病理证实为黏膜内癌。根据年龄（≤40岁和>40岁）分为青年组和中老年组，总结青年组临床病理特征和ESD治疗安全性。  结果  在所有黏膜内早期胃癌患者中，青年组患者30例（9.2%）。与中老年组相比，青年组黏膜内癌多发生于女性，病理类型以未分化型和混合型为主，更容易发生淋巴结转移。符合ESD适应证的分化型黏膜内癌的患者中，青年组淋巴结转移率为0；符合ESD相对适应证的未分化型黏膜内癌的患者中，青年组淋巴结转移率高达25.0%。  结论  青年患者黏膜内早期胃癌病理分化程度差，侵袭性更强，分化型黏膜内癌可考虑ESD治疗。      

胸段食管癌腹部淋巴结转移规律临床分析

  目的  分析胸段食管癌腹腔淋巴结转移规律。  方法  对164例胸段食管癌手术病例的腹腔淋巴结数据进行回顾性分析。  结果  胸上、中、下段三组食管癌病例,在浸润深度、分化程度、病理类型、病理分期等基础情况差异无统计学意义,三组的腹腔淋巴结转移率分别为胸上段6.9%、胸中段27.4%、胸下段39.6%,差异无统计学意义（P=0.086）。不同浸润深度、分化程度、病理类型间,腹腔淋巴结转移率差异无统计学意义。  结论  食管癌存在特殊的跳跃性淋巴结转移,食管胸上段癌只要侵及黏膜下层即有可能通过毛细淋巴管网向下跳跃性转移至腹腔淋巴结,而绝大多数的食管癌诊断时已达T_1b期以上,即肿瘤侵及黏膜层以下,因此并不能说早期胸上段高分化食管癌就不易发生腹腔淋巴结转移,手术时常规行腹腔淋巴结清扫是有必要的。      

未分化型早期胃癌的淋巴结转移规律分析

目的探讨未分化型早期胃癌(EGC)的淋巴结转移规律。方法对1994年1月至2008年12月手术治疗的335例早期胃癌的临床病理学资料进行回顾性分析。结果未分化型早期胃癌的淋巴结转移率为17.9%,其中黏膜内癌(M癌)和黏膜下层癌(SM癌)的淋巴结转移率分别为10.5%、25.6%,直径≤2.0cm和>2.0cm的淋巴结转移率分别为8.0%和25.8%,脉管瘤栓阳性和脉管瘤栓阴性的淋巴结转移率为50.0%和16.3%。单因素分析显示,肿瘤大小、浸润深度、脉管瘤栓与未分化型早期胃癌淋巴结转移相关(P<0.05)。多因素分析显示,肿瘤最大径>2cm、黏膜下层浸润和脉管瘤栓是未分化型早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、黏膜内癌、无脉管瘤栓的未分化型早期胃癌发生淋巴结转移风险小。     

73例初治甲状腺髓样癌术式探讨

  目的  探讨甲状腺髓样癌初治合理手术术式。  方法  回顾性分析73例甲状腺髓样癌初治病例资料, 研究颈淋巴结转移规律及术后复发情况。  结果  多灶性甲状腺髓样癌占26.0%(19/73)。全组颈淋巴结转移率为58.9%(43/73), 其中中央区淋巴结转移率52.1%(38/73), 同侧颈淋巴结转移率53.4%(39/73), 双侧侧颈转移率11.O%(8/73), 临床NO颈淋巴结隐匿性转移率为18.9%(7/37)。多因素Logistic回归分析显示, 中央区淋巴结转移是该侧侧颈淋巴结转移的独立危险因素, 原发灶T4是对侧侧颈淋巴结转移的独立危险因素。全组局部区域复发率28.8%(21/73)。全组5年累积生存率为86.4%。多因素分析表明远处转移、年龄≥45岁和原发灶T4是影响预后的独立危险因素。  结论  建议甲状腺髓样癌手术应常规行患侧中央区清扫, 并包含上纵隔区域; 术中证实有中央区淋巴结转移的病例, 建议行该侧侧颈清扫术; T4病例建议行全甲状腺切除+中央区+双颈清扫术。      

胃黏膜内癌的淋巴结转移特点分析

目的探讨黏膜内早期胃癌(EGC)淋巴结转移的危险因素,为早期胃癌的个体化治疗提供依据。方法对1994年1月至2008年12月间接受根治性D2切除术的212例黏膜内早期胃癌患者的临床病理学资料进行回顾性分析,应用单因素和多因素Logistic回归分析评估影响黏膜内早期胃癌淋巴结转移的危险因素。结果 212例黏膜内早期胃癌患者的淋巴结转移率为3.3%(7/212),其中肿瘤最大径≤2cm和>2cm的淋巴结转移率分别为0.8%和7.5%;分化型与和分化型患者的淋巴结转移率分别为1.4%和7.1%;有脉管瘤栓和无脉管瘤栓患者的淋巴结转移率分别为100.0%和2.4%。多因素分析显示,肿瘤最大径>2cm、未分化型腺癌和脉管瘤栓是黏膜内早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、分化型腺癌和无脉管瘤栓的黏膜内早期胃癌发生淋巴结转移风险小,可作为制订个体化治疗方案的参考。     

非小细胞肺癌的淋巴结转移相关因素及规律的探讨

  目的  探讨原发性非小细胞肺癌(NSCLC)年龄、性别、吸烟指数、肿瘤大小、病理类型、细胞分化程度与淋巴结转移的关系, 分析纵隔淋巴结转移的临床规律及分布特点。  方法  对96例非小细胞肺癌行肺切除术和淋巴结清扫术的患者进行临床病理分析。  结果  淋巴结转移与年龄、性别、吸烟指数无关, 肿瘤大小与淋巴结转移差异无统计学意义。高、中、低分化癌淋巴结转移率分别为15.8%、47.8%和59.0%, 肿瘤分化程度越低, 纵隔淋巴结转移率越高(P < 0.05)。病理类型与淋巴结转移无相关性, 鳞癌、腺癌的N₂转移率分别为13.6%、34.0%。肺腺癌较鳞癌易发生纵隔淋巴结转移(P < 0.05)。中心型肺癌与周围型肺癌纵隔淋巴结转移率差异无统计学意义(P > 0.05)。跳跃性N₂有12例, 跳跃式纵隔转移共9例。肺癌常跨区域纵隔转移, 肺下叶癌跨区域纵隔转移与肺上叶癌比较差异无统计学意义(P > 0.05)。  结论  非小细胞肺癌的淋巴结转移与细胞分化程度有密切关系, 与年龄、性别、吸烟指数、病理类型、原发肿瘤大小无关; 肺腺癌较鳞癌易发生纵隔淋巴结转移; 多数肺癌的淋巴结转移遵循由近及远、自上而下、由肺内经肺门再向纵隔的顺序转移规律; 部分纵隔淋巴结的转移呈"跳跃式"; 肺切除术时,施行系统性胸内淋巴结清扫是必要的。      

残胃癌患者脉管癌栓与临床病理特征和预后的关系

  目的  探讨残胃癌患者脉管癌栓与临床病理特征和预后的关系。  方法  回顾性分析1999年3月至2020年3月福建医科大学附属肿瘤医院接受手术治疗（包括根治性和姑息性手术）的208例残胃癌患者的临床病例资料。根据肿瘤是否有脉管癌栓,分为脉管癌栓组（118例）及无脉管癌栓组（90例）,比较两组的临床病理学特征、手术及淋巴结清扫情况及生存预后的差异。  结果  两组在浸润深度、淋巴结转移、TNM分期、组织分型、神经浸润及Borrmann分型的分布差异均具有统计学意义（均P<0.05）。多因素分析显示:神经浸润、脉管癌栓、肿瘤大小、TNM分期、联合脏器切除是影响残胃癌患者预后的独立危险因素（P<0.05）。两组在手术时间及淋巴结转移数目上差异具有统计学意义（P<0.05）。全组术后5年生存率为45.6%,其中脉管癌栓组与无脉管癌栓组5年生存率分别为28.8%和66.0%,差异具有统计学意义（P<0.05）。肿瘤大小≥5 cm、TNM Ⅱ期和TNM Ⅲ期的脉管癌栓组和无脉管癌栓组残胃癌患者术后5年生存率分别为20.2% vs. 59.6%、44.1% vs. 82.2%和19.9% vs. 42.7%,差异具有统计学意义（P<0.05）。  结论  脉管癌栓是判断残胃癌患者预后的重要指标。有脉管癌栓的残胃癌术后患者,尤其是肿瘤大小≥5 cm、TNM Ⅱ期或TNM Ⅲ期的更需要积极的辅助治疗。      

甲状腺乳头状癌颈部淋巴结转移的危险因素

  目的  探讨甲状腺乳头状癌中央区淋巴结和侧颈淋巴结转移的危险因素。  方法  回顾性分析2016年1月至2016年12月于天津医科大学肿瘤医院行甲状腺切除术的1 835例术后病理诊断为甲状腺乳头状癌患者的临床病例资料，对可能影响甲状腺乳头状癌淋巴结转移的相关因素进行单因素分析与多因素分析。  结果  1 835例患者中央区淋巴结转移率为54.88%（1 007例），侧颈淋巴结转移率为20.22%（371例）。单因素分析结果提示，男性、年龄 < 45岁、肿瘤直径>10 mm、多灶性、抗甲状腺球蛋白抗体（anti-Tg）>100.00 IU/mL、甲状腺球蛋白抗体（Tg）>130.70 μg/L者中央区淋巴结转移率及侧颈淋巴结转移率较高（P < 0.05）。抗甲状腺过氧化物酶抗体（anti-TPO）>100.00 IU/mL者中央区淋巴结转移率较低（P < 0.05）。此外，中央区淋巴结转移者侧颈淋巴结转移率较高（P < 0.05）。多因素分析结果提示，男性、年龄 < 45岁、肿瘤直径>10 mm、多灶性、anti-Tg>100.00 IU/mL是中央区淋巴结转移的独立危险因素。anti-TPO>100.00 IU/mL是中央区淋巴结转移的保护性因素。男性、年龄 < 45岁、肿瘤直径>10 mm、多灶性、anti-Tg>100.00 IU/mL、Tg>130.70 μg/L、中央区淋结转移者是侧颈淋巴结转移的独立危险因素。  结论  男性、年龄 < 45岁、肿瘤直径>10 mm、多灶性、anti-Tg>100.00 IU/mL是中央区淋巴结转移及侧颈淋巴结转移的高危因素；中央区淋巴结转移是侧颈淋巴结转移的危险因素；anti-TPO>100.00 IU/mL是中央区淋巴结转移的保护性因素。      

Lymph Node Metastasis in Early Signet Ring Cell Carcinoma:Endoscopic Mucosal Resection

Objective:To identify clinicopathological factors predictive of lymph node metastases(LNM)in early signet ring cell carcinoma(SRC),and further to expand the possibility of using endoscopic mucosal resection(EMR)for the treatment of early SRC.Methods:Data from 27 surgically treated patients with early SRC were collected,and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Results:In the ...     

Lymph Node Metastasis in Early Signet Ring Cell Carcinoma： Endoscopic Mucosal Resection

Objective  To identify clinicopathological factors predictive of lymph node metastases (LNM) in early signet ring cell carcinoma (SRC), and further to expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of early SRC. Methods  Data from 27 surgically treated patients with early SRC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Results  In the univariate analysis, a tumor larger than 3.0 cm, submucosal invasion, and the presence of lymphatic vessel involvement (LVI) were significantly associated with a higher rate of LNM (all P<0.05). In the multivariate model, the presence of LVI was found of to be an independent pathological risk factor for LNM. There was no LNM in 14 patients without the three clinicopathological risk factors (a tumor larger than 3.0 cm, submucosal invasion, and the presence of LVI). Conclusion  EMR alone may be sufficient treatment for intramucosal early SRC if the tumor is less than or equal to 3.0 cm in size, and when LVI is absent upon postoperative histological examination. When specimens show LVI, an additional radical gastrectomy with lymphadenectomy should be recommended. This work was supported by the Nature Science Foundation of Liaoning Province(No. 20042071).     

Predictive Factors of Lymph Node Metastasis in Early Mucinous Adenocarcinoma

OBJECTIVE To identify clinicopathologic factors which predict lymph node metastases (LNM) in early mucinous adenocarcinoma patients, and to further explore the possibility of using minimally invasive treatment for patients with the disease. METHODS Data was collected from 38 patients with early mucinous adenocarcinoma who were surgically treated, and the association between clinicopathologic factors and the presence of LNM was retrospectively analyzed using univariate and multivariate logistic regression analysis.RESULTS Tumor size greater than 2.0 cm, the development of submucosal invasion, and the presence of lymphatic vessel involvement (LVI) were confirmed through univariate analysis as having a significant association with LNM and were considered to be significant and independent risk factors for LNM through multivariate analysis.CONCLUSION Tumor size > 2.0 cm, the development of submucosal invasion, and the presence of LVI are independent predictive factors for LNM in early mucinous adenocarcinoma. Minimally invasive treatment may be an effective treatment for intramucosal early mucinous adenocarcinoma when the tumor size is 2.0 cm or less, and if LVI has not occurred, as confirmed by postoperative histologic examination.     

Predictive factors of lymph node metastasis in undifferentiated early gastric cancers and application of endoscopic mucosal resection

BackgroundFor intramucosal undifferentiated early gastric cancer (EGC), gastrectomy with lymphadenectomy is now the standard therapy. However, because approximately 96% of intramucosal undifferentiated EGC do not have lymph node metastasis (LNM). Gastrectomy with lymphadenectomy may be overtreatment for such patients. This study was conducted to identify clinicopathological factors predictive of LNM in undifferentiated EGC and further to expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of undifferentiated EGC.MethodsData from 108 patients with undifferentiated EGC and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM were retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated.ResultsThe tumor size (OR = 11.475, 95% CI: 2.054–64.104, P = 0.005), depth of invasion (OR = 11.704, 95% CI: 2.536–54.010, P = 0.002), and lymphatic vessel involvement (LVI) (OR = 13.688, 95% CI: 1.779–105.324, P = 0.012) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. The LNM rates were 5% (3/61) and 28% (13/47) with intramucosal and submucosal undifferentiated EGC respectively. LNM was observed in 50% (1/2) of patients with both risk factors (tumor larger than 2.0 cm and the presence of LVI) but in none of 25 patients without the two risk factors in intramucosal undifferentiated EGC. The 5-year survival rates were 88%, 82% and 50%, respectively in cases with none, one and two of the risk factors respectively in intramucosal undifferentiated EGC (P < 0.05).ConclusionsA tumor larger than 2.0 cm, submucosal invasion, and the presence of LVI are independently associated with the presence of LNM in undifferentiated EGC. EMR alone may be sufficient treatment for intramucosal undifferentiated EGC if the tumor is less than or equal to 2 cm in size, and when LVI is absent upon postoperative histological examination. When specimens show with LVI, unexpected submucosal invasion, and unexpectedly larger tumor size than that determined at pre-EMR endoscopic diagnosis, an additional radical gastrectomy is probably better for these patients.     

Predictive factors of lymph node metastasis in intramucosal poorly differentiated early gastric cancer and their impact on the laparoscopic surgery

Objective

The aim of this study was to identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using laparoscopic surgery for the treatment of intramucosal poorly differentiated EGC.

Methods

Data from 65 patients with intramucosal poorly differentiated EGC and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.

Results

Univariate analysis showed that number of tumors, tumor size and lymphatic vessel involvement (LVI) were the significant and independent risk factors for LNM (all P < 0.05). The LNM rates were 5.0%, 18.2% and 66.7%, respectively. There was no LNM in 31 patients without the three risk clinicopathological factors

Conclusion

The number of tumors, tumor size, and LVI are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used to set as a simple criterion to expand the possibility of using laparoscopic surgery for the treatment of intramucosal poorly differentiated EGC.     

374例根治术后肠型胃癌患者预后的影响因素分析

目的:肠型胃癌约占中国胃癌总数的40％～45％,本研究旨在探讨根治术后肠型胃癌预后的影响因素.方法:回顾性收集2010年7月至2015年7月于山东第一医科大学附属省立医院行根治性切除且术后病理证实为肠型胃癌患者的临床病理和预后资料.Log-rank检验比较各临床病理特征对无病生存期(disease-free survi...     

Lymphatic vascular invasion is an independent correlated factor for lymph node metastasis and the prognosis of resectable T2 gastric cancer patients

The objective of this study was to investigate the independent correlated factors for lymph node metastasis (LNM) and prognosis in T2 gastric cancer patients. A total of 135 pathologically confirmed T2 gastric cancer patients who received a gastrectomy at the Beijing University Cancer Hospital from Dec 1999 to Dec 2006 were studied retrospectively. The potential correlated factors for LNM and patients’ prognosis were analyzed, including gender, age, tumor location and size, depth of invasion, lymphatic vascular invasion (LVI), differentiation grade, histological type, Borrmann type, LNM, distant metastasis, TNM stage, and whether the patient was treated with a radical gastrectomy. LNM occurred in 69 patients, which represents a rate of LNM of 51.1 %. Multivariate logistic regression analysis showed that LVI and TNM stage were independent risk factors for LNM (p values were 0.002 and 0.029, respectively). The median follow-up time was 60.3 months. Multivariable survival analysis revealed that age (<60 vs. ≥60), TNM stage and LVI were independent prognostic factors for gastric cancer patients (p values were <0.001, 0.047, and 0.001, respectively). In conclusion, LVI was an independent factor for LNM and the prognosis of resectable T2 gastric cancer patients.