Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer

The purpose of this study was to determine outcome of the ratio of metastatic lymph nodes to the total number of dissected lymph nodes (MLR) in patients with gastric cancer. We retrospectively analyzed 111 patients who underwent D₂ lymph node dissection. The prognostic factors including UICC/AJCC TNM classification and MLR were evaluated by univariate and multivariate analysis. The MLR was significantly higher in patients with a larger tumor, lymphatic vessel invasion, blood vessel invasion and perineural invasion, and advanced stage. Moreover, the MLR was significantly associated with the depth of invasion and the number of lymph node metastasis. The univariate analysis revealed for overall survival (OS) that stage of disease, lymphatic vessel invasion, blood vessel invasion, perineural invasion, lymph node metastasis (UICC/AJCC pN stage) and MLR were relevant prognostic indicators. Furthermore, both UICC/AJCC pN stage and MLR were detected as prognostic factor by multivariate analysis, as was perineural invasion. Our results indicated that MLR and UICC/AJCC pN staging system were important prognostic factors for OS of patients with D₂ lymph node dissection in gastric cancer in a multivariate analysis. MLR may be useful for evaluating the status of lymph node metastasis in gastric cancer.     

Incorporation of perineural invasion of gastric carcinoma into the 7th edition tumor–node–metastasis staging system

The aim of this study was to determine the prognostic value of perineural invasion (PNI) in patients with gastric cancer who underwent curative resection. We retrospectively analyzed 518 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. Patients with PNI had a significantly larger tumors (≥5.0 cm), lymphatic venous invasion (positive), deeper tumor invasion (T4), more number of lymph node metastases (N3), and higher tumor stage (III). Regarding survival, multivariate analysis showed that PNI emerged as an independent prognostic factor for survival (hazard ratio (HR)?=?1.901, P?PNI and TNMIII_PNI stage both had lower ?2loglikelihood value (?2loglikelihood?=?3,306.608; ?2loglikelihood?=?2,535.151) and higher HR and 95 % CI (HR?=?1.879, 95 % CI?=?1.720–2.053; HR?=?2.268, 95 % CI?=?1.900–2.707), which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability. Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer and it should be incorporated into TNM staging.     

Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses

Background. The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. Methods. We classified 130 patients with stage IV gastric cancer into four groups: peritoneal metastasis, liver metastasis, lymph node metastasis, and multiple factor groups, according to the factors that determined stage IV in each patient and compared survival in the four groups. We also performed univariate and multivariate analyses of various prognostic clinicopathological factors. The 5-year survival rate in the patients with stage IV gastric cancer was 7.4%. Results. No significant differences were observed in survival among the four groups. Univariate analysis showed significant differences in survival among the categories of lymphatic invasion ( P = 0.0045), venous invasion ( P = 0.0024), peritoneal metastasis ( P = 0.0019), postoperative chemotherapy ( P = 0.0385), curability ( P = 0.0001), and lymph node dissection ( P = 0.0001). In the curability B group, survival was prolonged in the postoperative chemotherapy group. Multivariate analysis revealed the highest relative hazard (RH) for lymph node dissection (RH, 2.261), followed, in descending order, by curability (RH, 1.905), peritoneal metastasis (RH, 1.896), lymphatic invasion (RH, 1.736), and venous invasion (RH, 1.481). Conclusion. As prognostic factors in stage IV gastric cancer, the tumor factors of peritoneal metastasis and vessel invasion, and the treatment factors of curability and lymph node dissection may be important, and active treatment appears to improve survival. Received: March 2, 2000 / Accepted: June 2, 2000     

Pathology and prognosis of mucinous gastric carcinoma

BACKGROUND AND OBJECTIVES: Clinicopathologic characteristics of mucinous gastric carcinoma (MGC) are unclear, and whether surgical results of MGC are unfavorable is controversial. Pathology and prognosis of patients with MGC were studied using multivariate analysis. METHODS: The study included 17 patients with MGC and 614 with nonmucinous gastric carcinoma (NGC). The tumor was defined as MGC when more than one half of tumor area had mucin pools. Patients were evaluated with regard to age, sex, tumor location, size, gross type, depth of wall invasion, lymph node metastasis, lymphatic and vascular permeations, stage of disease, and operative curability. RESULTS: MGC tumors, when compared with NGC tumors, were featured by the large size (9.0 vs. 5.2 cm), grossly infiltrative type (76 vs. 30%), T2 or more invasion (100 vs 53%), positive lymph node metastasis (88 vs. 32%), lymphatic permeation (94 vs. 55%), vascular permeation (47 vs. 25%), and stages III and IV (88 vs. 32%). On a multivariate analysis, mucinous histologic type was not an independent prognostic factor. Although 5-year survival rate for all MGC patients was lower than that for all NGC patients, the survival rate was not different between the MGC and NGC patients when compared in the same category of tumor size, depth of wall invasion, lymph node metastasis, and stage. CONCLUSIONS: MGC is rare and detected mostly in an advanced stage. Mucinous histologic type itself is not a prognostic significance in patients with gastric carcinoma, and the biologic behavior of MGC is similar to that of ordinary advanced gastric carcinoma.     

Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer

Background We aimed to elucidate clinicopathological variables associated with lymph node metastasis of submucosal invasive gastric cancer. Methods Specimens were surgically resected from 201 patients who had primary submucosal gastric cancer. We studied 39 consecutive patients with lymph node metastasis and 162 patients without lymph node metastasis. We compared the following clinicopathological characteristics of the patients in relation to lymph node metastasis: age, sex, tumor size, histology, extent of submucosal invasion, lymphatic and venous invasion, and ulceration of the tumor. Submucosal invasion was divided subjectively into sm1, sm2, and sm3 (representing invasion of the upper-, middle-, and lower-third of the submucosa, respectively). We also studied the relationship between lymph node metastasis of submucosal gastric cancer and immunohistochemistry for p53, Ki67, vascular endothelial growth factor (VEGF), α-fetoprotein, sLe^a, and dendritic cells (DCs). Results In terms of conventional pathological factors, lymph node metastasis in submucosal gastric cancer was related to tumor size (P = 0.002), depth of submucosal invasion (P = 0.001), lymphatic invasion (P < 0.0001), and venous invasion (P = 0.012). Lymph node metastasis in sm1 gastric cancer was significantly related to VEGF expression (P = 0.047). Also, lymph node metastasis in sm3 gastric cancer was significantly correlated with DC expression (P = 0.016). Multivariate analysis showed that tumor size, tumor invasion depth in the submucosal layer, and lymphatic invasion were independent predictors of nodal metastasis in submucosal gastric cancer. Conclusion Conventional pathological factors, such as tumor size, depth of submucosal invasion, and lymphatic invasion, have a significant influence on lymph node metastasis. VEGF expression and DC expression may be helpful predictors of lymph node metastasis in patients with sm1 and sm3 gastric cancer, respectively.     

Clinical significance of nuclear expression of spleen tyrosine kinase (Syk) in gastric cancer

Spleen tyrosine kinase (Syk) expression was immunohistochemically examined in 250 gastric cancer patients. The rate of positive Syk expression was 42.4%. Syk expression was significantly associated with T1 tumors, lymphatic invasion, venous invasion and lymph node metastasis (P<0.0001). The 5-year survival rate was significantly higher among patients with nuclear Syk expression than among those who were negative for Syk expression (P=0.0003). However, Syk expression was not an independent prognostic factor. Loss of Syk expression was closely related to the malignant property of gastric cancer in the context of tumor depth and lymph node metastasis, especially in early gastric cancer.     

Lymphatic microvessel density using D2-40 is associated with nodal metastasis in non-small cell lung cancer

The monoclonal antibody D2-40 is a new selective marker for lymphatic endothelium. The lymphatic microvessel density (LMVD) using D2-40 has not yet been evaluated in non-small cell lung cancer (NSCLC). The aim of this study was to evaluate LMVD using D2-40 in NSCLC. We investigated LMVD in 77 patients with NSCLC who underwent curative tumor resection. We also determined the relation between LMVD and clinicopathologic factors, VEGF-C and Ang-2 and microvessel density (MVD) using factor VIII-related antigen. The median number of D2-40-positive vessels in the highest LMVD was 25 (range, 5-71). LMVD was significantly associated with tumor status, lymph node metastasis, stage, lymphatic invasion, VEGF-C protein and MVD (p=0.0149 for tumor status; p<0.0001 for nodal status; p<0.0001 for stage; p=0.0153 for lymphatic invasion; p=0.0030 for VEGF-C, and p=0.0029 for MVD). Furthermore, LMVD using D2-40 expression was shown to be an independent predictor of lymph node metastasis by multivariate analysis (p=0.0070). These data indicate that a high LMVD by D2-40 may be an indicator of lymph node metastasis in NSCLC.     

S100钙结合蛋白A2在胃癌组织中的表达及意义

目的:探讨S100A2在慢性胃炎、肠上皮化生和胃癌组织样本中的表达及与胃癌临床病理特征及预后的关系。方法:利用HE染色对所取胃组织标本进行病理组织学诊断;采用免疫组织化学方法检测标本S100A2蛋白的表达;qRT-PCR法检测S100A2 mRNA表达;Western blot检测S100A2蛋白的表达;采用Kaplan-Meier分析累积生存率。 结果:应用qRT-PCR方法分析不同胃组织标本S100A2 mRNA的表达水平,发现S100A2 mRNA的表达水平按以下顺序递减:胃炎,肠上皮化生,胃癌(P<0.001),与Western bolt分析S100A2蛋白的表达评定结果相吻合。免疫组化分析:S100A2在胃炎、肠上皮化生和胃癌组织细胞质中表达,S100A2阳性表达率为胃炎100％(73/73),肠上皮化生90.7％(78/86),胃癌48.9％(170/348) (P<0.001)。在胃癌中,S100A2蛋白的表达缺失在青年患者中多于老年患者。S100A2蛋白的表达与肿瘤大小、浸润深度、淋巴管和静脉浸润、淋巴结转移、肿瘤TNM分期呈负相关,并随胃癌分化程度降低,在高分化癌、中分化癌和低分化癌中,S100A2的阳性表达率分别为65.9%、56.4%和17.2%(P<0.05),和患者性别无相关性(P>0.05)。Kaplan-Meier分析累积生存率显示:弱或中度S100A2基因表达的患者累积生存率明显高于不表达S100A2的患者。多因素分析显示S100A2表达、浸润深度、淋巴管及静脉浸润、淋巴结转移、TNM分期是胃癌患者预后的独立因素。结论:在胃炎-肠上皮化生-胃癌过程中S100A2 mRNA和蛋白表达逐渐降低。S100A2表达与肿瘤大小、浸袭深度、淋巴管和静脉侵犯、淋巴结转移及TNM分期负相关,并随胃癌分化程度降低,S100A2的阳性表达率逐渐降低。S100A2表达是独立的胃癌预后预测因素,是胃癌患者预后良好的指标之一。     

Factors influencing axillary node metastasis in breast cancer

AIMS AND BACKGROUND: The status of the axillary lymph nodes at the time of diagnosis has been accepted as one of the most important prognostic factors for the overall and disease-free survival of patients with breast cancer. The aim of our study was to determine which factors influence axillary node involvement in invasive breast cancer. METHODS: The data presented here were obtained from 344 patients who were treated for invasive breast cancer at the Department of Radiation Oncology, Uluda? University Medical College, Bursa, Turkey. Possible prognostic factors were categorized as patient related and tumor related. The Mann-Whitney U test was used for univariate analysis and logistic regression was used for multivariate analysis. RESULTS: In univariate analysis, a familial cancer history (P = 0.0042), age < 40 years (P = 0.0276), higher T stage (P < 0.0000), nipple involvement (P = 0.0345), skin involvement (P = 0.0270), perineural invasion (P = 0.0231), and lymphatic vessel invasion (P < 0.0000) were correlated with increased axillary node involvement. A higher incidence of > or = 4 involved lymph nodes was associated with higher T stage (P = 0.0004), nipple involvement (P = 0.0292), presence of an extensive intraductal component (P = 0.0023), skin involvement (P = 0.0008), perineural invasion (P = 0.0523), and lymphatic vessel invasion (P < 0.0000) in univariate analysis. In multivariate analysis, age < 40 years (P = 0.0454), cancer history within the family (P = 0.0024), higher T stage (P = 0.0339), lymphatic vessel invasion (P = 0.0003), and perineural invasion (P = 0.0408) were found to be independent factors for axillary lymph node positivity. Age < 40 years (P = 0.0221), perineural invasion (P = 0.0408), and an extensive intraductal component (P = 0.0132) were associated with an increased incidence of > or = 4 involved nodes in the logistic regression analysis. In patients with breast cancer, the incidence of axillary lymph node involvement was independently influenced by age < 40 years, presence of cancer history within the family, higher T stage, lymphatic vessel invasion, and perineural invasion. CONCLUSIONS: In conclusion, absence of familial cancer history, presence of lymphatic vessel invasion, higher T stage, and age below 40 years independently increased the risk of axillary node involvement. Presence of perineural invasion and lymphatic vessel invasion, age below 40, and an extensive intraductal component of more than 25% independently affected the risk of having > or = 4 nodes involved. Patients characterized by these factors may be classified into a higher risk group for nodal involvement, but more data are needed to define factors that can help in the decision-making regarding the omission of axillary treatment.     

Galectin-3 expression is a potent prognostic marker in colorectal cancer

BACKGROUND: Galectin-3 is a beta-galactoside-binding protein whose expression has been correlated with progression and metastasis in colon cancer. It is expressed at elevated levels in a variety of neoplastic cells. The current study was designed to investigate, by clinicopathological analysis, the relationship between prognosis and galectin-3 expression, in colorectal cancer. PATIENTS AND METHODS: Galectin-3 expression was evaluated using immunohistochemical staining in 121 consecutive patients with colorectal cancer. The relationship between galectin-3 expression and clinicopathological factors was analyzed. RESULTS: Galectin-3-positive expression was detected in 79 patients (65%). The incidence of lymph node and distant metastasis in galectin 3-positive cancer was significantly higher than that in galectin-3-negative cases (p = 0.0007 and p = 0.014, respectively). Furthermore, cancers with galectin-3-positive expression revealed frequent venous invasion (p = 0.005) and lymphatic permeation (p = 0.041), larger size (p = 0.016) and deeper invasion to wall(p = 0.01) than in galectin-3-negative cases. While univariate analysis showed that survival in patients with galectin-3-positive expression was significantly poorer than in galectin-3-negative cases (p = 0.0027), galectin-3 expression was a prognostic factor independent of Dukes' stage and lymph node metastasis by multivariate analysis. CONCLUSION: We propose that galectin-3 expression is an independent factor for prognosis in colorectal cancer.     

Prognostic value of carcinoembryonic antigen, CA 19-9 and CA 72-4 in gastric carcinoma.

The prognostic value of preoperative serum levels of carcinoembryonic antigen (CEA), CA 19-9 and CA 72-4 tumor markers was investigated in patients with gastric cancer. Eighty-two patients who underwent surgical resection of gastric cancer were entered in the study. Correlation analyses showed that CA 72-4 was more frequently positive in patients with advanced tumors (p = 0.04), lymph node invasion (p = 0.02), liver metastasis (p = 0.02) and peritoneal involvement (p = 0.03). CA 19-9 was more frequently positive in patients with advanced tumors (p = 0.01) and with serosal (p = 0.04), lymph node (p = 0.008) and peritoneal involvement (p = 0.02). CEA was more frequently positive in patients with liver metastasis (p = 0.03). Low 3-year cumulative survival was significantly associated with elevated serum levels of CA 72-4 (p = 0.004), CA 19-9 (p = 0.001) and CEA (p < 0.001). Age, tumor stage and CA 72-4 provided prognostic information in the multivariate analysis. Patients with elevated serum levels of CA 72-4 showed a 4.2 times higher risk of death than patients with low levels of the marker. Our results suggest that CA 72-4 has prognostic value in gastric cancer, and patients with a high preoperative serum level of CA 72-4 have a greater risk of death due to gastric cancer.     

Prognostic role of lymphatic vessel invasion in early gastric cancer: A retrospective study of 188 cases

BackgroundLymphatic vessel invasion is an important prognostic factor for the gastric cancer without lymph node metastasis. However, the studies on early gastric cancers is still sparse. Therefore, we carried out this study to determine clinicopathological and surgical prognostic factors, especially lymphatic vessel invasion, for early gastric cancers.MethodsClinicopathological characteristics and prognostic outcomes of 188 patients who received a gastrectomy for early gastric cancer between 1980 and 2000 were retrospectively evaluated based on the subclassification of pN category. A multivariate analysis was performed by using the Cox regression model, where lymphatic vessel invasion and other potential prognostic factors were included.ResultsOf the 188 patients, 158 had T1N0M0 and 30 T1N1M0 cancers. In patients with T1N0M0 cancers, the survival rate was significantly lower in those with lymphatic vessel invasion than in those without (χ² = 4.025, P = 0.045). However, in patients with T1N1M0 cancers, the survival rates were not significantly different between those with and those without lymphatic vessel invasion (χ² = 0.253, P = 0.615). The multivariate analysis identified that age (P = 0.033) and lymph node metastasis (P = 0.019) were independent prognostic factors for all early gastric cancers. However, age (P = 0.042), tumor location (P = 0.032), and lymphatic vessel invasion (P = 0.010) were the independent prognostic factors for T1N0M0 cancers.ConclusionsLymphatic vessel invasion was an independent prognostic factor for T1N0M0 early gastric cancers, and thus may be a potential prominent factor that should be considered to be included in the category of lymphoid metastasis (both lymph node metastasis and lymphatic vessel invasion) in patients with early gastric cancer.     

Prognostic significance of lymphovascular invasion diagnosed by lymphatic endothelium immunostaining in breast cancer patients

Prognostic factors for breast cancer include axillary lymph node status, tumor size, histology, nuclear grade, presence of estrogen and progesterone receptors, HER2/neu status, and mean microvessel density (MVD). In this study, we evaluated the usefulness of a new marker, D2-40, by investigating lymph vascular invasion of the tumor immunohistochemically in 132 patients with breast cancer and compared it with those of well-known prognostic indicators. Positive immunostaining of lymphatic endothelium with D2-40 outlining tumor emboli in the lumen of lymphatics was defined as D2-LVI, and lymphatic invasion following conventional hematoxylin and eosin staining was defined as HE-LVI. Significant correlation was observed between HE-LVI and D2-LVI (p<0.001), between lymph node status and HE-LVI (p=0.005), and between recurrent status and D2-LVI (p=0.008) by univariate analysis. Based on multivariate analysis, lymph node status (p<0.001, OR=6.993), tumor size (p=0.005, OR=5.504), D2-LVI (p=0.006, OR=4.740), and MVD (p=0.002, OR=4.484) were independent prognostic factors of disease recurrence. A significant difference in disease-free survival was also found between patients with and without D2-LVI (p=0.0067), but not with or without HE-LVI. Even in node-positive cases, D2-LVI had prognostic meaning. D2-LVI may play a crucial role for predicting recurrence of breast cancers much more than expected. Our data identifying D2-LVI expression in tumors of patients with a poor disease-free survival prognosis provides an easier and more accurate prognostic method than identifying HE-LVI.     

Prognostic value of p53 protein expression for patients with gastric cancer--a multivariate analysis

Mutations in the p53 gene, one of the most common genetic alterations in human cancer, are implicated in tumorigenesis and tumour progression. Although p53 protein expression appears to be correlated to prognosis in patients with malignancy, its prognostic role in gastric cancer has remained controversial. We examined the clinical significance of p53 overexpression in 427 patients with gastric cancer, using multivariate analysis. Tumour sections of gastric cancer tissues from these 427 Japanese patients were stained immunohistochemically with monoclonal antibody PAb1801. The presence of p53 expression was statistically compared with clinicopathological features and post-operative survival, using univariate and multivariate analyses. p53 expression was detected in 38.6% (165 out of 427) of these gastric cancers and immunoreactivity was not observed in normal mucosa adjacent to the tumour. A higher rate of p53 detection was observed among large tumours and in those with a prominent depth of invasion, lymphatic and vascular invasion and lymph node involvement. Prognosis was significantly worse for patients with p53-positive-staining tumours. The 5-year survival rate was 62.5% for patients with p53-negative tumours and 43.3% for those with positive malignancies. p53 expression was a significant prognostic factor for node-positive gastric cancers in subjects undergoing treatment with curative resection, as assessed by Cox regression analysis. Thus, the expression of p53 was closely related to the potential for tumour advance and a poorer post-operative prognosis for patients with gastric cancer.     

术前SII-PNI评分与老年胃癌患者临床病理特征及预后关系的研究

  目的  基于外周血中性粒细胞、淋巴细胞及血小板计数的系统性炎症反应指数（systemic immune-inflammation index,SII）以及根据血清白蛋白水平和外周血淋巴细胞计数确定的预后营养指数（prognostic nutritional index,PNI）,探讨术前SII-PNI评分在预测老年胃癌患者根治术后预后中的临床价值。  方法  回顾性分析2012年1月至2015年1月于河北医科大学第四医院行根治性手术治疗的327例老年胃癌患者（年龄≥70岁）临床资料,分别计算术前SII及PNI值。利用ROC曲线确定SII、PNI的最佳cut-off值,根据评分将患者分为3组,比较各组患者之间的临床病理特征及生存预后。  结果  术前SII-PNI不同评分患者中,肿瘤直径、肿瘤浸润程度（pT分期）、淋巴结是否转移、pTNM分期、脉管浸润与神经受侵发生率以及Ki-67阳性比例比较,差异均具有统计学意义（均P<0.05）。Cox多因素分析显示,肿瘤组织学类型（P=0.023）、肿瘤浸润深度pT分期（P=0.016）、存在淋巴结转移（P=0.014）、肿瘤pTNM分期（P=0.001）和术前SII-PNI评分（P=0.001）是影响老年胃癌患者预后的独立危险因素。  结论  术前SII-PNI评分与老年胃癌患者的临床病理特征密切相关,同时评分越高患者术后易出现并发症,而且预后越差。      

Clinical significance of nm23 expression and chromosome 17 numerical aberrations in primary gastric cancer

The metastasis suppressor gene nm23 located on chromosome 17 might be one of the targets in deletions of chromosome 17. In this study, we analyzed the expression of nm23 and chromosome 17 aberrations in gastric cancer and assessed their clinicopathological and prognostic significance. In 103 gastric cancer patients, we examined nm23 expression by immunohistochemistry and detected chromosome 17 aberrations by fluorescence in situ hybridization. There was a significant difference in the expression of nm23 among differentiated histologic types (well > moderately > poorly) (p < 0.01). Negative expression of nm23 correlated with depth of invasion (p < 0.01), lymph node metastasis (p < 0.05), lymphatic invasion (p < 0.05), venous invasion (p < 0.05), poor prognosis (p < 0.05), and chromosome 17 loss (p < 0.05). Chromosome 17 aberrations broadly correlated with clinicopathological variables and were associated with poor prognosis (p < 0.05). Univariate analyses identified nm23 (p < 0.05), chromosome 17 aberrations (p < 0.05), tumor size (p < 0.01), depth of invasion (p < 0.0001), lymph node metastasis (P < 0.001), hepatic metastasis (p < 0.01), peritoneal dissemination (p < 0.01), and lymphatic invasion (p < 0.01) as significant prognostic factors. Multivariate analysis showed that expression of nm23 and chromosome 17 aberrations were not independent prognostic indicators. Our results indicate that negative expression of nm23 and chromosome 17 numerical aberrations correlate with tumor progression and poor prognosis but are not independent prognostic indicators.     

Vascular endothelial growth factor C expression correlates with lymphatic involvement and poor prognosis in patients with esophageal squamous cell carcinoma

Vascular endothelial growth factor C (VEGF-C), a member of VEGF gene family, is considered to induce both lymph node metastasis and lymphatic involvement in various cancers related to lymphangiogenesis. We examined the relationship between VEGF-C expression and clinicopathological features in 112 Japanese patients with esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy and reconstruction without preoperative treatment. VEGF-C expression was examined using immunohistochemical staining and RT-PCR in surgically resected tissues. Regarding VEGF-C there were positive findings in 44 (39.3%) cases. VEGF-C expression in ESCC significantly correlated with the depth of tumor (p=0.0131), lymph node metastasis (p=0.0211), lymphatic involvement (p<0.0001) and pathological stage (p=0.0164). The prognosis for the VEGF-C positive group was poorer than that for the VEGF-C negative group (p=0.038). Multivariate analysis indicated that VEGF-C expression in ESCC is an independent factor only in cases of lymphatic involvement. VEGF-C expression in ESCC may play a great key role in lymphatic spread and this may be a consideration in terms of deciding the most appropriate treatment.     

预后营养指数与胃癌术后临床特征及预后关系

目的:探讨预后营养指数（prognostic nutritional index ,PNI）与胃癌术后患者的临床特征、辅助化疗后不良反应及预后的关系。方法:回顾性分析148 例经病理确诊为胃癌并行胃癌根治切除术患者的临床随访病例资料。根据术前1 周内化验结果计算PNI 值。PNI 通过血清白蛋白（A,g/L）和总淋巴细胞计数（TLC ,× 109/L ）的公式（PNI=A+5 ×TLC）计算出。通过对受试者工作特征曲线（receiver operating characteristic curve,ROC ）的分析得出PNI 的cut-off 值。采用Kaplan-Meier 生存曲线和Cox 比例风险模型研究PNI 对胃癌术后患者预后的影响。结果:年龄<65岁的胃癌患者的PNI 值明显高于年龄≥65岁的患者（P<0.01）。术后病理提示T1、T2 期（P<0.01）及淋巴结转移阴性（P=0.013）的患者的PNI 平均值均显著高于对照组。未发生术后并发症（P<0.01）及术后辅助化疗不良反应≤2 级的患者,PNI 值显著高于对照组（P<0.01）。 采用5 年生存作为终点绘制PNI 值的ROC 曲线,当PNI 值为52.08时,Youden指数最大,敏感度为66.7％,特异度为34.3％。PNI 高值组累积5 年总生存率显著高于PNI 低值组（P<0.01）。 单因素及多因素生存分析显示:术前CEA 值（P=0.018）、侵犯深度（P=0.010）、脉管癌栓（P=0.010）、初次化疗距手术天数（P=0.034）和PNI 值（P=0.015）是胃癌术后患者总生存时间的独立预后因素。结论:PNI 值作为一项便捷且有效的指标,可用于初步判断胃癌术后患者辅助化疗的不良反应发生率及预后状况。