进展期胃癌根治术后早期复发的危险因素分析

目的 探讨进展期胃癌根治术后复发患者的临床资料和预后情况.方法 对进展期胃癌根治术后复发的147例患者进行回顾性研究,对复发的相关因素进行单因素和多因素Logistic回归分析,对预后的相关因素采用单因素Kaplan-Meier及多因素COX回归模型分析.结果 本组患者早期复发86例(距首次手术≤1年),晚期复发61例(距首次手术＞1年).两组患者的临床资料、肿瘤直径、Borrmann分型、手术方式、T分期、N分期、TNM分期之间相比差异均有统计学意义(均P＜0.05).多因素Logistic回归分析显示,TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素(P＜0.05).单因素分析结果 显示,胃癌术后化疗(P＜0.05)、T分期(P＜0.05)、N分期(P＜0.01)、TNM分期(P＜0.01)、复发时间(P＜0.01)和再手术(P＜0.01)是影响复发患者预后的主要因素;多因素分析结果 显示,TNM分期(P＜0.01)、复发时间(P＜0.05)和再手术(P＜0.01)是复发患者的独立预后影响因素.结论 TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素.胃癌术后复发患者的预后较差,积极行再手术治疗有助于延长患者的生存时间.

Abstract：

Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods The clinical data of 147 patients with recurrent gastric cancer was reviewed. Risk factors correlated with tumor recurrence and recurrent intervals were studied by logistic regression analysis. Survival analyses and comparisons were performed using Kaplan-Meier plots, the log rank test and the Cox proportional hazards model. Results Patients were divided into an "early recurrence group" consisting of 86 patients (recurred within one year after surgery) and a "late recurrence group" of 61 patients (recurred one year or more after surgery). There were significant difference in size of primary tumor, Borrmann stage, type of gastrectomy, T stage, N stage, TNM stage between the two groups(P ＜0.05). Multivariate analysis showed that the TNM stage and N stage independently influenced the recurrent time ( P ＜ 0. 05 ). In univariate survival analysis, post-gastrectomy chemotherapy(P ＜0. 05) , T stage (P ＜0. 05) , N stage(P ＜0.01) , TNM stage ( P ＜ 0. 01) , recurrence-free interval (P ＜ 0. 01) and reoperation (P ＜ 0.01) were significantly correlated with the prognosis. In multivariable analysis, TNM stage(P ＜0. 01) , recurrence-free interval ( P ＜ 0. 05 ) and reoperation ( P ＜ 0. 05 ) were independent factors predicting recurrence. Conclusions The TNM stage and N stage were the important factors predicting the time of recurrence after curative resection for gastric cancer. Patients with recurrent gastric cancer have poor prognosis and reoperation was associated with an improved survival in patients with recurrent gastric cancer.     

残胃癌临床病理特征与预后因素分析

目的 探讨残胃癌的临床病理特征和预后影响因素.方法 对1992年1月至2008年7月138例残胃癌患者的临床病理及生存资料进行回顾性分析,其中男性122例,女性16例,平均年龄61.5岁,距首次手术时间平均为21.9年.结果 本组残胃癌病理特征以未分化型(83.3%)、Borrmann Ⅲ+Ⅳ型(92.7%)为主,肿瘤直径＞4 cm者(75.7%)多见,其手术切除率(72.4%)及根治性切除率(59.4%)均低于一般胃癌.1、3、5年生存率分别为59.2%、30.1%、14.2%,总体中位生存期19.4个月.单因素分析中组织学类型、Borrmann分型、肿瘤直径、TNM分期、浸润深度、淋巴结转移数、远处转移及治疗方式是影响预后的相关因素.多因素分析中TNM分期、浸润深度、远处转移及治疗方式是影响预后的独立因素;根治性切除者中位生存期(36个月)明显长于姑息性切除(8个月)、短路手术及其他组(5个月,P＜0.05),行联合脏器切除的无远处转移T4期患者生存期为18.6个月,较无联合脏器切除组明显延长(P＜0.05).结论 残胃癌恶性程度较高、预后较差,TNM分期、浸润深度、远处转移及治疗方式是影响预后的独立因素,早期诊断及根治性切除是改善其预后的关键.

Abstract：

Objective To explore the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC). Methods The clinical data of 138 patients with GSC treated from January 1992 to July 2008 were reviewed and analyzed. The patients included 122 males and 16 females with a mean age of 61.5 years, and the mean interval between the initial operation and second diagnosis was 21.9 years.Results The endoscopy and pathological examination showed Borrmann Ⅲ/Ⅳ in 127(92.7%)patients and undifferentiated carcinoma in 115(83.3%)patients. The resectability and radical resectability rate were 72. 4% and 59.4%. The 1-, 3- and 5-year survival rates was 59.2%, 30.1% and 14.2%, respectively.The median overall survival time was 19.4 months. Univariate Log-rank test indicated that Borrmann type,histological type, tumor diameter, TNM stage, depth of invasion, number of metastatic lymph node, distant metastasis and option of treatment were significant prognostic factors for GSC. While TNM stage, depth of invasion, distant metastasis and option of treatment were prognostic factors on multivariable analysis. The median survival time of patients underwent radical resection was significantly longer(36 months)than that of patients received palliative resection(8 months, P＜0.05)and chemotherapy only(5 months, P＜0.05).Among patients with a tumor of T4 stage, the median survival time was statistically prolonged by combined evisceration(18.6 months)when compared with the patients received palliative surgery. Conclusions TNM stage, depth of invasion, distant metastasis and option of treatment are independent prognostic factors for GSC. Early diagnosis and radical resection may play an important role in improving the prognosis of GSC.     

趋化因子受体CCR7表达与胸中段食管癌淋巴结转移及预后的关系

目的 探讨趋化因子受体CCR7表达与胸中段食管鳞癌淋巴结转移及预后的相关性.方法 回顾2003年6月至2005年6月手术治疗184例胸中段食管癌病例临床资料.采用免疫组化进行趋化因子受体CCR7检测,Kaplan-meier法进行生存分析、用Cox回归分析判定独立预后因素.结果 CCR7表达率Ⅱ期和Ⅲ期病例分别为70.3%和85.5%(x2=5.0,P=0.02);T2和T3病例分别为64.9%和80.9%(x2=5.4,P=0.01);有、无淋巴结转移病例分别为86.4%和65.0%(x2=10.8,P=0.00)两组差异均有统计学意义.有、无CCR7表达病例的5年生存率为26.3%和66.0%,差异有统计学意义(x2=23.7,P=0.00);其中T2病例分别为35.1%和70.0%(P=0.01);T3病例分别为22.4%和60.9%(P=0.00);pN0分别为28.8%和66.7%(p=0.00);pN1分别为14.3%和63.6%(P=0.00),两组差异亦均有统计学意义.Cox回归分析结果显示,T分类、N分类和CCR7表达是预后独立的危险因素.结论 食管鳞癌不同的T、N分类中CCR7表达存在差别;CCR7表达者5年生存率降低;肿瘤的T分类、淋巴结转移和CCR7表达是独立的不利预后因素.

Abstract：

Objective To investigate the expression of chemokine receptor CCR7 and its correlation with lymph node metastasis and prognosis in esophageal cancer after esophagectomy. Methods One hundred and eighty-four patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent operation in Provincial Hospital Affiliated to Shandong University between June, 2003 and June, 2005. The expression of CCR7 was detected by immunohistochemistry. All statistic analyses were performed with SPSS 13.0 statistical software. According to the clinico-patho-logic factors, the difference of CCR7 expression was compared by x2 test. Kaplan-meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. Results The expression rate of CCR7 in stage Ⅰ , stage Ⅱ and stage Ⅲ patients was 25.0 % , 70.3% and 85.5% , respectively. The difference of CCR7 expression between stage Ⅱ and stageⅢ was statistically significant (x2 =5.0, P =0.02). The CCR7 expression rate in T1, T2 and T3 patients was 33.3% , 64.9% and 80.9% , respectively. The difference of CCR7 expression between T2and T3 was statistically significant (x2 =5.4, P =0.01). The level of expression of CCR7 in patients with lymph node metastasis was significantly higher than those without metastasis (x2 =10.8, P = 0.00). The 5-year survival rate instage Ⅰ , stage Ⅱand stage Ⅲ patients was 100.0% , 38. 3% and 22.4% , respectively. The 5-year survival rate in patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression (x2 = 23.7, P = 0.00). The 5-year survival rate in T2, T3, NO and N1 patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression The result of Cox analysis demonstrated that T , N and CCR7 overexpression were independent prognostic factors. Conclusion CCR7 expression was detected in esophageal squamous cell carcinoma and was found to be significantly associated with T stage,N stage and lymph node metastasis. The patients with CCR7 expression was significantly lower the 5-year survival rate than without CCR7 expression. T stage, lymph node metastasis and CCR7 expression were independent prognostic factors.     

Prognostic effect of number of lymph nodes sampled in patients with stage Ⅰ non-small cell lung cancer

Objective To investigate the prognostic effect of quantity of lymph node(LN)resected in operations of patients with stage Ⅰ non-small cell lung cancer(NSCLC).Methods The clinical, pathological and follow-up data of 74 patients with stage Ⅰ NSCLC who were treated with surgery from January 1998 to December 2002 Beijing Friendship Hospital, Affiliated to Capital Medical University were reviewed retrospectively.Grouping the patients, according to the quantity of lymph node resected, the Kaplan-Meier method and Cox proportional hazards model was used for univariate analysis and multivariate analysis of factors with prognostic effect.Results The five year survival rate and disease-free survival(DFS)rate of these 74 patients were 64.9% and 47.3%.The univariate analysis showed that tumor size(P =0.016),T-staging (P =0.008)and extent of lymph node dissection(P =0.013)could influence the survival rate.The 5-year OS and DFS rates of patients with less than 6 LNs resected were less than the other group(more than 6 LNs)apparently.The multifactorial analysis indicated that other than staging, the quantity of lymph node resected was also an influence factor of prognosis.Conclusions The OS rate of patients has positive correlation with quantity of lymph node resected in operations.Six LNs must be resected leastways in operations of patients with stage Ⅰ NSCLC.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

ⅢA-N2期非小细胞肺癌切除术后影响预后的因素分析

目的 分析ⅢA-N2期非小细胞肺癌患者的临床情况和影响预后的相关因素,探讨手术及辅助治疗对预后的影响.方法 回顾性分析2000年1月至2005年12月经手术治疗的657例ⅢA-N2期非小细胞肺癌患者的临床资料,应用Kaplan-Meier法进行生存分析.单因素分析各变量与预后的关系采用Log-rank检验,多因素分析采用Cox模型.结果 术后全组患者的l、3和5年累计生存率分别为64.4%、26.0%和17.9%,中位生存期18个月.单因素分析中,影响生存期的不利因素为:肿瘤最大径>3 cm,高T分期,N2淋巴结无跳跃转移,纵隔淋巴结阳性数>4个,隆突下淋巴结阳性,治疗方式(单纯手术预后差,患者术后联合放化疗优于术后单纯化疗),术后未放疗、化疗,化疗周期小于4个.多因素分析显示,肿瘤直径(P=0.001),隆突下淋巴结阳性(P=0.019),纵隔淋巴结转移个数(P=0.006),术后化疗周期(P=0.007),术后放疗(P=0.055)和术后放化疗(P=0.026)对预后有明显影响.结论 ⅢA-N2期非小细胞肺癌患者5年生存率低,肿瘤直径、隆突下淋巴结阳性、纵隔淋巴结转移个数、术后化疗周期、术后联合放化疗是影响预后的独立因素.术后单站和多站纵隔淋巴结转移的预后相似,影响预后的主要是纵隔淋巴结的阳性个数,术后联合放化疗优于术后单纯化疗.     

支气管成形肺叶切除术治疗218例非小细胞肺癌

目的 探讨支气管成形肺叶切除术治疗非小细胞肺癌(NSCLC)的手术适应证、并发症以及影响预后的相关因素.方法 回顾性分析218例接受支气管成形肺叶切除术的NSCLC病人的临床资料.结果 手术死亡率为3.2%,并发症发生率为20.2%,1、3、5年生存率分别为76%、55%、42%.N分期(P=0.000)和术后辅助化疗(P=0.021)是影响生存率的独立因素.结论 对于肺功能正常病人而言,支气管成形肺叶切除术同样是治疗NSCLC的有效手段.但对于N1和N<,2>,特别是N<,2>病人应慎重手术,可考虑先行新辅助化疗,术后进行辅助化疗以提高疗效.     

224例无淋巴结转移的进展期胃癌预后因素分析

目的探讨无淋巴结转移的进展期胃癌预后危险因素。方法回顾性分析福建省立医院1998—2008年10年间行D2胃癌根治术的236例淋巴结清扫数目在12枚以上、无淋巴结转移（N0期）的进展期胃癌患者的临床病理资料。结果本组患者中224例（94．9％）接受了随访,其5年总体生存率和5年无瘤生存率分别为75．2％和66．4％。T2期和T3期患者的复发率分别为5．8％（8／138）和14．0％（12／86）：5年总体生存率分别为82．5％和59．0％;5年无瘤生存率分别为70．4％和52．2％：差异均有统计学意义（均P〈0．05）。单因素预后分析显示,浸润深度、Lauren分型及淋巴结清扫数目与本组胃癌患者预后有关（P〈0．05）。多因素预后分析证实,浸润深度是本组患者的独立预后因素（P〈0．05）。结论T2N0期胃癌患者的预后明显优于T3N0期患者;对N0期胃癌患者决定是否行辅助治疗及制定随访策略时应考虑浸润深度这一因素。     

淋巴结切除数量对Ⅰ期非小细胞肺癌患者预后的影响

目的 分析Ⅰ期非小细胞肺癌(NSCLC)患者术中淋巴结(LN)的切除数量对预后的影响.方法 回顾性分析1998年1月-2002年12月5年间在首都医科大学附属北京友谊医院接受手术治疗的74例Ⅰ期非小细胞肺癌患者临床、病理和随访资料.根据术中切除淋巴结的数量,将全部患者分组,运用Kaplan-Meier生存分析和Cox比例风险模型,对影响预后的因素进行单因素和多因素分析.结果 74例患者5年生存率为64.9%,5年无病生存率为47.3%.单因素分析显示,肿瘤大小(P=0.016)、T分期(P=0.008)和淋巴结清扫范围(P=0.013)会影响患者的生存率,淋巴结切除数量少于6枚的患者生存率和无病生存率明显低于切除淋巴结数量在6枚以上者.多因素分析结果显示淋巴结切除数量和分期均是影响患者预后的因素.结论 患者的生存率与术中淋巴结切除数量呈正相关.研究数据表明,在Ⅰ期非小细胞肺癌患者手术中至少应该切除6个以上淋巴结.     

Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer

Optimal surgical treatment for patients with stage IIIA N2 non-small cell lung cancer (NSCLC) remains a matter of debate, because of the outcomes. The outcomes may be affected from variations in patterns of lymph node metastasis. As the patterns of lymph node sub-classifications, multiple station metastases of mediastinal lymph nodes (MN2), highest metastasis of the mediastinal lymph nodes (HM), distribution of metastatic nodes (skip N2 or non-skip N2), and clinical (c-) N factor have been cited. We investigated these factors for patients with pathological stage IIIA (pIIIA) N2 NSCLC. We reviewed 121 consecutive patients with pIIIA N2 who underwent complete resection. Age, gender, tumor laterality, histology, lobe location of the tumor, c-T factor, pathological (p-) T factor, c-N factor, MN2, HM and skip N2 condition were used as prognostic variables. Overall five-year survival rate was 41.8%. Based on log-rank testing, c-T factor (P = 0.022), p-T factor (P = 0.0002), c-N factor (P = 0.009), HM (P = 0.019) and skip N2 (P = 0.030) were identified as significantly prognostic. Using these variables, p-T factor, c-N factor and skip N2 showed significance and independence on Cox multivariate analysis. The sub-classification of lymph node metastasis in patients with p-stage IIIA N2 NSCLC has clinical implications for the prognosis.     

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??Study of relation between lymph nodes metastatic ratio and prognosis of colorectal cancer JIANG Ke-wei, LIU Yan, YE Ying-jiang, et al. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract Objective To study the relation between lymph nodes metastatic ratio??LNR??and disease-free survival (DFS) as well as overall survival (OS) in stage III colorectal cancer. Methods One hundred and twenty-four patients with stage III colorectal cancer performed radical resection between January 2000 and April 2004 in the Department of Gastrointestinal Surgery, Peking University People’s Hospital were analyzed. Patients were assigned to 3 groups based on LNR: LNR??0.167, 0.167≤LNR??0.562 and LNR≥0.562. The relation between overall and disease-free survival at 5 years and 10 variables including age, sex, tumor location, size, grade, histology, T stage, number of positive LNs, and LNR, was analyzed by multivariate analysis. Survival curves were constructed using the Kaplan-Meier method. Results Both LNR and the number of positive LNs were significant prognostic factors for 5ys-DFS and OS in patients with stage III colorectal cancer. LNR was an independent prognostic factor for 5ys-OS. LNR remained an independent prognostic factor in patients with not more than 12 lymph nodes examined. Conclusion LNR is an important prognostic factor in patients with stage III colorectal cancer, which should be used in future staging systems or stratification schemes for colorectal caner with metastatic LNs, especially for not more than 12 lymph nodes examined.     

Prognostic value of cytokeratin-positive cells in the bone marrow and lymph nodes of patients with resected nonsmall cell lung cancer: a multicenter prospective study

BACKGROUND: This study was designed to prospectively substantiate the prognostic value of cytokeratin-positive (CK(+)) cells in the bone marrow (BM) and regional lymph nodes (LNs) in resected nonsmall cell lung cancer (NSCLC) patients from a large population within a multicenter study. METHODS: The study population consisted of 351 patients with stages I to IIIA NSCLC from 15 Japanese institutes. BM aspirates were stained immunocytochemically with the anti-cytokeratin antibody, CK2. The hilar and mediastinal LNs of 216 patients with stage I NSCLC were stained immunohistochemically with the anti-CK antibody, AE1/AE3. RESULTS: CK(+) cells were detected in 112 patients (31.9%) of the 351 BM aspirate patients. The frequency of CK(+) cells showed no differences among pathologic stages. The patients with CK(+) cells in the BM had a tendency to have shorter survival periods than those without CK(+) cells (p = 0.076). Although the presence of CK(+) cells in the BM of patients with stage I did not allow the prediction of overall survival, it reduced the overall survival significantly in patients with stages II to IIIA. CK(+) cells in the LNs were detected in 34 of 216 patients (15.7%) with stage I. The patients with CK(+) cells in the LNs had a poor prognosis by both univariate (p = 0.004) and multivariate analyses (p = 0.018). CONCLUSIONS: The presence of CK(+) cells in the BM was related to a poor prognosis for patients with stages II to IIIA NSCLC; however, it did not predict the prognosis of patients with stage I. For stage I NSCLC, the detection of CK(+) cells in the LNs implied a poor prognosis for the patients.     

Luminal亚型浸润性乳腺癌

目的 研究Luminal亚型浸润性乳腺癌的临床特点和生存状况.方法 回顾性分析中国医学科学院肿瘤医院2002年1月1日至9月30日收治的162例接受手术治疗、资料完整的浸润性Luminal亚型乳腺癌的临床资料,对其临床特征、复发及生存情况进行分析.结果 162例患者随访4 ～98个月,中位随访时间92个月,41例患者(25.3％,41/162)出现局部复发或远处转移,包括远处转移32例(19.8％,32/162),局部复发2例(1.2％,2/162)及局部复发合并远处转移7例(4.3％,7/162).总的无病生存率为73.1％,5年无病生存率为79.6％;27例死亡(16.7％,27/162),总生存率为82.5％,5年生存率为85.3％.Kaplen-Meier单因素生存分析显示,肿瘤大小、淋巴结状况、临床分期影响患者的总生存时间(P＜0.05);肿瘤大小、淋巴结状况、肿瘤分级、临床分期、PR影响患者无病生存时间(P＜0.05).多因素分析显示,TNM分期、PR和PCNA是影响总生存时间的独立影响因素(OR =0.633,95％ CI:0.411～0.976,P ＜0.05; OR =0.823,95％ CI:1.012～ 3.283,P＜0.05);TNM分期和PR是影响无病生存时间的独立影响因素(OR =3.273,95％CI:1.719 ～6.232,P＜0.01; OR=0.599,95％CI:0.423 ～0.850,P＜0.01).结论 在浸润性Luminal亚型乳腺癌中,PR、PCNA状况均能明显影响患者预后.     

ⅢA-N2期非小细胞肺癌纵隔淋巴结跳跃式转移的临床和预后分析

目的 探讨ⅢA-N2期非小细胞肺癌(NSCLC)纵隔淋巴结跳跃式转移的临床病理特征和分布规律,并分析跳跃转移对生存期的影响.方法 回顾性分析2000年1月至2004年12月478例行手术并经病理证实的ⅢA-N2期非小细胞肺癌患者的临床资料,分为跳跃转移组和非跳跃转移组,分析两组的临床病理特征,N2分布情况以及对生存期的影响并进行统计学分析.结果 全组N2跳跃转移的发生率为40.6%,与性别和吸烟情况有关(χ2=5.340,p=0.021和χ2=7.143,P=0.008),且鳞状细胞癌易发生跳跃转移(χ2=7.602,P=0.022),上叶较下叶更易发生跳跃转移(χ2=5.097,P=0.024),上纵隔淋巴结区为跳跃转移好发区(χ2=7.046,P=0.030).跳跃转移时,右上肺癌易转移至2、3、4组淋巴结,右中和右下肺癌则易转移至7组淋巴结;左上肺癌时,71.7%的转移N2淋巴结位于5、6组淋巴结,而左下肺癌则较易转移至7、9组淋巴结.跳跃转移组5年生存率优于非跳跃转移组(22.1%比13.6%,P=0.001),生存分析显示,跳跃转移是影响N2患者生存期的独立因素.结论 在N2期NSCLC中,跳跃转移易发生于肺上叶以及上纵隔区.跳跃转移可作为ⅢA-N2期NSCLC的一个亚群,具有更高的生存率.     

手术切除的T4卫星灶非小细胞肺癌的预后分析

目的 研究手术治疗后T4卫星灶非小细胞肺癌的生存和预后.方法 回顾性分析1995年1月至2005年3月经手术切除的42例T4卫星灶N0-2M0非小细胞肺癌患者的术后生存情况,评价各临床病理因素与预后的关系,并与同期32例手术切除的T4局部器官侵犯N0-2M0的非小细胞肺癌进行生存比较.结果 T4卫星灶组无手术死亡,术后早期并发症率为14.3%,1、3、5年生存率分别为76.2%、57.1%和46.0%;T4局部器官侵犯组术后早期并发症率为28.1%,1、3、5年生存率分别为62.3%、31.5%和20.0%;两组生存率有明显差异(P<0.05).根据淋巴结转移情况进一步分组,两组中N0M0患者的生存率均高于同组的N1-2M0患者(P<0.05).单因素分析显示,组织学类型、原发灶大小、有无淋巴结转移及是否术后辅助化疗与T4卫星灶患者的5年生存率相关;多因素分析显示原发灶大小、有无淋巴结转移及是否接受术后化疗是独立的预后影响因素.结论 原发灶直径3 cm、淋巴结转移以及未接受术后化疗的T4卫星灶非小细胞肺癌预后不佳,经手术完全切除的T4卫星灶非小细胞肺癌的预后好于T4局部器官侵犯者.