乳头状肾细胞癌的临床治疗分析——附23例报告

目的总结分析乳头状肾细胞癌的临床特点,提高其治疗水平。方法回顾性分析1980～2000年收治的23例乳头状肾细胞癌患者的临床资料。男14例,女9例。中位年龄48岁（24～71岁）。左侧11例,右侧12例。在19例初治的患者中,临床表现血尿8例（42．1％）,腰痛7例（36．8％）,无症状者4例（21．1％）;肾脏肿瘤中位最大径5．5cm（2．5～10．0cm）。另4例为外院术后出现复发和转移。结果乳头状肾细胞癌占同期收治肾癌的2．4％（23／975）。失随访4例。术后总5年生存率69．6％。其中初治19例,5年生存率为84．2％。14例早期局限性癌（T1a～T2N0M0）患者5年生存率100％,但2例分别于术后7年6个月和10年出现转移,其中1例双肺转移患者行肺转移瘤切除和生物化疗后已生存9年且健在,1例失访。3例局部淋巴结转移和2例远处转移的患者中,1例术后2年6个月出现肺转移瘤和切口转移手术联合生物化疗后生存3年,1例同期肺转移瘤患者行肺转移瘤切除和放疗后生存6年,而余3例中,2例失访,1例生存6个月。而外院初治出现复发的4例中,2例患者再次行复发肿瘤切除,分别生存1年和2年6个月,另2例转移患者中,1例生存9个月,1例失访。结论乳头状肾细胞癌在国内少见。早期局限性乳头状肾细胞癌术后预后良好。对于复发或转移的乳头状肾细胞癌患者,手术切除转移瘤或复发瘤可提高生存期。     

肾细胞癌NDRG-1和E-cadherin表达及其与临床病理因素、MVD及预后的关系

目的：研究N-myc下游调节基因（NDRG-1）和上皮型钙粘素（E-cadherin）在肾细胞癌组织中的表达,探讨其与肾细胞癌临床病理因素、微血管密度（MVD）及预后的关系。方法：应用免疫组织化学SP法检测49例肾细胞癌组织及相对应的癌旁肾脏组织中NDRG-1、E-cadherin表达情况。结果：NDRG-1和E-cadherin在正常肾组织表达均高于肾细胞癌组织,差异有显著性（P〈0.01）;二者随肾细胞癌肿瘤组织学分级、临床分期增高表达减弱,有肾门淋巴结转移者表达低于无淋巴结转移者,E-cadherin表达降低还与肾盂浸润、肾静脉癌栓相关,差异均有显著性（P〈0.05）;NDRG-1和E-cadherin表达均与肾细胞癌MVD呈负相关性（P〈0.05）;NDRG-1和E-cadherin表达阴性病例术后存活时间均显著短于阳性病例（P=0.001）;肾细胞癌组织中NDRG-1和E-cadherin表达无相关性（r=-0.253,P=0.086）。结论：NDRG-1和E-cadherin表达降低与肾细胞癌的浸润、转移及血管生成和生存时间密切相关,检测NDRG-1和E-cadherin可作为预测肾细胞癌浸润转移及预后有意义的指标。     

局麻下经皮冷冻消融治疗肾肿瘤的初步报告

目的探讨局麻下经皮冷冻消融治疗肾肿瘤的近期临床疗效。方法 对6例肾肿瘤患者(共6个肿瘤)行局麻下经皮冷冻消融治疗。均经CT或MRI检查证实:肿瘤位于左肾3例,右肾3例;肾上极1例,中极3例,下极2例;肿瘤直径平均2.9(1.4～4.8)cm,远离集合系统,无远处转移。临床分期均为T1aN0M0。术中常规行穿刺病理检查。结果 6例患者手术均成功,平均手术时间(68±21)min。未出现严重并发症。穿刺病理检查,6个肿瘤中,透明细胞癌4个,乳头状肾细胞癌1个,血管平滑肌脂肪瘤1个。无局部复发或远处转移病例。结论 局麻下经皮冷冻消融治疗肾肿瘤安全有效,远期疗效尚需进一步随访观察。     

肾细胞癌NDRG-1和E-cadherin表达及其与临床病理因素、MVD及预后的关系

目的:研究N-myc下游调节基因(NDRG-1)和上皮型钙粘素(E-cadherin)在肾细胞癌组织中的表达,探讨其与肾细胞癌临床病理因素、微血管密度(MVD)及预后的关系。方法:应用免疫组织化学SP法检测49例肾细胞癌组织及相对应的癌旁肾脏组织中NDRG-1、E-cadherin表达情况。结果:NDRG-1和E-cadherin在正常肾组织表达均高于肾细胞癌组织,差异有显著性(P<0.01);二者随肾细胞癌肿瘤组织学分级、临床分期增高表达减弱,有肾门淋巴结转移者表达低于无淋巴结转移者,E-cadherin表达降低还与肾盂浸润、肾静脉癌栓相关,差异均有显著性(P<0.05);NDRG-1和E-cadherin表达均与肾细胞癌MVD呈负相关性(P<0.05);NDRG-1和E-cadherin表达阴性病例术后存活时间均显著短于阳性病例(P=0.001);肾细胞癌组织中NDRG-1和E-cadherin表达无相关性(r=-0.253,P=0.086)。结论:NDRG-1和E-cadherin表达降低与肾细胞癌的浸润、转移及血管生成和生存时间密切相关,检测NDRG-1和E-cadherin可作为预测肾细胞癌浸润转移及预后有意义的指标。     

乳头状肾细胞癌60例临床特点及预后相关因素分析#br#

目的分析乳头状肾细胞癌的临床病理特征,探讨其诊疗及预后因素,提高对疾病认识和诊治水平。 方法收集2008年1月至2017年12月中国医科大学附属盛京医院泌尿外科收治的60例乳头状肾细胞癌患者资料,其中男41例,女19例,年龄37～80岁;病变位于左肾34例,右肾26例。行肾癌根治性切除术44例,保留肾单位手术16例。用Log rank检验分析患者临床病理特征与生存时间的关系,用Cox回归模型进行多因素分析。 结果术后病理结果均为乳头状肾细胞癌,其中Ⅰ型35例,Ⅱ型25例。肿瘤平均直径50 cm（19～120 cm）。肿瘤TNM分期：pT1～T2期51例,pT3～T4期9例。Fuhrman分级：Ⅰ～Ⅱ级49例,Ⅲ～Ⅳ级11例。6例患者出现淋巴结转移,6例伴有癌栓,5例发生远处转移,6例死亡。Log rank检验结果显示,肿瘤病理分级、分型、是否有远处转移与患者生存时间相关（P＜005）。而Cox多因素回归分析结果显示,肿瘤病理分级是乳头状肾细胞癌患者生存时间的独立影响因子（P＜005）。 结论乳头状肾细胞癌是肾细胞癌少见类型,Ⅱ型比Ⅰ型预后差,病理级别与预后密切相关,是影响生存时间的独立因素。手术切除是主要治疗方式,总体预后较好。     

N—myc下游调节基因1蛋白在肾细胞癌中的表达及其意义

目的探讨N—myc下游调节基因1（NDRG1）蛋白在肾细胞癌组织中的表达及其与微血管密度（MVD）和临床病理因素之间的关系。方法应用免疫组织化学sP法检测49例肾细胞癌及相应癌旁正常肾组织NDRG1和CD34表达,采用CD34染色进行MVD计数。结果NDRG1为细胞质和（或）膜表达蛋白,在正常肾近曲小管、远曲小管表达率为100％（49／49）,显著高于在。肾细胞癌组织中的阳性率[51％（25／49）]（P〈0．05）。NDRG1表达随组织学分级增高而降低（x^2=9．968,P=0．007）;有淋巴结转移组和无淋巴结转移组NDRG1表达率分别为0（0／5）和56．8％（25／44）,差异有统计学意义（X^2=5．800,P=0．016）;NDRG1表达越低,临床分期越晚（X^2=6．437,P=0．011）,MVD值越高（t=2．235,P=0．030）。结论NDRGI在肾细胞癌中可能为一种抑癌基因,其表达降低与肾细胞癌侵袭、转移有关,且可能通过参与调节肾细胞癌血管形成而发挥抑制肿瘤生长和转移的作用。     

影响肾癌根治术后患者生存的多因素分析

目的:分析、筛选影响肾癌根治术后患者生存的相关因素.方法:对1993年1月至2006年12月收治并采用"肾癌根治术"治疗的389例肾细胞癌患者进行随访.将所有资料编码后建立数据库,采用寿命表法计算总体生存率,采用Cox回归模型比较多种因素对生存时间的影响.结果:透明细胞癌307例(78.92%),乳头细胞癌51例(13.11%),嫌色细胞癌21例(5.40%),集合管癌2例(0.51%),未分化8例(2.06%);TNM分期(根据2002年AJCC标准):T1N0M0 198例,T2N0M0 113例,T1N1M0 3例,T2N1M0 10例,T3N0M0 51例,T3N1M0 14例;获得随访268例肾癌根治术后患者1、3、5、10年生存率分别为96.5%、90.7%、75.7%、65.8%;Robson分期:I期311例,Ⅱ期40例,Ⅲ期38例;合并瘤栓35例,无瘤栓254例.多因素分析显示:"TNM分期"、"Robson分期"、"合并瘤栓"、"术后治疗"对预后的影响有显著意义(x2=22.50,P=0.001),其中影响肾癌预后的因素中最重要的是病理分期(TNM分期、Robson分期),回归系数分别为0.533、0.674,相对危险度分别为1.941、2.011(P=0.004,P=0.002);而"性别"、"年龄"、"肾癌三联征"、"病程"、"侧别"、"手术入路"对肾癌根治术后病人预后的影响无显著意义(P＞0.05).结论:肾癌根治术是治疗肾癌的的一种安全、有效手段;"TNM分期"、"Robson分期"、"合并瘤栓"是影响预后的危险因素,"术后治疗"是预后的保护性因素.     

维持性血液透析并发肾癌的临床病理特点

目的:探讨维持性血液透析并发肾癌的临床病理特点及预后。方法:回顾性分析我院2013年01月至2020年01月收治的10例维持性血液透析并发肾癌患者的临床病理资料,并与同期肾功能正常肾癌患者比较。结果:男6例,女4例;平均年龄49.4(31～63)岁,维持血透时间平均49.6（19～62）个月。3例患者存在获得性肾囊肿。临床表现为肉眼血尿1例,其余9例无肾肿瘤临床症状。肿瘤均单侧单发。肿瘤最大径平均为3.9（1.2～5.4） cm。仅1例血尿患者临床分期T3aN0M0,余9例临床分期T1N0M0。患者均行后腹腔镜根治性肾切除术。术后病理证实为肾透明细胞癌9例（90%）,乳头状肾细胞癌1例（10%）。相较肾功能正常肾癌患者,维持性血液透析并发肾癌患者具有年轻、瘤体小和分级低的特点（P＜0.05）,且平均随访64.7（26～104）个月,患者均存活,未见肿瘤复发及远处转移。结论:维持性血液透析并发肾癌患者具有较好的临床病理结果,积极手术治疗预后好。维持性血液透析患者需警惕并发肾癌的风险,由于患者大多无临床症状,故需定期筛查。     

保留肾单位手术治疗双肾细胞癌十例临床分析

目的:观察保留肾单位手术治疗双侧肾细胞癌的疗效.方法:回顾性分析10例双侧肾细胞癌患者的临床资料.7例同时性肾癌中,1例行双侧Ⅰ期手术,6例行分期手术.其中3例行双肾肿瘤剜除术,1例行双肾部分切除及右肾上腺切除术,2例行一侧肾癌根治性切除术及对侧肾肿瘤剜除术,1例行一侧肾癌根治性切除术、下腔静脉切开取癌栓术及对侧肾肿瘤剜除术.3例异时性肾癌均分期手术,其中2例行双肾肿瘤剜除术,1例行一侧肾癌根治性切除术,对侧肾肿瘤剜除术.所有患者术后均行生物学治疗3个月.10例获随访3个月～8年,平均19个月.结果:7例未见肿瘤复发和转移.1例术后6个月出现肺转移,已带瘤生存3个月;1例术后1年出现残肾肿瘤复发,经生物学治疗,已带瘤生存3个月;1例术后3个月后死于肾衰竭.异时性肾癌者的先发一侧行肾癌根治术,对侧肾出现肿瘤的时间分别为9个月、2年和6年.结论:保留肾单位的肾切除术是目前双侧肾癌较为理想的治疗方法,它对肾功能的影响较少.双侧肾癌的预后和单侧肾癌一样,与肿瘤的分期和分级有关,而与肿瘤是否多发无关.     

肾嫌色细胞癌28例临床分析并文献复习

目的分析肾嫌色细胞癌的临床及病理特点以提高对其的诊治水平。方法回顾性分析苏州大学附属第三医院2010年1月至2017年12月收治的28例肾嫌色细胞癌患者的资料,其中男12例,女16例;年龄27～78岁,中位年龄57岁。患者肿瘤均局限于单侧肾脏,其中左肾17例,右肾11例。结果28例患者均行手术治疗,术后病理均证实为肾嫌色细胞癌。7例行开放肾癌根治术,16例行腹腔镜下腹膜后肾癌根治术,5例行腹腔镜下保留肾单位手术。病理分期:pT1N0M0期23例,pT2N0M0期5例。28例患者均获得随访,随访12～72个月,平均24个月,28例患者均无瘤生存,行开放手术和腹腔镜手术患者的预后无明显差异。结论肾嫌色细胞癌是具有特殊形态的少见肾癌类型,确诊有赖于典型的病理特征。手术切除是肾嫌色细胞癌的主要治疗方式,其较少复发和转移,预后良好。     

Validity and Necessity of Sub-classification of N3 in the 7thUICC TNM Stage of Gastric Cancer

Background: The 7th TNM staging is the first authoritative standard for evaluation of effectiveness oftreatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed.In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stagegastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute andHospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth ofinvasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate oflymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastriccancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis thanother sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0.T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. Inmultivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors.Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should thereforebe applied in the TNM stage system.     

T1micN0M0、T1aN0M0和T1bN0M0乳腺癌376例临床特征和预后分析

目的:分析T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者的临床病理学特征,了解其生存状态,探讨与预后相关的独立影响因素。方法:收集2002年1月—2005年12月4487例可手术的乳腺癌患者的临床病理学资料,回顾性分析其中376例T1micN0M0、T1aN0M0和T1bN0M0患者的临床病理学特征、复发和转移以及生存情况。结果:376例患者中,66例(17.6%)为T1mic(pT≤0.1cm),122例(32.4%)为T1a(0.1cm相似文献   

N1站淋巴结检出数目对pT1～3N0M0非小细胞肺癌患者预后的影响

目的探讨N1站淋巴结检出数目与pT1～3N0M0非小细胞肺癌(NSCLC)患者临床病理特征及预后的关系。方法选择2013年1月至2015年3月在安徽医科大学附属省立医院接受肺癌根治术的pT1～3N0M0 NSCLC患者337例, 采用受试者工作特征(ROC)曲线的分析确定以N1站淋巴结检出数目预测pT1～3N0M0 NSCLC患者5年生存的最佳界值, 根据最佳界值分组, 分析N1站淋巴结检出数目与pT1～3N0M0 NSCLC患者临床病理特征及预后的关系。结果 337例患者共检出N1站淋巴结1 321枚, 每例患者平均3.9枚。中位生存时间为42.0个月, 1、3、5年生存率分别为82.2%、57.1%和24.9%。ROC曲线分析显示, 以N1站淋巴结检出数目预测pT1～3N0M0 NSCLC患者5年生存的最佳界值4.5枚, 取整数后, 以N1站淋巴结检出数目为5枚作为界值, 将患者分为检出淋巴结<5枚组(212例)和检出淋巴结≥5枚组(125例)。检出淋巴结≥5枚组接受辅助化疗的患者比例为19.2%, 高于检出淋巴结<5枚组(9.0%, P=0.007), 两组患者其他临...     

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.     

Diagnosis and treatment of bladder cancer

The authors present a retrospective analysis of the results of transurethral conservative and radical operations in 125 patients with invasive cancer of the urinary bladder (UB) treated in the Research Institute of Urology throughout 1992-2002. Transurethral resection (TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3 and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17 (23.6%) cases, respectively. 53 patients with advanced invasive UB cancer have undergone radical cystectomy varying by the method of urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0M0, pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences after TUR occurred in 12 (16.7%) patients with stage pT2a, in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free survival after TUR at stage T2 reached 97.5 +/- 3.2 and 47.4 +/- 2.8, respectively, at stage T3 and T4--57.1 +/- 4.3 and 26.6 +/- 3.4%, respectively. Postcystectomy distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For all 53 patients a 2-year corrected survival made up 68 +/- 12.0%. Thus, transurethral electrosurgery is an effective treatment of invasive UB cancer; the only radical surgical treatment for invasive UB cancer is cystectomy.     

Indications for one-stage and delayed urethrectomy after radical cystectomy in patients with invasive cancer of the urinary bladder

Our aim was to determine indications for urethrectomy in patients with muscle-invasive cancer of the urinary bladder (UBC) which is essential for choice of urine derivation. A total of 51 patients with invasive UBC at the age of 33-78 years (mean age 60 years) were treated: 7 patients with pT2bN0M0, 1 patient with pT2bN1M0, 18 patients with pT3aN0M0, 3 patients with pT3aN1M0, 14 patients with pT3bN0M0, 6 patients with pT4aN0M0, 2 patients with pT4bN0M0. Urethrectomy was indicated for men with involvement of the prostatic urethra (stage t4a) and urinary bladder cervix, multiple tumors of the bladder, pelvic lymph node lesions, detection of tumor cells by instant biopsy in the free urethral edge, poor differentiation of the tumor (G3) in combination with one of the above factors, emergence of urethrorrhagia late after cystectomy; for women with involvement of the bladder cervix and Lieutaud's triangle in combination with poor differentiation of the tumor cells (G3). Cystectomy was followed by urine derivation of the following type: uretero-ureteroanastomosis with nephrostomy (n = 2), ureterocutaneostomy (n = 3), Briker's operation (n = 22), ureterosygmoanastomosis with creation of sigmoid reservoir (method Mainz pouch II) (n = 21), Studer orthotopic plastic reconstruction (n = 2) and Hautmann plastic surgery (n = 1). Urethrectomy was made in 16 patients. One-stage operation was conducted in 14 patients (suprapubic approach--8 males, perineal one--in 6 females). Delayed urethrectomy was made in 2 patients. Intra- and postoperative complications caused by urethral removal were absent. Corrected 2-year survival for all 51 patients was 70.8 +/- 11.3%. Among the deceased were 2 patients who had undergone urethrectomy at the stage T2b and T4a 5 and 8 months after primary operation, respectively. Thus, we believe that urethrectomy must be made in the above indications and poor differentiation of the tumor cells (G3).     

Prognostic value of programmed death-1, programmed death-ligand 1, programmed death-ligand 2 expression,and CD8(+) T cell density in primary tumors and metastatic lymph nodes from patients with stage T1-4N+M0 gastric adenocarcinoma

Background: Anti-programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) immunotherapy has been proved to be effective on gastric cancer in ongoing clinical trials. However, the value of PD-L1 in predicting responses of patients with gastric cancer to anti-PD-1/PD-L1 immunotherapy is controversial. Some studies suggested that intra- and inter-tumoral heterogeneity of PD-L1 expression might explain the controversy. This study aimed to analyze the expression of PD-L1, PD-L2, and PD-1 as well as CD8(+) T-cell density in primary tumors and lymph nodes from patients with stage T1-4N+M0 gastric adenocarcinoma to explore the heterogeneity of PD-1 signaling pathway molecules. Methods: In primary tumors and metastatic as well as non-metastatic lymph nodes from patients with stage T1-4N+M0 gastric adenocarcinoma, we detected PD-L1 and PD-L2 expression with immunohistochemistry. CD8(+) T-cell density in primary tumors and PD-1 expression on CD8(+) T cells were detected with immunofluorescence. Uni-variate analysis was used to determine the prognostic values of them. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival and disease-free survival. Results: Among 119 eligible patients who had undergone surgical resection, the positive rate of PD-L1 was higher in metastatic lymph nodes than in primary tumors (45.4％ vs. 38.7％,P= 0.005); the positive rate of PD-1 on CD8(+) T cells was significantly higher in primary tumors and metastatic lymph nodes than in tumor-free lymph nodes (both P < 0.001). The intensity of PD-1 expression on CD8(+) T cells in primary tumors and in metastatic lymph nodes were stronger than that in tumor-free lymph nodes from the same patient. Beside, the positive rate of PD-L2 did not show any differences between primary tumors and metastatic lymph nodes. In multivariate analysis, PD-L1 expression, PD-L2 expression, a low density of CD8(+) T cells in primary tumors, and PD-1 expression on CD8(+) T cells in primary tumors were associated with poor prognosis.Conclusion: The expression of PD-L1 is heterogeneous in primary tumors and in metastatic lymph nodes from patients with stage T1-4N+M0 gastric adenocarcinoma, which might explain the inconsistent results in assessing the prognostic value of PD-L1 expression in previous studies.     

Radical treatment of invasive bladder cancer

We have conducted a retrospective analysis of radical cystectomy in 53 patients (45 males and 8 females, 85 and 15%, respectively) with invasive bladder cancer (BC) treated in the Research Institute of Urology in 1997-2002. Stages T2N0M0, pT3aN0M0, T3bN0M0, pT4aN0M0, pT4aN1-2M0 were in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%), 8 (15%) cases, respectively. Well differentiated transitional cell BC (G1) was detected in 1 (2%) patient, moderately differentiated (G2) in 16 (30%) cases, poorly differentiated (G3) in 36 (68%) patients. The following methods of urine derivation were used: orthotopic plastic surgery (n = 3, 6%), ureterocutaneostomy (n = 4, 8%), Mainz pouch II operation (n = 16, 30%), Hassan operation (n = 5, 9%), Bricker procedure (n = 22, 44%), transureteroanastomosis (n = 3, 6%). In the postoperative period there was one lethal outcome, early complications in 5 (9%) patients, late complications in 9 (17%) patients. Distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For 53 patients 2-year corrected survival was 68 +/- 12.0%. We have come to the conclusion that the only radical surgical treatment of invasive BC is cystectomy, limitations to which are connected only with complexity of subsequent urine derivation.     

术后放疗对T1-2N1M0期三阴乳腺癌患者预后的影响

目的 分析T1-2N1M0期三阴性乳腺癌（TNBC）患者行改良根治术后放疗与否对生存的影响。方法 回顾性分析2004年1月至2010年9月接受改良根治术后129例T1-2N1M0期TNBC患者的临床资料,其中61例行术后常规放疗（放疗组）,68例未行放疗（未放疗组）。分析两组5年总生存率、5年无局部复发生存率和5年无病生存率以及影响局部复发的因素。结果 中位随访时间为67个月,全组患者中27例（20.9％）出现局部区域复发。放疗组较未放疗组提高了5年无局部复发生存率（88.5％ vs. 70.6％,P=0.017）和5年无病生存率（78.7％ vs.63.2％, P=0.068）。放疗组和未放疗组的5年生存率分别为88.5％和82.4％（P=0.341）。单因素分析显示年龄、T分期、淋巴结阳性数、是否放疗是影响无局部复发生存的预后因素（P＜0.05）。多因素分析显示未放疗（HR=3.432,P=0.010）和淋巴结3枚阳性（HR=2.915,P=0.020）是影响局部区域复发的独立预后因素。结论 术后放疗可明显改善T1-2N1M0期TNBC患者的无局部复发生存。淋巴结3枚阳性者局部控制更差,增加区域淋巴结照射是可行的。     

Prognostic Significance of the Number of Negative Lymph Nodes in Postoperative Locally Advanced Gastric Cancer Patients

OBJECTIVE To evaluate the impact of the number of negative lymph nodes on disease free survival (DFS) in patients with locally advanced gastric cancer.METHODS A total of 485 patients who underwent surgery for locally advanced gastric cancer (pT3N0-2M0) and had a DFS at least 6 months were enrolled in this retrospective study. The medical records of the patients were reviewed in detail, and the characteristics of the patients and the findings of pathologic examination were analyzed in order to find the potential association with DFS. Subgroup analysis according to pathologic stage was performed. Multivariate analysis using the COX regression method was also conducted in order to identify the independent prognostic factors. The Kaplan-Meier method was used to plot DFS curves. The DFS rate was compared in each subgroup.RESULTS COX regression analysis showed that the DFS rate of gastric cancer patients with pathologic stage T3N0-2M0 was significantly associated with age, degree of tumor differentiation, tumor location as well as the number of negative lymph nodes. Among patients with stage T3N0M0 disease, who had 1-4 and 5 or more negative lymph nodes, the 2-year DFS rate was 8.3% and 55.6%, respectively. Meanwhile, the 3-year DFS rates of the same group of patients was 0% and 24.9%, respectively (P = 0.025). In the T3N1M0 subgroup, the 2-year DFS rate of patients with 3 or fewer, 4-9, and 10 or more negative lymph nodes was 17.3%, 39.1%, 52.6%, respectively. The 3-year DFS rate in this group was 4.2%, 6.0%, 17.1%, respectively (P < 0.001). In the T3N2M0 subgroup, the 2-year DFS rate of patients with 7 or fewer and 8 or more negative lymph nodes was 11.5% and 35%, respectively. The 3-year DFS rate of the same group of patients with 8 or more negative lymph nodes was also significantly improved (0.8% vs. 5%, respectively; P = 0.015).CONCLUSION For gastric cancer patients with pathologic stage T3N0-2M0, the number of negative lymph nodes is an independent prognostic factor for DFS. The number of negative lymph nodes may reflect the level of regional lymph node dissection or the accuracy of the pathologic staging.