平阳霉素诱导化疗在T2舌鳞癌治疗中的应用价值

背景与目的：诱导化疗在舌鳞癌治疗中具有重要作用,本研究目的在于探讨单药平阳霉素诱导化疗在T2舌鳞癌治疗中的应用价值。方法：回顾性分析单纯手术及单药平阳霉素诱导化疗加手术分别治疗36例舌鳞癌T2病变患者后,对其生存及复发情况的影响。结果：单纯手术组及诱导化疗加手术组的5年生存率分别为81.46％和57.14％,差异有显著性（P=0.0299）;区域/局部复发率分别为22.2％和33.3％,中位复发时间分别为20和24个月。对Ⅱ、Ⅲ期及Ⅳ期患者,两种治疗措施的5年生存率无显著差异（P=0.0949;P=0.0939）。在Ⅲ及Ⅳ期病变中,单纯手术组和诱导化疗加手术组的区域/局部复发率分别为12.5％和35.7％,中位复发时间分别为12和12.8个月。结论：单药平阳霉素诱导化疗对舌鳞癌T2病变的治疗价值不大。不管是早T2病变还是晚T2病变,它对患者的5年生存率没有明显影响,对局部控制率的影响仍有待进一步观察。     

Selection of gastrectomy for adenocarcinomas arising in the gastric fundus

A retrospective study involving 174 patients with adenocarcinoma of the gastric fundus treated with proximal subtotal (PS), extended proximal subtotal (EPS), total (T), and extended total (ET) gastrectomy showed that 1)there were no statistically significant differences in operative mortality between the four gastrectomy types; 2)ET was associated with a significantly lower incidence of local recurrence than T (P less than 0.05) and PS (P less than 0.001); 3)ET resulted in a significantly higher survival rate than PS or T (P less than 0.01) when the three procedures were applied in patients who had TNM stage I and II tumors; 4)patients with stage III and IV tumors did poorly regardless of gastrectomy type. The study implies that intraoperative tumor staging might identify stage I and II patients who benefit the most from radical surgery and those with stage III and IV tumors who should receive palliative surgery.     

Proposal of a stage-specific surveillance strategy for colorectal cancer patients: A retrospective analysis of Japanese large cohort

Background

Frequency and duration of postoperative surveillance for colorectal cancer patients remain debatable, and follow-up data regarding stage I or resected stage IV patients are limited.

Carcinoma of the nasopharynx: survival and patterns of recurrence

We have analyzed survival, disease-free (NED) survival, and patterns of recurrence for 76 patients with carcinoma of the nasopharynx treated from June 1964 through July 1979. Patients with Stages I through IV, who were treated for cure, comprise the study group. Megavoltage teletherapy treatment was delivered to the primary bilateral neck and supraclavicular areas. Dose to the nasopharynx ranged from less than 55 Gy to 70 Gy with several patients receiving higher doses. The observed 5 year NED survival rates were: Stage I, 75%; Stage II, 20%; Stage III, 42%; and Stage IV, 31%. During a 5-year minimum follow-up for all patients, 46 or 60.5% failed. Ninety-five percent of these failures occurred within 3 years; only two patients relapsed after more than 5 years.     

Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy

PURPOSE: To evaluate the prognostic value of the posttreatment TNM stage as a predictor of outcome in locally advanced rectal cancers treated with preoperative chemotherapy and radiotherapy. METHODS AND MATERIALS: Between 1993 and 2000, 128 patients with tethered (103) or fixed (25) rectal cancers were treated with 50 Gy preoperative pelvic radiotherapy and two cycles of concurrent 5-fluorouracil infusion (20 mg/kg/d) and leucovorin (200 mg/m(2)/d) chemotherapy on Days 1-4 and 22-25 and a single bolus mitomycin C injection (8 mg/m(2)) on Day 1. Of the 128 patients, 111 had Stage T3 and 17 Stage T4 according to the rectal ultrasound or CT findings and clinical evaluation. All 128 patients underwent surgery 8 weeks after chemoradiotherapy. Postoperatively, the disease stage was determined according to the surgical and pathologic findings using the American Joint Committee on Cancer TNM staging system. RESULTS: Of the 128 patients, 32 had postchemoradiotherapy (pCR) Stage 0 (T0N0M0), 37 pCR Stage I, 26 pCR Stage II, 28 pCR Stage III, and 5 pCR Stage IV disease. Of the 128 patients, 79 had pCR Stage T0-T2, 35 pCR Stage T3, and 14 pCR Stage T4. The rate of T stage downstaging was 66% (84 of 128). Of the 128 patients, 25% achieved a pathologic complete response, and 31 (24%) had positive nodal disease. Lymphovascular or perineural invasion was found in 13 patients (10%). The 5-year disease-specific survival rate was 97% for pCR Stage 0, 88% for pCR Stage I, 74% for pCR Stage II, 44% for pCR Stage III, and 0% for pCR Stage IV (p = 0.0000059). The 5-year relapse-free survival rate was 97% for pCR Stage 0, 80% for pCR Stage I, 72% for pCR Stage II, 42% for pCR Stage III, and 0% for pCR Stage IV (p < 0.000001). In univariate analysis, the pretreatment tumor status (fixed vs. tethered tumors), the pCR TNM stage, T stage downstaging, pathologic T4 tumors, node-positive disease after chemoradiotherapy, and lymphovascular or perineural invasion were statistically significant prognosticators of disease-specific survival and relapse-free survival. pCR Stage T4 disease was a strong predictor of local recurrence. The 5-year local control rate was 98% for pCR T0-T2, 89% for pCR T3, and 65% for pCR T4 disease (p = 0.00044). In multivariate analysis, the pCR TNM stage was the most statistically significant independent predictor of survival (p = 0.003) and relapse-free survival (p < 0.001). CONCLUSION: For patients who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, the pCR TNM stage was a strong prognosticator of recurrence and survival. It can be used to identify high-risk patients for additional postoperative therapy.     

肝癌根治性切除术后联合肝动脉化疗栓塞和门静脉化疗对预防复 …

目的 探讨在肝癌根治性切除术后联合肝动脉化疗栓塞（ｈｅｐａｔｉｃ ｃｈｅｍｏｅｍｂｏ－ｌｉｚａｔｉｏｎ,ＨＡＣＥ）和门静脉化疗（ＰＶＣ）对预防术后复发的价值。方法 总结１９９１年８月～１９９５年７月收治符合根治性切除的原发性肝癌患者８１例。其中,术后联合ＨＡＣＥ和ＰＶＣ（Ⅰ组）２３例,单纯ＨＡＣＥ（Ⅱ组）３０例,未做特殊处理（Ⅲ组）２８例。全部患者随访３年以上。将３组进行对比研究。结果 患者术后１     

Nucleolar organizer regions as a prognostic indicator for stage I non-small cell lung cancer.

When the number of silver-stained nucleolar organizer regions (Ag-NORs) was counted in 274 patients with non-small cell lung cancer, the mean number per nucleus in patients overall was 5.07 +/- 1.92 (SD). With the use of the tumor (T)-nodes (N)-metastasis (M) classification, the mean Ag-NOR count for patients with T1 and T2 disease was statistically lower than that for those with T3 and T4 disease (P less than 0.01). The mean Ag-NOR counts were lower in patients with N0 disease than in those with N1 and N2 disease (P less than 0.01); lower in patients with stage I disease than in those with stage II, IIIA, IIIB, or IV disease (P less than 0.01); and lower in patients with adenocarcinoma than in those with squamous cell carcinoma (P less than 0.01) or large-cell carcinoma (P less than 0.05). In 131 patients with stage I disease, the mean Ag-NOR count was 3.80 +/- 1.32, and the 5-year survival rates of patients with Ag-NOR counts of less than 3.80 and greater than or equal to 3.80 were 78 and 44%, respectively, including 78% and 25% for adenocarcinoma, respectively (P less than 0.01). However, there was no statistically significant difference for those in stage II, IIIA, IIIB, or IV, and in stage I (without an adenocarcinoma). Because patients with stage I non-small cell lung cancer and a high number of Ag-NORs had a poor prognosis, Ag-NORs can serve as a pertinent marker of an early recurrence.     

Improvements observed in care and outcome in carcinoma of the larynx

The 1978 Patterns of Care Studies (PCS) survey of carcinoma of the larynx reviewed the process (pre-treatment evaluation and treatment) and outcome of 521 patients. When compared to results from the 1973 PCS survey, several important changes have been observed. The use of surgery in conjunction with radiation therapy (RT) increased in Stage III cases from less than 30% to greater than 60% and in Stage IV cases from 48% to greater than 70%. This change in therapy was associated with a decline in locoregional failure in this patient group. Among Stage I and II supra- and subglottic carcinomas, an improvement in 3-year local tumor control (Stage I: 78 to 100% and Stage II: 54 to 74%) and overall freedom from recurrence (Stage I: 78 to 100% and Stage II: 45 to 73%) was seen over this 5-year period with no identifiable change in process for this subgroup. Also noted was an improvement in the freedom from recurrence rate for Stage III and IV patients receiving treatment at facilities with low process scores. The 1978 PCS survey confirmed the presence of superior patient outcome in several subgroups and the relationship of this improvement to patient process.     

Squamous cell carcinoma of the oral tongue

Between 1958 and 1983 at Beilinson Medical Center, Petah Tiqva, Israel, 75 patients were diagnosed as having squamous cell carcinoma of the body of the tongue. Of these, 42 were male and 33 female and the average age at the time of diagnosis was 61.6 years. 29.33% were in clinical stage I, 36% in stage II, 26.67% in stage III and 8% in stage IV. Fifteen patients underwent only surgery, nine received only irradiation and 51 received combined treatment. The 5-year survival rate was 68.3% with a significant difference between that for stage I (90%) and stage II (83.7%) and that for stages III and IV (43.07% and 0%, respectively) (P less than 0.001). Among the 24 with recurrence of the malignancy, 20 died despite treatment and four patients died of causes unrelated to the malignancy. From this experience it was concluded that local excision of the tumor should be performed only in stage I patients and that in stage II patients prophylactic treatment of the neck (neck dissection and irradiation) should be undertaken because of the high incidence of occult metastases.     

Malignant potentiality of squamous cell carcinoma of the esophagus predictable by DNA analysis

Cell nuclear deoxyribonucleic acid (DNA) content was microspectrophotometrically determined in biopsy specimens from 75 patients with squamous cell carcinoma of the esophagus. The relationships among DNA distribution patterns, pathohistologic features, and prognosis were investigated. In patients with a high hyperploid DNA content (type IV), there was a high frequency of lymph node metastasis and lymphatic invasion, as compared with those exhibiting the near diploid DNA content (type II). In the type IV group, 22 of 23 patients died within 2 years, whereas patients with type II had a good clinical course and the 5-year survival rate was 60%. The DNA distribution pattern, determined by a multivariate Cox model analysis, was one of independent and significant prognostic variables. As these findings suggest that the DNA distribution pattern reflects the malignant potentiality of the tumor, the preoperative determinations of the DNA pattern in biopsy specimens of the esophageal carcinoma should provide a valuable parameter for predicting the prognosis.     

Neoadjuvant chemotherapy consisting of cisplatin and continuous infusions of bleomycin and 5-fluorouracil for advanced head and neck cancer. The need for a new stratification for stage IV (M0) disease.

A Phase II study of cisplatin (100 mg/m2 on day 1) and bleomycin (15 mg intravenous push day 1) followed by 5 days of continuous intravenous infusions of 5-fluorouracil (5-FU) (650 mg/m2/d) and bleomycin (16 mg/m2/d) repeated at 21-day intervals was performed in 54 previously untreated patients with nonmetastatic (M0), locoregionally advanced head and neck squamous cell carcinoma (SCC). The aim of this study was to increase the complete response rate to chemotherapy and to identify prognostic factors that may influence local control and disease-free survival. From April 1986 until August 1988, 5 patients with Stage III and 49 with Stage IV (International Union Against Cancer-American Joint Committee on Cancer 1986 [UICC-AJCC]) disease received this regimen. Thirty (61%) patients with Stage IV disease had bulky nodal disease (9 N2c and 21 N3) and 29 (53%) had T4 primary lesions. The response rate was 59% (95% confidence interval, 47% to 71%) and the complete response rate to chemotherapy was 13% (95% confidence interval, 0% to 26%). The response rate was greatly influenced by tumoral volume and performance status (PS). The complete response rate to chemotherapy was 40% for patients with Stage III disease (2 of 5 patients) versus 10% for patients with Stage IV disease (5 of 49 patients; P = 0.02). The response rate for patients with Stage III disease was 100% (5 of 5 patients) versus 55% for patients with Stage IV disease (27 of 49 patients; P = 0.14). For patients with Stage IV bulky nodal disease (N2c-N3), the response rate was 43% (13 of 30 patients) and the complete response rate to chemotherapy was 3% (1 of 30 patients) versus 68% (13 of 19 patients; P = 0.13) and 21% (4 of 19 patients; P = 0.07), respectively, for patients with Stage IV less than N2b disease. The local control rate after definitive therapy was 100% for patients with Stage III disease, 70% (17 of 24 patients) for patients with Stage IV less than N2b disease, and 17% (5 of 30 patients) for patients with bulky nodal disease (P = 0.0005). As of February 1991, with a median follow-up time of 38 months (range, 30 to 53 months), 4 of 5 patients with Stage III disease and 7 of 19 patients with Stage IV less than N2b disease were alive with no evidence of disease (37%) versus 0 of 30 patients with bulky nodal disease (P = 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)     

外阴癌临床治疗309例报告

目的　分析外阴癌不同治疗方法的结果 ,并探讨其复发转移的特征。方法　采用回顾性研究的方法 ,对 30 9例外阴癌的临床治疗结果进行分析。结果　 30 9例患者总的 5年生存率为6 7.9% ,Ⅰ、Ⅱ、Ⅲ及Ⅳ期的 5年生存率分别为 86 .9%、82 .5 %、5 9.2 %和 43.6 %。总的治疗失败率为49 .8% (其中 2年内失败者占 6 9.5 % ) ;复发部位依复发时间不同而异 ,83.6 %的腹股沟、盆腔及远处转移发生在治疗后 2年内 ,外阴局部复发占 2年后治疗失败的 81.1%。外阴癌复发转移与年龄无关。Ⅰ期癌各种治疗方法的生存率及治疗失败率差异无显著性。Ⅱ期癌外阴根治性切除 腹股沟清扫术生存率较高 (P <0 .0 5 ) ;腹股沟淋巴结阳性者 ,手术治疗的失败率显著低于放疗 (P <0 .0 5 ) ;腹股沟淋巴结阴性者 ,两种治疗方式差异无显著性 ;腹股沟预防照射剂量Dm达 6 0Gy者 ,失败率显著低于剂量Dm <6 0Gy者 (P <0 .0 5 )。结论　早期外阴癌应施行外阴根治性切除 ,加施预防性淋巴清扫或腹股沟足量放疗 ;对中晚期患者 ,争取切除原发灶及行腹股沟淋巴清扫 ,并辅以术前、术后放疗。     

Prognostic significance of primary-tumor extension,stage and grade of nuclear differentiation in patients with renal cell carcinoma

Surgery remains the preferred therapy for renal cell carcinoma. The various adjunctive or complementary therapies currently yield disappointing results. Identifying reliable prognostic factors could help in selecting patients most likely to benefit from postoperative adjuvant therapies. We reviewed the surgical records of 78 patients who had undergone radical nephrectomy with lymphadenectomy for renal cell carcinoma, matched for type of operation and histology. According to staging (TNM), 5.1% of the patients were classified as stage I, 51.3% as stage II, 29.5% as stage III and 14.5% as stage IV. Of the 78 patients 40 were T2N0 and 21 T3aN0. Tumor grading showed that 39.7% of the patients had well-differentiated tumors(G1), 41.1% moderately-differentiated (G2), and 19.2% poorly-differentiated tumors (G3). Overall actuarial survival at 5 and 10 years was 100% for stage 1; 91.3% at 5 years and 83.1% at 10 years for stage II; 45.5% and 34.1% for stage III; and 29.1% and nil for stage IV (stage II vs stage III p = 0.0001). Patients with tumors confined to the kidney (pT2N0) had better 5- and 10-year survival rates than patients with tumors infiltrating the perirenal fat (pT3aN0) (p = 0.000006). Survival differed according to nuclear grading (G1 vs G3 ; p = 0.000005; G2 vs G3; p = 0.0009). In conclusion our review identified tumor stage, primary-tumor extension, and the grade of nuclear differentiation as reliable prognostic factors in patients with renal cell carcinomas.     

The Intergroup Rhabdomyosarcoma Study-I. A final report

The results of treatment of 686, previously untreated patients younger than 21 years with rhabdomyosarcoma or undifferentiated sarcoma, who were entered on Intergroup Rhabdomyosarcoma Study-I (IRS-I) were analyzed after a minimum potential follow-up time of 7 years. Patients in Clinical Group I (localized disease, completely resected) were randomized to receive either vincristine, dactinomycin, and cyclophosphamide (VAC) or VAC + radiation. At 5 years, approximately 80% of patients given either treatment were still disease-free and there was no significant difference between treatments in the overall percentages of patients surviving of 93% and 81%, respectively (P = 0.67). Patients in Clinical Group II (regional disease, grossly resected) were randomized to receive either vincristine and dactinomycin (VA) + radiation or VAC + radiation. At 5 years, 72% and 65% of the patients, respectively, were disease-free and there was no evidence of a difference between treatments (P = 0.46). The overall survival percentage at 5 years was approximately 72% for both treatments. Patients in Clinical Groups III (gross residual disease after surgery) and IV (metastatic disease) were randomized to receive either "pulse" VAC + radiation or "pulse" VAC + Adriamycin (doxorubicin) + radiation. The complete remission (CR) rate was 69% in Clinical Group III and 50% in IV, with no statistically significant difference in CR rates between treatments in either group. Those who achieved a CR had a nearly 60% chance of staying in remission for 5 years in Clinical Group III compared with approximately 30% in Clinical Group IV. The overall survival percentage at 5 years was 52% in Clinical Group III compared to 20% in Clinical Group IV (P less than 0.0001). The 5-year survival percentage for the entire cohort of 686 patients was 55%. Survival after relapse was poor, being 32% at 1 year and 17% at 2 years. The risk of distant metastasis was much greater than the risk of local recurrence within each clinical group, and there was no evidence of differing types of relapses between treatments. Primary tumors of the orbit and genitourinary tract carried the best prognosis, whereas tumors of the retroperitoneum had the worst prognosis. The authors conclude that for the therapeutic regimens evaluated there was no therapeutic advantage to including radiation in the treatment of Clinical Group I disease, or cyclophosphamide given as a daily low-dose oral regimen in the treatment of Clinical Group II disease or Adriamycin in the treatment of Clinical Groups III and IV diseases.     

CARCINOMA ARISING IN BARRETT'S ESOPHAGUS (A REPORT OF 51 CASES)

李辉，姚松朝ＣＡＲＣＩＮＯＭＡＡＲＩＳＩＮＧＩＮＢＡＲＲＥＴＴ＇ＳＥＳＯＰＨＡＧＵＳ（ＡＲＥＰＯＲＴＯＦ５１ＣＡＳＥＳ）￥ＬｉＨｕｉ；ＹａｏＳｏｎｇｃｈａｏ；ＷａｌｓｈＴＮＨｅｎｎｅｓｓｙＴＰＪ（ＤｅｐａｒｔｍｅｎｔｏｆＣａｒｄｉｏｔｈｏｒａｃｉｃＳ...     

T3-T4期声门型喉癌颈淋巴结转移情况及其与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率低,有关报道不多,本研究旨在探讨T3-T4期声门型喉癌颈淋巴结转移的相关因素及其对预后的影响。方法:回顾性分析我院1992～2000年收治T3-T4期声门型喉癌83例的临床资料,对颈淋巴结转移率、转移淋巴结的分布、影响cN0颈部复发的因素(颈部预防性放疗、病理分级及T分期)、淋巴结转移与预后的关系。结果:T3-T4期声门型喉癌,总的颈淋巴结转移率为20.5%,cN0颈部复发率为14.3%。绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,仅1例位于对侧Ⅱ区。cN0者中,颈部预防性放疗与颈部观察在颈部复发率上无差异(P=0.772);病理分级影响cN0颈部复发率(P=0.028);不同T分期颈部复发率无差异(P=0.217)。cN 患者预后明显差于cN0患者(P<0.001);cN0颈部复发不影响预后(P=0.460)。对T3-T4期声门型喉癌cN 患者采用治疗性颈清扫;对cN0患者颈部可密切观察,待出现淋巴结复发再积极治疗。结论:T3-T4期声门型喉癌主要转移至同侧Ⅱ、Ⅲ、Ⅳ区;病理组织分化级别越差,cN0颈部复发的风险越大;cN0颈部复发与预后无关;对cN0患者颈部可进行密切观察;对出现淋巴结复发者应积极治疗。     

Carcinoma of the intact uterine cervix treated with radiotherapy alone: A french cooperative study: Update and multivariate analysis of prognostics factors

: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993.

: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I–II and in 10% of Stages III–IV, more than 5 cm in 13.5% of Stages I–II, and in 16% of Stages III–IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I–II and in 32.5% of Stages III–IV.

: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) in 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III–IV: Stage and positive lymphagiogram are predictive factors for relapse and death. Te MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I–II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I–II (p = 0.05 and p = 0.005, respectively).

: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.     

333例声门型喉癌颈淋巴结转移与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率不高,颈部处理尚无统一认识.本研究探讨声门型喉癌颈淋巴结转移的预后及其影响因素.方法:收集1992年1月1日至2000年12月31日中山大学肿瘤防治中心收治的333例声门型喉癌患者的临床资料,对颈淋巴结转移情况、预后及颈部处理进行回顾性分析.结果:全组患者总的颈淋巴结转移率9.61%(32/333),隐性淋巴结转移率6.23%(20/321).绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区(28/32).病理分化级别与总的淋巴结转移率(P=0.092)及隐性淋巴结转移率(P=0.067)无明显相关性.总的淋巴结转移率(P=0.002)及隐性淋巴结转移率(P=0.015)随T分期升高而增高.cN0患者颈选择性放疗对隐性淋巴结转移率的影响无显著性(P=0.363).初治cN 组(3、5年生存率分别为56.25%、46;67%)预后差于初治cN0组(3、5年生存率分别为88.70%、85.37%)(P＜0.001);初治cN0组中出现隐性淋巴结转移的预后(3、5年生存率分别为68.18%、63.31%)差于未出现隐性淋巴结转移(3、5年生存率分别为89.00%、85.55%):初治cN 组有淋巴结转移的预后(3、5年生存率分别为41.67%、16.67%)差于初治cNO组中出现隐性淋巴结转移组(3、5年生存率分别为68.18%、63.31%)(P=0.004).结论:声门型喉癌绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,最多位于同侧Ⅱ区;声门型喉癌颈淋巴结转移影响预后.     

In vitro uptake of bromodeoxyuridine by human hepatocellular carcinoma and its relation to histopathologic findings and biologic behavior.

The in vitro uptake of bromodeoxyuridine (BrdU) by hepatocellular carcinoma (HCC) cells was studied in 30 hepatectomized patients. Labeling of the nuclei by BrdU expressed as labeling index (LI) was 5.6 +/- 3.2% (mean +/- standard deviation), with a considerable variation from case to case. The mean LI in Grade III to IV cancers (less differentiated, by Edmondson and Steiner's classification, 11.1 +/- 2.1%) was significantly larger (P less than 0.001) than that in Grade I to II cancers (more differentiated, 4.5 +/- 2.0%). Capsule formation was found in all 17 patients except one (94%) with a low DNA synthetic HCC (LI less than 6.0%) compared with seven of 13 (54%) with a high DNA synthetic HCC (LI greater than or equal to 6.0%, P less than 0.02). The 2-year survival rate after surgery was significantly higher (P less than 0.02), and intrahepatic metastasis was significantly less (P less than 0.05) in the former group than in the latter. The BrdU LI of HCC tumors showed a strong correlation with histopathologic findings and the biologic behavior of HCC.     

Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of stage I breast cancer

The results of a selective policy of conservative surgery without radiation over a 14-year period with a minimum 5 year follow-up indicates that routine postoperative radiotherapy can be safely omitted in certain cases. Eighty-one patients were studied, the overall survival at 5 years and 10 years was 88% and 73% respectively. The risk of local recurrence within the treated breast or axilla was 10% at 5 years and 11% within the total follow-up period. Most (91%) local recurrences were noted within 5 years. The rate of dying from breast cancer did not change over 10 years of follow up. The risk of recurrence was significantly higher in younger (less than 46 years) patients (P less than 0.05) and premenopausal patients (P less than 0.005) compared with older, post menopausal patients. The risk of dying from breast cancer was also significantly greater in the younger premenopausal women. At 10 years the rate of dying from breast cancer was unchanged from that seen soon after diagnosis. In postmenopausal patients with tumours less than 2 cm and uninvolved axillary nodes after pathological assessment, radiotherapy can be safely omitted. In these patients there is a low risk of local recurrence (10%), similar to that reported following segmental mastectomy and radiation.