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.     

青年女性乳腺癌临床病理学特点及预后相关因素分析

目的 探讨青年女性乳腺癌临床病理学特征,分析临床治疗选择与预后的关系。方法 回顾性分析自2008年1月至2014年12月北京大学第一医院乳腺疾病中心经治的乳腺癌病例,比较同期青年组（<35岁）与年长组（≥35岁）的临床病理学差异,探讨青年女性乳腺癌临床病理学特征与预后之间的相关性,绘制Kaplan-Meier曲线计算生存期,通过Log-rank检验进行单因素分析,并行Cox模型多因素分析,应用后退法筛选影响生存的危险因素。结果 青年女性乳腺癌110例,占全部乳腺癌的5.7%,中位年龄32（21~34）岁,与同时期≥35岁病人相比较,两组Luminal A型、Luminal B型（HER2阴性）分布差异有统计学意义（P＜0.001）。青年女性乳腺癌临床分期、原位癌发病率、HR阳性及HER2阳性乳腺癌所占比例与≥35岁病人差异均无统计学意义。青年女性乳腺癌病人选择保乳手术、全乳房切除联合成形手术的比例与≥35岁病人差异具有统计学意义（P<0.001）。中位随访时间31.5（8~78）个月,5年存活率93.3%,5年无进展存活率89.3%。单因素及多因素分析显示,青年女性乳腺癌无进展生存期与N分期（P＜0.001）、M分期（P＜0.001）相关,总生存期与N分期相关（P＜0.001）。结论 青年女性乳腺癌具有独特的临床病理学特点,在强化内分泌治疗的同时应注意生育保护,由于对外形、生活质量要求更高,青年女性乳腺癌的外科手术方式需要个体化选择。     

Analysis of prognostic factors and clinicopathological staging of thymoma

The prognostic value of four clinical variables (age and sex of patients, association with myasthenia gravis, and clinical stage) and histological type was analyzed in 83 consecutive patients with thymoma, histologically classified as cortical, medullary, and mixed. Age, sex, and association with myasthenia gravis did not prove to represent significant prognostic factors; clinical stage and histological type, on the contrary, had a highly significant prognostic value (p less than 0.001). A model of clinicopathological staging, based on both clinical stage and histological type, in which three major prognostic groups are considered is proposed. The degree of significance of this model is higher (p less than 0.0001) than that of clinical stage and histological type considered individually; its validity is further supported by the results of multivariate analysis according to the Cox regression model (p = 0.0001). We think it represents a prognostically valuable approach to the problem of management of thymoma.     

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

BACKGROUNDColorectal cancer is a common tumor with a quite high-related mortality. Despite the used curative treatments, patients will develop cancer recurrence in up to 50% of the cases and/or other primary neoplasms. Although most of the recurrences are discovered within 3 years from the first treatment, a small percentage is found after 5 years. The early detection of recurrence is crucial to allow further therapies improving patients’ survival. Several follow-up programs have been developed but the optimal one is far from being established.AIMTo evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.METHODSPerioperative and long-term data of all consecutive patients surgically treated with curative intent, from January 2006 to June 2009, for colorectal adenocar-cinoma, were retrospectively reviewed to find potential prognostic factors associated with: (1) Recurrence incidence; (2) Incidence of an early (within 3 years from surgery) or late recurrence; and (3) Different sites of recurrence. In addition, the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.RESULTSOur study included 234 patients. The median follow-up period has been 119 ± 46.2 mo. The recurrence rate has been 25.6%. Patients with a higher chance to develop recurrence had also the following characteristics: Higher levels of preoperative glycemia and carcinoembryonic antigen, highest anaesthesiologists Score score, occlusion, received a complex operation performed with an open technique, after a longer hospital stay, and showed advanced tumors. The independent prognostic factors for recurrence were the hospital stay, N stage 2, and M stage 1 (multivariate analysis). Younger ages were significantly associated with an early recurrence onset. Patients that received intermediate colectomies or segmental resections, having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurrence, while metastatic diseases at diagnosis were linked with local recurrence. Neoadjuvant treatments showed lung recurrence. Finally, bigger tumors and higher lymph node ratio were associated with peritoneal recurrence (marginally significant). Thirty patients developed a second malignancy during the follow-up time.CONCLUSIONSeveral prognostic factors should be considered for tailored follow-up programs, eventually, beyond 5 years from the first treatment.     

Population-based study of prognostic factors in stage II colonic cancer

BACKGROUND: Adjuvant chemotherapy in stage II colorectal cancer may be considered for patients whose tumours have poor prognostic features. The aim of this study was to evaluate the prognostic significance of commonly reported clinical and pathological features of stage II colonic cancer. METHODS: A population-based observational study of all patients with stage II colonic cancer diagnosed in the state of Western Australia from 1993 to 2003 was performed. A total of 1306 patients treated by surgery alone were identified, with a median follow-up of 59 (range 0-145) months. RESULTS: Multivariable analysis revealed that the only independent prognostic factors for disease-specific survival were stage T4 (hazard ratio (HR) 1.75 (95 per cent confidence interval (c.i.) 1.32 to 2.32); P < 0.001) and vascular invasion (HR 1.63 (95 per cent c.i. 1.15 to 2.30); P < 0.001). In younger patients (aged 75 years or less), who are more likely to be considered for chemotherapy, these two features showed independent prognostic significance but with higher HR values (1.96 for stage T4 and 2.73 for vascular invasion). Stage T4 and/or the presence of vascular invasion identified a 'poor' prognostic group, comprising 26.6 per cent of younger patients and with a 5-year survival rate of 71.2 per cent. The remaining 'good' prognostic group had a survival rate of 84.3 per cent at 5 years' follow-up. CONCLUSION: This study highlights the importance of accurate pathological assessment of tumour stage and vascular invasion for the prognostic stratification of patients with stage II colonic cancer. The results provide clarification of guidelines for the management of stage II disease in relation to recommendations for chemotherapy.     

偶发性前列腺癌的临床病理学研究

目的:探讨偶发性前列腺癌的临床病理特征及预后.方法:回顾性分析580例膀胱癌根治术中96例偶发前列腺癌的临床资料及病理学特征,并进行预后随访.结果:偶发前列腺癌的发生率为16.6％(96/580).年龄42～90岁,中位年龄为73岁;其中≤60岁6例(6.2％),＞60岁90例(93.8％).肿瘤平均最大直径约3.5 ...     

A clinicopathological study of synchronous multiple gastric cancer

In a 7 1/2-year period (from 1 January 1980 to 30 June 1987), 997 patients with gastric cancer underwent gastric resection at the Department of Surgery, Matsuyama Red Cross Hospital, Japan. We studied clinicopathologically 83 patients (182 lesions) with synchronous multiple gastric cancer and compared them with patients who had solitary cancers only in the same period. We found that elderly men had a relatively high incidence of multiple gastric cancer, and that early cancer of the elevated well differentiated type was the most common. Of the 182 lesions, as many as 42 (23.1 per cent) were missed in the preoperative examination. Eighteen of these 42 lesions were found only with the aid of a microscope in sections almost incidentally excised. Small flat lesions tended to be missed. We should always be conscious that other gastric lesions may be present when treating patients with gastric cancer.     

不同部位可根治性胃癌病理特征外科处理方式及预后因素比较

目的 比较不同部位可根治性胃癌的病理特征、外科处理方式及预后影响因素。 方法 中山大学附属第一医院胃肠胰外科对1999年8月至2006年3月诊治的356例临床病理数据完整、无远处转移、并接受根治手术的原发性非全胃癌,依肿瘤部位分为胃上部癌(U,96例)、胃中部癌(M, 93例)、胃下部癌(L, 167例) 3组,对其临床病理特征、外科处理方式、预后影响因素进行分析比较。结果 不同部位癌的肿瘤直径、浆膜浸润、淋巴结转移状况、TNM分期、组织分型、术前癌胚抗原（CEA）值等差异无统计学意义(P >0.05)。U、M、L部癌的中位生存期分别为49.0、70.1、70.9个月;U部癌预后差于其他组(P <0.05)。胃癌总体的独立预后因素包括术后病理分期（pTNM）、Borrmann分型、根治方式;U部癌的独立预后因素为pTNM、根治方式;M部癌的独立预后因素为pTNM、Borrmann分型;L部癌的独立预后因素为pTNM、根治方式。结论 不同部位可根治性胃癌的病理特征、预后影响因素不同,外科处理方法应区别对待。     

Molecular prognostic factors in bladder cancer

Summary In this paper the predictive value of molecular prognostic parameters for bladder cancer is discussed. DNA ploidy has additional prognostic value for grade 2 tumors, irrespective of stage, with aneuploid tumors having a poor prognosis. Overexpression of the epidermal growth factor receptor (EGFR) can be used as a prognostic factor for the group of superficial tumors. Both abnormal E-cadherin and retinoblastoma (RB) expression have additional prognostic value for invasive tumors. The exact predictive value for the superficial tumors needs further study. The results with respect to p53 are conflicting and its exact role especially in the progression of pT1g3 tumors has to be clarified. In view of the discordance concerning its prognostic value, c-erbB-2 overexpression also needs further study. It appears that at this moment only a few molecular markers seem to have potential prognostic value, but their precise clinical relevance has to be studied more extensively. In particular the value of progression markers in the superficial TCC needs more attention.     

Biomolecular prognostic factors in colorectal cancer

There is general agreement that staging of colorectal neoplasms based on classic anatomopathological parameters does not allow accurate selection of patients at higher risk of an adverse outcome. For this reason, identification of new prognostic factors is desirable. Such factors should be easily determined and expressed at an early stage of carcinogenesis. Moreover, it would be useful to identify factors predictive of response to radiotherapy and chemotherapy. Various molecules are involved in the carcinogenetic pathway and metastasis formation. The aim of this review is to analyse whether any of them are currently useful in clinical practice and which of them warrant further study. At present, apart from CEA, whose prognostic value has been known for some time, we do not have sufficient data to definitively incorporate any of the other biomarkers in clinical practice. The most promising factors would appear to be loss of heterozigosity of chromosome 18q21 (DCC) and microsatellite instability. However, other molecules warrant further in-depth study. In particular, growth factor receptors may play a role not only as prognostic factors but also in view of their therapeutic potential.     

Molecular prognostic factors in penile cancer

Objectives  Penile cancer is a rare tumour in developed countries but more common in South America and East Africa. Although pathological prognostic factors have been established, there is great interest in evaluating molecular markers which correlate with prognosis and outcome. Methods  We have reviewed the current status of our understanding of the molecular biology of penile cancer in order to identify established and potential prognostic factors in penile cancer. We have conducted an extensive literature search to review the current understanding of the role of prognostic markers in penile cancer. Results  Although several markers have been evaluated, currently the clinical application of these markers is limited. HPV positive tumours show a variable prognostic outcome. P53 status may correlate with survival in T1 disease but further studies are required to establish the link to lymph node spread. Conclusions  Pathological variables are well-established but further work is required to investigate the role of molecular markers. The development of molecular prognostic markers is important for the surveillance of patients and prediction of lymph node involvement as well as a prognostic marker for survival.     

Assessment of prognostic factors in breast cancer

Prognostic factors predict the long term outcome of treatment, recurrence rate and overall survival. Treatment decision is based on assessment of prognostic factors. They are classified as clinical (age, menopausal status, tumoral growth rate, inflammatory signs), histological (tumoral stage, pathological type, grading, tumoral necrosis, lymph nodes status, margins status) and biological factors (steroidal receptors pattern, ploidy etc). There are tumor markers currently evaluated, being considered conventional and new markers that are not usually evaluated. Patients with negative lymph node will show no recurrences after surgery and/or radiotherapy in 70% of the cases. Factors with specific prognostic value are used for deciding on the therapeutic strategy in negative axillary node cases.     

A clinicopathological study of metastasis of lung cancer and metastatic lung cancer

In a series of 282 resected lung specimens of primary lung cancer and 28 of metastatic lung cancer, an investigation was made on some factors influencing on the metastasis. These factors were blood vessel invasion of tumor cells, lymphoid cell infiltration at the site of vessel invasion and the basement membrane formation around the tumor foci. The relationships between the cumulative survivals and these various factors were realized with the following results. Findings of blood vessel invasion were equally correlated with the prognosis of patients as lymph node metastasis. Among patients with blood vessel invasion, those with prominent lymphoid cell reaction at the site of vessel invasion showed the longer survival than those of negative reaction. The formation of basement membrane, which was thought to be a factor influencing on the prognosis, around tumor cells, were correlated with the blood vessel invasion.     

微创食管癌切除术后淋巴结转移规律及预后分析

目的淋巴结转移是食管癌转移的主要方式,对食管癌患者预后有重要影响,本文探讨食管癌胸腹二区淋巴结的转移规律。 方法选取2010年1月至2016年10月于山东大学齐鲁医院经微创食管癌切除术(minimally invasive esophagectomy, MIE)治疗的食管癌患者613例,参照日本食管肿瘤研究会(JEOG)淋巴结分区标准清扫淋巴结,统计各组淋巴结的转移率。对2010年1月至2013年10月行MIE治疗的203例食管癌患者进行生存分析。另外410例患者由于术后时间较短,随访数据未列入统计。 结果胸上段食管癌较多发生上纵隔淋巴结转移,其左、右喉返神经旁淋巴结转移率分别高达35.9%、40.7%,均显著高于胸中段和胸下段食管癌;胸中段食管癌既向上发生上纵隔淋巴结转移,又向下发生腹腔淋巴结转移;胸下段食管癌主要向胃周淋巴结转移,其中胃左动脉旁淋巴结转移率最高。单因素分析结果显示,病变长度、肿瘤分化程度、肿瘤浸润深度、淋巴结转移程度是影响食管癌患者预后的相关因素(P< 0.05)。COX多因素回归分析结果显示,肿瘤低分化和淋巴结转移是影响食管癌患者预后不良的独立危险因素(P< 0.05)。 结论手术治疗食管癌应重点清扫双侧喉返神经旁淋巴结和胃左动脉旁淋巴结。     

A clinicopathological study of bladder cancer associated with upper urinary tract cancer

OBJECTIVES: To analyse the clinicopathological features of bladder cancer associated with upper urinary tract cancer (UUTC). PATIENTS AND METHODS: Among 106 patients with primary UUTC (mean age 65 years, range 45-82) who underwent surgical treatment, 44 also had bladder cancer. The patients were divided into three groups according to the timing of the appearance of bladder cancer. In group 1, 10 patients had UUTC preceding bladder cancer, group 2 comprised 14 patients with concurrent bladder cancer and group 3, 20 with subsequent bladder cancer; their clinicopathological data were analysed. RESULTS: Among several clinicopathological factors examined, only the number of UUT tumours was significantly correlated with the incidence of associated bladder cancer (P < 0.01). There was no significant difference between survival rates of patients with UUTC with and without associated bladder cancer. The incidence of high-stage or high-grade tumours in both the UUT and bladder in group 2 was higher than that in groups 1 and 3 (P < 0.05), and the survival rate in group 2 was significantly lower than in those in groups 1 and 3 (P < 0.05). Furthermore, the survival rate of patients in group 2 was significantly lower than that of all other patients (P < 0.01). CONCLUSIONS: These findings suggest that bladder cancer associated with UUTC has a different biological character depending on the timing of tumour appearance, and that patients with UUTC and concurrent bladder cancer should undergo careful follow-up and aggressive adjuvant therapy.     

A clinicopathological evaluation of prognostic factors of urothelial tumors of the renal pelvis and ureter]

We investigated the clinicopathological features of 109 patients with urothelial tumors of the renal pelvis and ureter who underwent surgery at four institute from April, 1975 to September, 1997. The patients consisted of 71 males and 38 females, and the mean age was 66.8 years, ranging from 41 to 92 years. Mean followup period was 43 months. The prognostic significance of the pathological factors; pT, Grade, INF, tumor size, pL, pV and pN were evaluated. All these factors affected the survival rates significantly in univariate analysis. Multivariate analysis showed the most influential prognostic factors to be pT and pN.