Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.     

Influence of Clinical and Pathologic Parameters on Prognosis of Cervical Carcinoma in China

Objective: To explore the influence of clinical and pathologic parameters on the prognosis of squamous cell carcinoma and adenocarcinoma. Methods: 702 cases of cervical carcinoma were retrospec-tively studied. Cox regression model was informed in multi-variable analysis. Results: The retrospective analysis showed that 630 out of 702 cases of cervical carcinoma were squamous cell carcinoma, cumulative rate 89.4% and 72 case were adenocarcinoma, cumulative rate 10.6% respectively. The 5-year survival rate was lower for patients with adenocarcinoma than for patients with squamous cell carcinoma (58.3% vs 57.3%), but there was no significant difference. Cox regression model showed that the variable into equation for squamous cell carcinoma included tumor grade of differentiation, lymph node metastasis and FIGO stage, but only lymph node metastasis and FIGO stage for adenocarcinoma. Conclusion: FIGO stage and lymph node metastasis was independent parameter evaluating prognosis of cervical carcinoma.     

Prognostic Factors for Patients with FIGO Stage-IB Cervical Squamous Cell Carcinoma：Does the Tumor Size（≤4 cm or〉4 cm）Really Matter？

OBJECTIVE To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery. METHODS A retrospective analysis of clinical data from 174 cases of FIGO Stage-IB cervical squamous cell carcinoma treated in our institute was conducted. RESULTS The 5-year overal disease-free survival of the patients was 79.4%and the recurrence rate was 16.7%.Seventy-five percent of the 60 patients with a tumor>4 cm and 28.1%of the 114 patients with a tumor≤4 cm received preoperative radiotherapy,resuting in a significant difference be- tween the two groups(P<0.001).The 5-year disease-free survival rate for the groups with a tumor≤4 cm without and with preoperative radiotherapy, and with a tumor>4 cm without and with preoperative radiation therapy were 80.5%,85.2%,69.3%and 77.1%,respectively.There was no significant dif- ference between any of the groups(P>0.05).A univariate analysis showed that pelvic node metastasis,a positive parametrial surgical margin and post- operative adjuvant therapy were al significantly correlated with the 5-year disease-free survivals(P<0.05).Multivariate analysis revealed that pelvic node metastasis(P=0.004)and a positive parametrial surgical margin(P= 0.040)were independent factors that influenced the prognosis.The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 57.4%and 44.7%respectively in the high-risk group(patients with pelvic lymphatic metastasis and/or positive parametrial surgical margin)(P=0.575) and the recurrence ratio was 7/18 and 6/14 for the cases of the two tumor sizes in the same risk group.There was no significant difference between the two groups(P=0.821).The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 86.5%and 82.9%respectively in the low-risk group(patients without pelvic lymph-node metastasis and/or positive para- metrial surgical margin),respectively(P>0.05)and the recurrence ratio was 9/95 and 7/47 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups(P>0.05). CONCLUSIONS For FIGO Stage-IB cervical squamous cel carcinoma patients with radical surgery as the major means of treatment,the features of pelvic lymph-node metastasis and a positive parametrial surgical margin are independent factors that influence the prognosis.The tumor size can not be used as a criterion for predicting the prognosis.     

Occult cervical metastasis of squamous cell carcinoma of tongue among CN0 patients and its treatment

Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.     

SMALL CELL CARCINOMA OF THE URINARY BLADDER：THREE CASES REPORT

Objective: To study the clinical features of patients with primary small cell carcinoma (SCC) of the bladder and to improve the diagnosis and treatment. Methods:Clinical data of 3 cases with primary SCC of the bladder were discussed and the pathology, diagnosis, treatment and prognosis were reviewed. Results: 3 cases of primary SCC of the bladder were presented. Of them the diagnosis was confirmed by pathological examination after operation (2 cases) and biopsy (1 case). One case with stage T4M1 died after three months‘ chemotherapy. One case with stage T2M0 underwent partial cystectomy and was treated with chemotherapy and one year later died of miocardial infarction. Another case with stage T4M0 underwent radical cystectomy and postoperative irradiation therapy. The patient was alive and had no recurrence of symptoms during two years follow-up. Conclusion: Primary SCC of the urinary bladder is highly malignant. Radical cystectomy combined with radiotherapy appears to be the efficient treatment. Chemotherapy seems to be of no significant effect.     

凋亡抑制蛋白Survivin和血管内皮生长因子高表达是喉鳞状细胞癌生存预后的独立预测因子

Objective: To study the relationship between Survivin and VEGF proteins in a subgroup of patients with squa-mous carcinoma of larynx. Methods: 108 cases of squamous carcinoma of larynx with clinical data were collected and expressions of Survivin and VEGF in peripheral blood were investigated by enzyme-linked immunosorbent assay (ELISA). Results: Expressions of Survivin and VEGF were significantly associated with T stage, N stage and metastasis of squamous carcinoma of larynx. The patients with Survivin or VEGF over-expressions presented lower survival rate, respectively, as compared to those of low-expression (P < 0.05). The survival rate in squamous carcinoma of larynx patients with Survivin and VEGF dual over-expressions was significantly lower than that of patients with dual low-expression (P < 0.05). Multivariate analysis indicated that both Survivin and VEGF over-expressions in squamous carcinoma of larynx peripheral blood samples were strong independent factors of poor prognosis in squamous carcinoma of larynx patients. Conclusion: Survivin and VEGF over-expressions are independent prognostic factors for the patients with squamous carcinoma of larynx. These results also suggest that peripheral blood Survivin and VEGF expressions are valuable prognostic markers for prognosis prediction in squamous carcinoma of larynx patients.     

Pattern of lymphatic metastasis and influencing factors in thoracic esophageal carcinoma

OBJECTIVE To explore the regular patterns of lymphatic metastasis in thoracic esophageal carcinoma （TEC） and the factors influencing these patterns. METHODS Data of 229 TEC patients who underwent radical esophagectomy and thoracoabdominal 2-field lymphadenectomy were reviewed. Within this patient population, a total of 2458 lymph nodes were dissected during surgery. The distribution of the nodular metastasis rates （NMR） in various diseased regions in the esophageal carcinoma （EC） patients as well as factors influencing metastases such as the depth of tumor infiltration, tumor size, tumor morphology, and degree of tumor differentiation were analyzed. RESULTS i） Lymphatic metastasis （LM） occurred in 102 EC cases, and the lymphatic metastasis rate （LMR） was 44.5% （102/229）. The NMR was 9.5% （258/2458）. ii） The NMRs were 19.0%, 6.7%, 9.8% and 12.2% in the superior, middle and inferior mediastinum, and abdominal cavity, respectively, in patients with EC in the superior thoracic segment; 26.1%, 7.4%, 11.8% and 11.9% in the same sites of the mediastinum, respectively, in those with middle thoracic-segment EC; and 0%, 1.6%, 5.3%, and 10.0%, respectively, in the same sites in those with inferior thoracic EC. iii） The LMRs of the EC patients in stage-T1, T2, T3 and T4 were 28.6%, 43.8%, 47.6% and 31.3%, respectively, and the NMRs of the patients were 7.9%, 10.8%, 10.7% and 10.8%, respectively. There were no significant differences between the LMR and the NMR of the EC patients in stage T1 to T4 （X^2 = 2.733, P = 0.435 and X2 = 0.686, P = 0.876）. iv） The LMR of the patients with the length of tumor 〈 3 cm, 〉 3 cm and 〈 5 cm, and 〉 5 cm were 45.2%, 43.4% and 46.2%, respectively, and the NMR according to the same range of the tumor size above were 9.1%, 11.6% and 11.7%, respectively. There were no significant differences between the groups （X2 --- 0.094, P = 0.954 and X2 = 3.933, P = 0.140）. v） The NMRs of the medullary, ulcerative, fungoid and sclerotic-type EC were 14.0%, 9.6%, 4.3% and 18.3%, respectively （X^2 = 19.292, P = 0.000）, among which the NMR of the fungoid-type EC was the lowest. The LMRs were 42.5% and 75.0%, respectively in the cases with squamous cell carcinoma （SqCC） and poorly differentiated SqCC （X^2 = 4.852, P = 0.028）, and the NMRs were 9.5% and 18.6% correspondingly in the 2 groups （X^2 = 11.323, P = 0.001）. LM was commonly seen in the cases with poorly differentiated tumors. CONCLUSION Lymph node metastases of TEC spreads widely and can involve many regions. Metastasis can even be found in early stages of EC. Morphologic type and the degree of tumor differentiation are the main factors affecting the LM.     

The Effects of Microwave Ablation and Surgical Resection on Hematogenous Dissemination of Cancer Cells in Treating Patients with Small Primary Hepatocellular Carcinoma

OBJECTIVE To conduct a comparative study of the effects of treatment using microwave ablation versus surgical resection on hematogenous dissemination of cancer cells, and on the level of immune cells of the peripheral blood in patients with small primary hepatocellular carcinoma (PHC,≤5 cm). METHODS Forty patients with small PHC (maximal diameter≤5 cm) were divided into a microwave group (19 cases) and a surgical operation group (21 cases). A real-time (RT) quantitative nested RT-PCR examination was performed for peripheral blood alpha-fetoprotein (AFP) mRNA. Studies were conducted to determine the level of CD3, CD4, CD8 and CD4/CD8 cells and for liver function at 30 min before, and 30 min,1 day and 3 days after the treatment. RESULTS Compared to the value before ablation, no obvious changes of CD3, CD4, CD8 and CD4/CD8 cells were found in patients of the microwave group within 7 days after ablation, but CD3, CD4 and CD4/CD8 cells in the operation group were lower compared to that before operation. The copy number of AFP mRNA in the peripheral blood samples of the patients of the 2 groups before operation was determined in 67.5% of the patients (27/40). There was an rise in the expression after treatment but no statistical difference was found in comparing the 2 groups. Follow-up of the patients was conducted for 1 to 16 months. For patients with continuous expression of peripheral blood AFP mRNA, the possibility of relapse and metastasis was increased. CONCLUSION Surgical resection or microwave ablation can cause more exfoliation of hepatoma carcinoma cells in the peripheral blood of patients with small PHC. The immune function of peripheral blood cells decreased in the patients after surgical resection, however, the immune function was better protected following microwave ablation. Microwave ablation causes minor reduction in liver function, and the treatment method presents a definite value for PHC therapy.     

Analysis of the Prognosis for Patients with Stage T3N0-1M0 Nasopharyngeal Carcinoma Treated by Chemotherapy Combined with Radiotherapy

OBJECTIVE To investigate the relationship between the therapeutic modality and prognostic factors for the patients with T3N0-1M0 nasopharyngeal carcinoma. METHODS The clinical data from 127 cases of T3N0-1M0 nasopharyngeal carcinoma patients with initial treatment, during the period from January 4th, 2000 to November 12th, 2001, were retrospectively analyzed. The cases were divided into Group A with simple radiotherapy (90) and Group B with the radiation therapy combined with chemotherapy (37), based on various patients' conditions. In group B, inductive chemotherapy was conducted for 18 cases, inductive chemotherapy plus homochronous chemotherapy for 5 and homochronous chemotherapy for 14. RESULTS The 5-year overall survival (OS) in the groups A and B was 73.4% and 72.3% respectively (P>0.05); the cancer-correlated survival (CCS) in the 2 groups was 76.4% and 72.3% respectively (P>0.05); the disease-free survival (DFS) in group A and B was 65.5% and 71.7% respectively (P<0.05). A multiple analysis showed that the mode of radiation therapy plus chemotherapy was a favorable independent impact factor for DFS. CONCLUSION Chemotherapy plus radiotherapy can improve the DFS of patients with T3N0-1M0 nasopharyngeal carcinoma, but fails to prolong the survival time of the patients. The modality of chemotherapy plus radiotherapy is not the necessary choice in treatment of patients with T3N0-1M0 nasopharyngeal carcinoma.     

Clinical significance of hypoxia inducible factor-1α expression on postoperative adjuvant radiotherapy in esophageal carcinoma

Objective To determine the effects of hypoxia inducible factor-1α(HIF-1α) expression on postoperative adjuvant radiotherapy in esophageal carcinoma. Methods 95 cases with esophageal carcinoms who received radical operation were analyzed with followed-up data from 1995 to 1998.Expression of HIF-1α in 45 patients with esophageal carcinoma who received radiotherapy after radical operation were deternlined by immunohistochemical method in contrast with 50 patients with esophageal carcinoma received surgery alone.Kaplan-Meier method and COX proportional hazard model were used to analyze.Results The positive expression of HIF-1α in esophageal carcinoma was observed mainly in the nucleus of tumor cells.The positive expression rate of HIF-1α in esophageal carcinoma was 58.9%.The expression of HIF-1α had no relationship with age,sex,histologic subtype and T stage,but had positive relationship with recurrence and distant metastasis.There was significant difference between patients with positive and negative HIF-1α protein expression in surgery alone and postoperation radiotherapy group. COX model analysis showed that HIF-1α had separate and significant impacts on prognosis in surgery group and surgery plus radiotherapy group. Conclusion Over expression of HIF-1α protein suggests a poor prognosis,and has tendency to resist radiotherapy in esophageal carcinoma.     

改良Ivor-Lewis手术治疗62例胸中下段食管鳞癌的疗效分析

目的探讨改良Ivor-Lewis手术治疗胸中下段食管鳞癌的临床疗效。方法回顾性分析62例采用改良Ivor—Lewis手术治疗的胸中下段食管鳞癌患者的临床资料。生存率计算采用Kap／an．Meier方法。结果术后10例出现并发症,占16．1％。死亡2例,占3．2％。淋巴结转移率58．0％,上纵隔转移率最低（16．5％）,下纵膈转移率最高（40．9％）。全组平均生存时间为（52．06±3．21）个月,3、5年生存率分别为52．2％、24．5％。Ⅰ、Ⅱ、Ⅲ期患者3、5年生存率分别为93．4％和70．5％、49．3％和27．5％、36．2％和12．6％。结论改良Ivor—Lewis手术具有良好的手术视野．淋巴结清扫彻底的优点,可减少术后并发症,提高患者生存期．是治疗胸中下段食管鳞癌较理想的手术方式．     

Laryngeal carcinoma in patients 40 years of age and younger

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1N0M0) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1N0M0) and seven patients (35%) had laryngeal carcinoma in Stage II (T2N0M0) and III (T3N0M0). Patients with T1N0M0 received only radiotherapy. Three patients with T2N0M0 underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3N0M0 received pre-operative and postoperative radiotherapy in addition to total laryngectomy. The 5-year survival rate for T1N0M0 and T2N0M0 was 100% and for T3N0M0 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.     

Isolated intracranial metastasis from an early glottic cancer: how rare a presentation?

The incidence of distant metastasis with laryngeal tumors varies from 1–4% [1]. The lungs are the most frequent site, followed by bone and liver. Intracranial metastases are rarely clinically diagnosed in head neck cancer patients and if present are mainly located in the cerebrum and cerebellum. Early stage glottic squamous carcinoma with subsequent distant metastasis is rare [2]. We report a patient with T1N0 glottic tumor who underwent a curative radiotherapy and on 3 months follow up presented with isolated intracranial metastasis.     

电视胸腔镜辅助下食管癌切除（附33例报告）

目的：总结电视胸腔镜辅助下（video-assisted thoraeoscopic surgery,VATS）食管癌切除的临床经验,评价VATS食管癌切除的近期效果.方法：回顾性分析我院1998年1月至2009年12月行VATS食管癌切除的33例临床资料.男21例,女12例;年龄37-83岁,平均65岁.肿瘤平均长度4.8cm,均为鳞状细胞癌.胸上段癌7例,胸中段癌13例,胸下段癌13例;TNM分期：T1 N0M0 5例,T1N1M0 8例,T2N0M0 10例,T2N1M0 8例,T3N1M02例.手术操作分三步：经右胸VATS游离食管肿瘤清扫淋巴结;经上腹部切口游离胃;颈部食管胃吻合.结果：33例均成功经VATS切除食管肿瘤.手术时间平均2.5h,其中VATS游离时间1.0h,胸腔出血量平均120ml,清扫淋巴结平均17.1个,其中胸部淋巴结8.6个.平均住院时间11.2d.术后发生心率失常2例,肺部感染5例,无死亡.结论：完全采用VATS对Ⅰ、Ⅱ期食管癌切除是可行的,近期手术效果较好.     

Clinical Studies of Postoperative Arterial Infusion Chemotherapy in Patients with Pathologic T3 Esophageal Squamous Carcinoma

Multi-sample and multi-center studies have provided no evidence to indicate that preoperative chemo-radiation therapy can in- crease the 5 year survival rate of patients with esophageal squamous carcinoma, although some clinical studies have indicated tha…     

Cutaneous metastasis at a surgical drain site after gastric cancer resection

Cutaneous metastasis from intra-abdominal malignant solid tumours such as gastric adenocarcinoma is very rare. Here, we report the case of a 76-year-old male patient with a T4N2M0, poorly differentiated, signet-ring cell gastric carcinoma, who underwent potentially curative resection of the tumour and developed cutaneous metastasis at the site of the surgical drain 4 months after the operation while he was on chemotherapy. The lesion involved the skin and the subcutaneous fat only. A CT scan revealed local recurrence at the resection bed but no distant metastases. The patient died 1 month later. It is concluded that the development of cutaneous metastasis after gastric carcinoma resection indicates tumour recurrence or disseminated disease and is associated with poor prognosis.     

膀胱鳞状细胞癌诊疗体会

目的:探讨膀胱鳞状细胞癌的病因、诊断与治疗。方法:回顾性分析8例膀胱鳞癌患者的临床资料,复习相关文献。结果:2例行膀胱部分切除术,6例行膀胱全切术,术后均行放疗或免疫疗法,行膀胱部分切除术者至今仍生存1例,为结合免疫治疗患者,1例死亡者由于恶性肿瘤转移。行膀胱全切术者6例,至今生存2例,3例死亡,此3例均由于恶性肿瘤多发转移,1例失访。结论:膀胱鳞癌的预后较差,大多数患者在被诊断时已属晚期,膀胱鳞癌的恶性程度较高,早期诊断和治疗非常重要,行膀胱全切术效果较确实,术后结合免疫疗法可延长生存时间。     

Two cases of gastric endocrine cell carcinoma

Gastric endocrine cell carcinoma is rare and associated with a poor prognosis. The first case was a man in his sixties with gastric endocrine cell carcinoma, of which a clinical finding was T2N1M0H1 (Stage IV). S-1 + CDDP therapy was selected and failed. CDDP+CPT-11 therapy was started and CT showed a partial response in ten months. But the tumor was re-grown and the patient died twenty months after diagnosis. The second case was a man in his seventies with gastric endocrine cell carcinoma, of which a clinical finding was T3N1M0H0P0, Stage IIIa, underwent total gastrectomy. Abdominal contrast-enhanced CT scan performed a month after the operation disclosed hepatic metastasis. After two months of S-1 regimen, CDDP + CPT-11 therapy was started.     

pT1-3N0M0期食管鳞癌二野术后复发和转移的因素分析

目的 回顾分析影响pT1-3N0M0期食管鳞癌术后复发和转移的因素。方法 收集胸段食管鳞癌行胸腹二野R0术后、病理分期为pT1-3N0M0期、手术前后未行辅助放疗和/或化疗、术后生存期≥3个月者 488例。Cox模型多因素分析。结果 至随访期结束总复发率为36.9%(180/488),LRR率为21.5%(105/488)、DM率为6.8%(33/488),LRR合并DM率为8.6%(42/488)。多因素分析显示肿瘤位置和pT分期是影响术后总复发、LRR和DM的因素;胸上段鳞癌和pT3期者复发率高,胸中段鳞癌和pT2期者次之,胸下段鳞癌和pT1期者复发率低。结论 肿瘤位置和pT分期是影响pT1-3N0M0期食管鳞癌二野R0术后复发和转移的重要因素,其结果有助于指导术后辅助放疗适应证选择。