Evaluation of hepatic resection for metachronous liver metastases from gastric cancer

To evaluate the effect of hepatic resection for metachronous liver metastases after resection of gastric cancer, the clinicopathological factors of gastric cancer, state of liver metastasis, surgical procedures for liver metastasis, and remote survival were studied. Between 1989 and 2001, 30 consecutive patients underwent hepatic resections (36 resections) for metachronous liver metastases. The patients included 25 men and 5 women, and the median age was 60 years old (range 46-86 years old). As for curability, curative A/curative B was 10/20, and H0/H1/H2 was 25/3/2. The mean period from initial surgery to the liver resection was 19.3 months (range 6.3-65.2 months), and the liver metastatic conditions were H1 for 27 patients and H2 for 9 patients. By number of liver metastases, 27 patients had 1 lesion, 24 patients had 2, and 5 patients had more than 3 lesions. Twenty-nine patients were negative and 7 were positive for lymph node metastasis. A partial resection was performed for 13 patients, a subsegmentectomy for 3 patients, a segmentectomy for 7 patients, a lobectomy for 8 patients, and an extended lobectomy for 5 patients. For all patients except those who had other causes of death, the overall mean survival time was 702 days and the 5-year survival rate was 26.4%. There were four 5-year survivors after hepatic resection. In conclusion, the main prognostic factor after resection of metachronous liver metastases was the existence of lymph node metastasis, and the remote survival of patients with abdominal para-aortic lymph node recurrence was poor. The type of liver resection was not a predictor of survival. The resection of liver recurrence was evaluated clinically, but we should maintain strict criteria and select adequate surgical procedures.     

Prognostic and clinical evaluation of axillary lymph node metastasis in esophageal cancer

Axillary lymph node metastasis (ALNM) from esophageal cancer is rare. Its prognosis and effective treatments remain unknown. Between 1997 and 2005, esophagectomy was performed in 361 patients with esophageal cancer in our hospital. ALNM was identified in four patients (1.1%). All patients had left ALNM with ipsilateral left supraclavicular lymph node metastasis. In two patients ALNM developed after radical esophagectomy with regional lymphadenectomy and in the other two patients after chemoradiotherapy of primary lesions. Axillary lymphadenectomy with chemoradiotherapy was given to all patients. Median survival time and disease-free survival (DFS) after initial treatment for primary esophageal cancer were 30.5 months and 11.5 months, respectively. One patient, who had a small number of regional lymph node metastases (two lymph nodes) at esophagectomy and prolonged DFS (22 months) until axillary node recurrence, is still alive, 67 months after axillary lymphadenectomy. The other three patients, who had larger numbers of regional lymph node metastases (average, 8.3) and shorter DFS (average, 9.7 months), died of recurrence an average of 13.3 months after axillary lymphadenectomy. In conclusion, although ALNM is considered a type of distant organ metastasis, if it is a solitary recurrence, good survival may be obtained after appropriate loco-regional therapy. The number of metastatic regional lymph nodes at initial esophagectomy and the duration of DFS until axillary node recurrence can help to guide the decision whether aggressive treatments are warranted.     

205例初治转移性乳腺癌的临床病理特点和生存分析

  目的  探讨转移性乳腺癌（metastatic breast cancer,MBC）的临床病理特征及生存预后。  方法  收集2008年1月至2010年12月天津医科大学肿瘤医院205例乳腺癌根治术后出现复发及转移的初治患者的临床资料,对其临床病理特征及生存情况进行回顾性分析。  结果  205例初治MBC患者的中位生存期为32（1~132）个月,分子分型为Luminal A、Luminal B、HER-2过表达型和三阴型乳腺癌,其中位生存期分别为36（4~132）、32（7~122）、29（1~85）和24（1~98）个月。单因素和多因素分析显示,淋巴结转移、临床分期、分子分型、内脏转移、首发转移部位数目均与转移性乳腺癌患者的预后有关（P < 0.05）。淋巴结转移、临床分期、分子分型及内脏转移是影响转移性乳腺癌患者预后的独立因素（P < 0.05）。  结论  淋巴结转移、临床分期、三阴型乳腺癌及内脏转移是影响不良预后的独立因素,对判断预后和制定个体化治疗提供了重要依据,并对今后临床工作的开展具有指导意义。      

Rectal cancer with synchronous inguinal lymph node metastasis without distant metastasis. A call for further oncological evaluation

This study aimed to compare the survival of patients with isolated inguinal lymph node metastases from rectal cancer to patients with inguinal and additional synchronous distant metastases from rectal cancer who treated with curative intent. A retrospective review of all consecutive adult patients with rectal adenocarcinoma and inguinal lymph node involvement who underwent curative therapy at our institution from 2002 to 2020 was conducted. Patients were classified as having synchronous inguinal lymph node metastasis (SILNM), or synchronous inguinal lymph node and distant organ metastasis (SILNDOM). Patients in the SILNM group had a median overall survival of 75 months compared to 17.6 months in the SILNDOM group;p-value = 0.09. The recurrence-free survival for patients with SILNM was 19.6 months compared to 2.4 months in the SILNDOM group;p-value = 0.053. In conclusion, SILNM appears to represent a distinct subgroup of patients with metastatic rectal cancer. These patients warrant consideration of treatment with curative intent. Further studies are needed.     

Radiotherapy in the treatment of hepatocellular carcinoma and its metastases

A study was conducted to evaluate the effect of external radiation therapy on hepatocellular carcinoma (HCC) and its metastatic lesions. A total of 33 patients with cytopathologically proven HCC were subjected to radiation therapy over a 4-year period, and treatment was discontinued in 8 cases due to jaundice, severe discomfort, or early mortality. Thus, 25 patients with 28 lesions underwent irradiation with a total dose ranging between 3000 and 5600. Of these, seven were irradiated for liver tumors, and the results showed that two lesions decreased in size, the symptoms improved in 1 case, and another patient maintained stable disease for 4 months. Among the 21 metastatic lesions treated, only 2 patients failed respond to the treatment. Nine subjects were irradiated for bone metastases, and the bone pain subsided in all but one case. The survival for bone metastasis was as long as 23 months when the primary tumor was treated effectively. Three of the four cases of irradiated skin nodules disappeared and had not recurred after 5 months, 1 year, and 4 years, respectively. Tumor shrinkage or symptoms of relief were noted for three abdominal lymph nodes, one neck lymph node, one pleural tumor, and one lung tumor. Clinical improvement associated with a stable lesion was observed in two patients with brain metastasis. Follow-up revealed regrowth of the tumor or recurrence of symptoms in most of the patients. However, none of the patients died as a direct result of a metastatic lesion. Although external radiation therapy is palliative in intent, it appears to be useful in the treatment of HCC and its metastatic lesions.Presented at The Second International Symposium on Treatment of Liver Cancer. Taipei, 3–4 February 1991     

皮肤恶性黑素瘤的外科治疗

目的:探讨皮肤恶性黑素瘤的外科治疗方式.方法:回顾性分析2007年10月—2011年12月共93例皮肤恶性黑素瘤患者的临床资料、外科手术方式和预后.按照美国癌症联合委员会(American Joint Committee on Cancer,AJCC)外科分期标准: ⅠA期1例, Ⅰ B期2例,Ⅱ A期8例,Ⅱ B期9例,Ⅱ C期20例,Ⅲ A期18例,Ⅲ B期17例,Ⅲ C期16例,Ⅳ期2例;外科手术方式:广泛切除术26例,广泛切除术十游离植皮或转移皮瓣重建术7例,截指(趾)8例,髂腹股沟淋巴结清扫术32例,腋窝淋巴结清扫术3例,广泛切除术十一期髂腹股沟淋巴结清扫术15例,广泛切除术十一期腋窝淋巴结清扫术2例;术后辅助化疗53例,干扰素或白细胞介素治疗78例.对77例患者进行了随访,平均随访时间为20 (2～50)个月.结果:Ⅰ期3例患者均存活;Ⅱ期获随访的28例患者中,8例于术后12个月时出现腹股沟淋巴结转移,2例于术后18个月时出现骨转移,6例于术后36个月时出现皮内转移;Ⅲ期获随访的44例患者中,11例于随访期间死于肺转移,5例死于肝转移;Ⅳ期2例患者中,1例于术后12个月时因肺转移而死亡,1例于术后11个月时因肝转移而死亡.随访期间,77例患者中的43例患者为无进展生存.结论:早期发现以及早期手术治疗皮肤恶性黑素瘤可以获得较好的疾病控制率,规范化的区域淋巴结清扫术是控制疾病进展的重要手段,术后辅助治疗可使生存获益.     

Lymphadenectomy for isolated lymph node metastasis from extremity soft-tissue sarcomas

BACKGROUND: Previous studies have suggested that the prognosis in patients with extremity soft-tissue sarcomas (ESTS) with isolated lymph node (LN) metastases (stage IV) is comparable to that of patients with high-risk ESTS without metastases (stage III). This study was performed to determine the outcomes of patients who underwent aggressive therapy, including lymphadenectomy in patients with LN metastasis from ESTS. METHODS: Demographic details, pathology of the primary disease, timing of LN metastasis, and details of the multimodality treatment were obtained from the medical records of 35 patients with nodal metastasis from ESTS who were treated between 1981 and 2003. Survival after the diagnosis of primary disease and LN metastasis was compared with established historical outcomes for patients with American Joint Commission on Cancer (AJCC) stages III and IV ESTS. RESULTS: Epithelioid sarcomas (23%) and malignant fibrous histiocytomas (23%) were the most common primary histologic types. Twenty (57%) patients presented with synchronous nodal metastasis. Median follow-up from the time of diagnosis of lymph node metastasis was 48.5 months. The 1-year, 2-year, and 5-year actuarial survival rates in patients with synchronous nodal metastasis after lymphadenectomy and additional therapy were 79%, 62%, and 52%, respectively. In comparison, the 1-year, 2-year, and 5-year actuarial survival rates in patients with metachronous nodal metastasis after lymphadenectomy and additional therapy were 100%, 95%, and 66%, respectively. CONCLUSIONS: Patients with isolated regional lymph node metastases who are treated with aggressive approaches, including regional LN dissection, may experience prolonged survival similar to that which more closely approximates the survival seen in patients with stage III disease (5-year survival rate, 50%) rather than the survival seen in patients with stage IV disease (5-year survival rate, 25%). These data lend support for reconsideration of the current AJCC staging system for ESTS.     

322例广泛期SCLC不同转移部位的生存分析

目的 探讨广泛期SCLC患者不同转移部位对预后的影响。方法 回顾分析本院2011-2015年间收治的经病理学或细胞学诊断的广泛期SCLC患者322例,其中原发病灶伴远处器官转移246例,原发病灶伴非区域淋巴结转移76例。转移累及单器官261例,累及多器官61例。322例患者绝大多数接受EP、CE方案化疗,187例接受胸部3DRT。采用Kaplan-Meier法计算生存率,Logrank法比较组间生存差异,Cox模型多因素预后分析。结果 全组中位生存期和1、2年OS分别为11.7个月和47.9%、19.5%;转移累及单器官者分别为12.4个月和52.5%、21.9%,转移累及多器官者分别为8.9个月和30.5%、11.2%(P=0.014)。单器官转移中肝转移预后最差,中位生存期仅为8.5个月,非区域淋巴结转移预后最好,中位生存期为14.5个月(P=0.001);除去肝转移以外单器官转移生存差异无统计学意义(P=0.139)。多器官转移中伴肝转移和伴骨转移预后最差(P=0.016、0.006),而有无脑转移对广泛期SCLC多器官转移患者预后影响不大(P=0.995)。单纯肝转移和多器官转移预后无明显差异(P=0.862)。结论 广泛期SCLC患者初诊时单器官转移累及肝脏对预后有影响且预后最差;多器官转移伴肝转移以及伴骨转移预后最差,而有无脑转移对预后影响不大。转移一旦累及肝脏,单器官受累和多器官受累生存无明显差异。     

Analysis of hepatic lymph node metastasis in liver metastases from colorectal cancer

We analyzed the clinical significance of hepatic lymph node metastasis in 48 patients who underwent a resection of colorectal liver metastases with hepatic lymph node (HN) dissection from 2001 to 2010. The frequency and the site of HN metastasis were investigated to clarify the relationship between clinical background and the significance of HN metastasis. In the frequency of HN metastases, positive lymph node metastases were detected in three (9.1%) out of 33 cases with synchronous liver metastasis and in one (6.7%) out of 15 cases with metachronous liver metastasis. In the site of HN metastasis, No. 8a and No. 12a lymph node metastasis was observed in one case each. No. 12b lymph node metastasis was seen in two cases. These cases with the presence of HN metastasis recurred within 13 months. On multivariate analysis using Cox proportional hazards models, hepatic lymph node metastases was an independent risk factor for overall survival (hazard ratio (95% CI): 4.165 (1.018-17.044), p=0.04). Our results indicated that HN metastases in colorectal liver metastases were a poor prognostic factor. Based on the results, we will examine the efficacy of adjuvant chemotherapy for the patients with HN metastases in the future.     

胸部食管癌转移淋巴结数与预后的临床研究

目的 探讨胸部食管癌转移淋巴结的个数与预后的关系。方法 采用颈、胸、腹三切口施行胸部食管癌手术１１２例,同时施行三区域淋巴结清扫。选择９个可能对食管癌切除术后预后产生影响的特征性临床因素,通过Ｃｏｘ比例风险模型,利用累计生存率对食管癌切除术后患者进行预后多因素分析。结果 本组总５年生存率为５８．４％,其中无淋巴结转移组（Ａ组）为８８．４％、转移淋巴结１～３枚组（Ｂ组）为５０．８％,转移≥４枚组（Ｃ     

宫颈癌综合治疗后远处淋巴结转移临床分析

目的:探讨宫颈癌综合治疗后远处淋巴结复发转移的临床特征、治疗和预后。方法:对5例远处淋巴结转移的宫颈癌患者的临床资料进行分析。结果:5例患者接受手术、化疗或放疗等综合治疗。所有患者术前磁共振显像(MRI)/计算机断层扫描(CT)检查未发现远处转移,而于治疗结束后1个月～2年出现,其中4例发生腹主动脉旁淋巴结转移,2例合并左锁骨上淋巴结转移。经全身化疗及三维适形放疗,4例死亡,平均生存15.3个月,1例带瘤生存24个月。结论:腹主动脉旁及左锁骨上淋巴结转移可能是宫颈低分化癌患者远处复发转移部位之一,需要应用手术、化疗及放疗等综合治疗。正电子发射断层扫描(PET)/单光子发射扫描(SPECT)技术是诊断、随访及评价预后的重要工具。     

手术切除联合辅助放化疗对腮腺黏液表皮样癌的疗效及预后影响因素

目的：探讨手术切除联合辅助放化疗对腮腺黏液表皮样癌的疗效及患者预后影响因素。方法选择80例腮腺黏液表皮样癌患者,按照治疗方案分为单纯手术组30例和术后联合放化疗组50例,对患者进行为期5年随访,以患者性别、年龄、病程、TMN分期、病理分型、手术类型、治疗方案、淋巴结远端转移等资料作为观察指标,分析影响患者预后的因素。结果术后联合放化疗组患者5年生存率为84.0%,高于单纯手术组5年生存率为63.3%（χ2=4.422,P=0.035）;生存分析显示术后联合放化疗组中位生存期为90.6个月高于单纯手术组的69.8个月,差异有统计学意义（χ2=12.039,P=0.001）。单因素分析显示年龄﹥60岁、T3～T4分级、低分化程度、单纯手术切除、合并淋巴结远端转移患者5年生存率降低（P﹤0.05）;多因素分析显示病理分型、治疗方案、淋巴结远端转移是影响患者预后的独立危险因素。结论术后辅助放化疗能够提高腮腺黏液表皮样癌患者的5年生存率,病理分型、治疗方案、淋巴结远端转移是影响患者预后的独立危险因素。     

243例肺外小细胞癌患者的治疗及预后分析

目的 探讨肺外小细胞癌(EPSCC)的临床特点、治疗方法和预后.方法 回顾性分析1977年至2007年中国医学科学院肿瘤医院收治的243例EPSCC患者的临床资料.243 例EPSCC患者中,局限期209例,广泛期34例;采用以化疗为基础的综合治疗者170例,局部治疗[手术和(或)放疗]者73例.结果 EPSCC的原发部位以消化道多见,占67.9%.全组243例患者的半年、1年、2年、3年和5年总生存率分别为88.9%,67.2%、36.8%、27.3%和18.3%.局限期患者的中位生存时间(18.6个月)明显长于广泛期患者(14.0个月,P=0.030).无脉管瘤栓者的中位生存时间(19.2个月)明显长于有脉管瘤栓者(14.4个月,P=0.026).无区域淋巴结转移者的中位生存时间(39.5个月)明显长于有区域淋巴结转移者(13.9个月,p=0.000).多因素分析显示,肿瘤的美国退伍军人肺癌协会(VALSG)分期、有无脉管瘤栓和根治术后区域淋巴结转移情况是影响EPSCC患者预后的独立因素.不同原发部位EPSCC 患者的中位生存时间差异无统计学意义(P=0.075),其中妇科肿瘤、头颈部肿瘤和消化道肿瘤患者的中位生存时间分别为28.0、20.1和14.3个月.采用以化疗为基础的综合治疗者的中位生存时间为20.2个月,明显长于局部治疗的患者(12.2个月,P=0.000).80.4%的局限期患者在治疗过程中出现远处转移.结论 EPSCC 是一种少见的恶性肿瘤,易发生早期转移,预后不佳.EPSCC的部分临床特点与小细胞肺癌有相似之处,但是在病因学、临床转归、预后和脑转移率等方面又有不同.手术切除后联合化疗和放疗的综合治疗有可能会改善EPSCC的治疗效果.     

胸段食管鳞癌腹腔淋巴结转移特点及广泛清除的临床意义

目的:了解胸段食管鳞癌腹腔淋巴结转移特点及对预后的影响,探讨合理的腹腔淋巴结清除范围。方法:对241例手术切除胸段食管鳞癌患者的临床资料进行回顾性分析。结果:腹腔淋巴结转移率32·4%,转移度9·8%。肝总动脉旁、腹腔动脉旁及肝十二指肠韧带内淋巴结转移度分别为6·6%、6·9%和6·3%。影响腹腔淋巴结转移的因素为肿瘤部位、浸润深度及组织分化程度。患者术后3年腹腔局部复发率为5·4%。有腹腔淋巴结转移患者的术后3年生存率为42·3%,低于无淋巴结转移患者的70·6%,P<0·01。结论:腹腔淋巴结转移是影响食管癌切除患者预后的一个主要因素,对腹腔淋巴结的广泛清除可以降低术后的局部复发率。     

第7版食管癌锁骨上淋巴结转移分期方式的探讨及152例病例分析

分析食管癌锁骨上淋巴结转移放疗疗效及探讨第7版国际食管癌M分期方式。方法：回顾分析2005年1月至2009年12月经病理证实的锁骨上淋巴结转移的胸段食管癌病例152例,其中食管原发灶放射治疗患者95例,手术治疗57例;食管原发灶治疗后锁骨上淋巴结转移的患者81例,首诊时发现71例;141例患者锁骨上淋巴结行放射治疗,11例未行放射治疗。结果：全组患者中位随访时间为17（2～68）个月。放射治疗后近期疗效评价52.5%的患者达CR（74/141）、41.8%达PR（59/141）、3.6%达NC（5/141）、2.1%达PD（3/141）。至随访截止日期生存者40例,1、2、3年生存率分别为69.1%、37.4%、24.0%。多因素分析显示年龄、锁骨上淋巴结转移时间、单侧或双侧转移、近期疗效及是否合并内脏转移对预后的影响有统计学意义（P<0.05）。根据第7版国际食管癌TNM分期按食管原发灶首诊时有无胸腔内及锁骨上区淋巴结转移分为N分期（39例）和M分期（71例）组,两组患者1、2、3年总生存率分别为82.1%、54.1%、31.0%和56.3%、28.1%、21.7%（P=0.041）。按照第6版国际食管癌TNM分期,根据患者食管原发灶首诊时有锁骨上区淋巴结转移的M分期组71例分为M1a 20例与M1b 51例,两组患者1、2、3年总生存率分别为60.0%、27.3%、27.3%和54.9%、28.7%、19.0%,（P=0.930）。单纯锁骨上淋巴结转移（104例）与合并内脏转移（48例）患者的1、2、3年生存率分别为72.1%、47.0%、32.9%和62.5%、17.5%、5.8%（P<0.001）。结论：胸段食管癌出现锁骨上淋巴结转移与胸腔内淋巴结转移患者生存情况存在显著性差异;单纯锁骨上淋巴结转移与合并内脏器官转移患者的预后有显著性差异,分期时是否应将锁骨上淋巴结转移划分为M分期或N分期,还是分亚组需进一步研究;原发灶的位置对食管癌锁骨上淋巴结转移的预后影响不大;患者的年龄、锁骨上淋巴结转移时间、单侧或双侧转移、近期疗效及是否合并内脏转移对预后有影响。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的：探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义。方法：收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系。结果：103例患者胃癌淋巴结转移率为68.9%（71/103）。随着肿瘤直径的增加,淋巴结转移率（度）也增高（P〈0.05）;临床分期中,胃癌的淋巴结转移率（度）随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率（度）均低于其它期（P〈0.01）;Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%（40/49）,高于其它型（P〈0.05）,而Ⅳ型患者淋巴结转移度32.4%（161/497）最高。结论：淋巴结转移率和转移度随着胃癌的临床进展而增高。合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性。     

胃癌的淋巴结转移与清扫范围关系的探讨

目的:探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义.方法:收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系.结果:103例患者胃癌淋巴结转移率为68.9%(71/103).随着肿瘤直径的增加,淋巴结转移率(度)也增高(P<0.05);临床分期中,胃癌的淋巴结转移率(度)随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率(度)均低于其它期 (P<0.01);Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%(40/49),高于其它型(P<0.05),而Ⅳ型患者淋巴结转移度32.4%(161/497)最高.结论:淋巴结转移率和转移度随着胃癌的临床进展而增高.合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性.     

Thyroid metastases from colorectal cancer: the Institut Gustave Roussy experience

The prevalence of thyroid metastases in colorectal cancer (CRC) patients is unknown. We retrieved the records of all patients with CRC and pathologically proved thyroid metastasis for the period 1993-2004. Among 5,862 consecutive patients with CRC, 6 (0.1%) were diagnosed with thyroid metastases, a median of 61 months after the diagnosis of primary tumour, and a median of 19 months after the last surgical resection or radiofrequency ablation of other metastases (which were present in all cases). Signs and symptoms, when present (n=3), consisted of cervical pain, cervical adenopathy, goitre, dysphagia, and/or dysphonia. In other cases, the diagnosis was made by positron emission tomography scanning. Thyroidectomy was performed in the 5 patients with isolated thyroid metastases, with cervical lymph node dissection being required in all cases. The only patient treated conservatively because of concomitant liver and lung metastases developed life-threatening dyspnoea, which required emergent tracheal stenting. Median overall survival was 77 months, 58 months, and 12 months after the diagnosis of primary CRC, initial metastases, and thyroid metastasis, respectively. It is concluded that thyroid metastases are rare and occur late in the course of CRC. Thyroidectomy (with cervical lymph node dissection) may result in prevention or improvement of life-threatening symptoms and prolonged survival.     

Prognostic factors in patients with Hürthle cell neoplasms of the thyroid

BACKGROUND: Hürthle cell neoplasms, often considered a variant of follicular thyroid neoplasms, represent 3% of thyroid carcinomas. Only a handful of publications have focused on the biologic behavior, prognostic factors, and treatment outcomes of Hürthle cell carcinoma. The objective of the current study was to identify the clinical and pathologic features of Hürthle cell carcinomas that predict disease progression or death. METHODS: The authors reviewed medical records of patients who were treated for Hürthle cell carcinoma (HCC) and Hürthle cell adenoma (HCA) at The University of Texas M. D. Anderson Cancer Center from March 1944 to February 1995, including follow-up information. The pathologic diagnosis was confirmed by one of the authors. RESULTS: The authors identified 127 patients with Hürthle cell neoplasms, 89 patients with HCC and 38 patients with HCA. Seven patients with HCC had foci of anaplastic thyroid carcinoma. Survival for this subgroup was worse compared with the overall group and was analyzed separately. The HCC group was significantly older (age 51.8 years vs. age 43.1. years) and had larger tumors (4.3 cm vs. 2.9 cm) compared with the HCA group. No differences were seen in gender or previous radiation exposure. Forty percent of patients in the HCC group died of thyroid carcinoma, whereas no patients in the HCA group died of the disease. There has been no improvement in all-cause and disease specific mortality in the past 5 decades for patients with these neoplasms. Conventional staging systems predicted mortality with minor differences. Of the patients with known metastasis, 38% showed radioiodine uptake. Univariate analysis identified older age, higher disease stage, tumor size, extraglandular invasion, multifocality, lymph node disease, distant metastasis, extensive surgery, external beam radiation therapy, and chemotherapy as factors that were associated with decreased survival. Tumor encapsulation was associated with improved survival. Although radioactive iodine treatment had no overall effect on survival, subgroup analysis showed that patients who received radioactive iodine for adjuvant ablation therapy had better outcomes compared either with patients who did not receive radioactive iodine or with patients who received radioactive iodine as treatment for residual disease. Multivariate analysis indicated that older age and larger tumor size predicted worse survival through an association with worse behaving tumors (multifocal, less encapsulated, and with extraglandular invasion). The decreased survival in patients with lymph node metastases may be explained by its association with distant metastases. The association of extensive surgery, external beam radiation therapy, and chemotherapy with worse survival also disappeared once those factors were analyzed together with other prognostic factors, such as distant metastases. CONCLUSIONS: Several clinical and pathologic prognostic factors were identified in patients with HCC and HCA. Older age and larger tumor size predicted reduced survival. Radioactive iodine therapy may confer a survival benefit when it is used for adjuvant ablation therapy, but not when residual disease is present. The authors could not demonstrate a survival benefit for the use of extensive surgery, external beam radiation therapy, or chemotherapy.     

Ⅲa-N2非小细胞肺癌纵隔淋巴结转移综合模式的预后价值

  目的  研究跳跃转移与肺叶特异性转移对Ⅲa-N2非小细胞肺癌（non small cell lung cancer,NSCLC）的预后意义。  方法  天津医科大学肿瘤医院2008年1月至2009年12月行完全切除和系统淋巴结清扫的218例pN2期NSCLC被纳入本研究。根据有无N1区淋巴结转移将分为连续转移与跳跃性转移;根据纵隔淋巴结转移范围是否超出肺叶特异性区域分为纵隔广泛转移与肺叶特异性转移。对各组的总生存（overall survival,OS）和无病生存（disease free survival,DFS）进行了比较。  结果  全组患者的5年OS为21.6%,5年DFS为16.8%。跳跃性转移及连续转移病例的5年OS分别为37.6%和22.0%（P =0.008）;DFS分别为29.1%和15.0%（P =0.022）。肺叶特异性转移和广泛转移的5年OS分别为38.3%和20.4%（P =0.005）;DFS分别为28.4%和15.1%（P =0.009）。根据两者的组合将所有患者进一步分为3组:仅有跳跃性转移和肺叶特异性转移（A组）,发生连续转移或者纵隔广泛转移中的一项（B组）;既有连续转移又有纵隔广泛转移（C组）。3组的5年OS分别为47.1%,28.1%和16.6%（P =0.001）;5年DFS分别为35.2%,20.8%和11.2%（P =0.002）。多因素分析表明,这种综合转移模式是OS和DFS的独立预后因素。  结论  淋巴结转移的综合模式是Ⅲa-N2的一种独立的预后因素,在评价患者预后及筛选术后治疗患者时应该将这种综合模式考虑在内。