人结直肠癌裸小鼠原位移植肝转移模型的建立及其生物学特性的研究

建立人结直肠癌裸鼠原位移植肝转移模型,为探讨人结直肠癌肝转移机制和抗转移治疗提供实验工具。方法 采用组织学完整的人结直肠癌手术标本植入裸鼠结直肠壁内,观察原位移植的成瘤,移植瘤的侵袭和转移及其形态学特征。结果从３４例人结直肠癌标本中筛选出一株人结肠癌裸鼠直转移模型ＨＣＶ－ＭＨＮ－Ｉ,已传至１８代,一株人直肠癌裸鼠矸转移模型 ＨＲＡ,ＨＭＮ－２,已传至２１代。     

肿瘤干细胞研究进展

肿瘤是一种干细胞疾病。干细胞的基因突变导致正常的自我更新和分化失衡，干细胞转变成为肿瘤干细胞(TSC)，而后者具有增殖分化形成肿瘤的能力。TSC的存在已在造血系统肿瘤中得到证实，最近亦有在实体瘤中的相关报道。现对TSC及其在各种肿瘤中的研究进展作一综述。     

胃癌侵袭和转移分子机制研究进展

胃癌是我国常见的恶性肿瘤之一 ,占消化道恶性肿瘤第一位 ,癌细胞侵袭和转移是影响其疗效的主要原因。胃癌侵袭和转移的过程非常复杂 ,从分子水平可将其归纳为：粘附分子介导癌细胞与正常细胞、细胞外基质（ＥＣＭ）进行粘附 ;癌细胞释放多种蛋白水解酶降解所粘附的组织 ;水解酶使胃癌细胞粘附部位形成空隙 ,从而使胃癌细胞向纵深方向或远处运动 ;着床的癌细胞在多种促血管生成因子的作用下形成新生血管 ;癌细胞通过自身机制逃避宿主免疫监视系统的杀伤作用得以生存增殖。明确胃癌侵袭和转移具体的分子机制 ,采取有效的阻断转移 ,对估计预后…     

48例胸腺瘤复发转移的治疗与预后

目的 回顾性分析48例胸腺瘤复发转移患者的治疗结果。方法 48例符合入组条件的复发转移性胸腺瘤进入研究，收集临床资料和随访资料，采用SPSS10．0统计软件，Kaplan-Meier方法 统计总生存率和再治疗后生存率，Cox回归比例风险模型用于影响预后的多因素分析。结果 48例中，27例复发，均为纵隔内复发；26例转移。复发肿瘤手术再切除1例，手术＋术后放疗7例，放疗10例，放疗＋化疗4例，化疗5例，复发放疗中接受二程放疗者为14例。转移患者中接受放疗9例，放疗＋化疗4例，化疗12例，手术＋化疗1例。全组5、10年总生存率分别为55％、31％，中位生存期5年（1．0～32．0年）。全组再治疗后的5、10年生存率分别为38％、25％，中位生存期2．7年（0．3～14．5年）。多因素分析表明无任何因素影响再治疗后生存率。结论全组再治疗后的生存结果提示对胸腺瘤复发或转移者仍应采取积极的挽救性治疗。     

第三届亚太地区肿瘤预防与控制大会胜利召开

第三届亚太地区肿瘤预防与控制大会于2006年11月2至5日在泰国首都曼谷召开。大会的议题是国家肿瘤控制计划、肿瘤登记、肿瘤流行病、分子肿瘤流行病、遗传流行病、肿瘤筛查、感染与肿瘤、肿瘤标志物、肿瘤预防、肿瘤的化学预防等。与会者来自泰国、韩国、印尼、印度、巴基斯坦、斯里兰卡、日本、中国大陆、香港、台湾、新加坡、越南、伊朗、尼泊尔、马来西亚、土耳其、巴布亚新几内亚、不丹、美国、法国、瑞     

综合治疗鼻咽癌疗效观察

鼻咽癌是我国南方尤其是广东常见的癌瘤之一。在东南亚华裔移民广东籍人较多,鼻咽癌发病率也较高。据我院1981年1月至1982年12月综合门诊共诊治1334例海外华侨、港澳同胞恶性肿瘤病人中,鼻咽癌也占39.58％(528/1334),可见在华侨及港澳同胞中鼻咽癌也是常见的癌瘤。本文收集了1980年10月至1987年10月经病理确诊未经治疗的来自华侨港澳的鼻咽癌住院病人共213例进行放疗或化疗加放疗两组     

B超诊断恶性黑色素瘤多脏器转移1例

患者,男,40岁,以全身无痛性结节伴腹胀,腰疼入院。一年前,曾因左足跟黑斑破裂出血行局部病灶活检,经中国医学科学院病理科诊断为:恶性黑色素细胞瘤。查体:慢性消耗病容,全身淋巴结不同程度肿大,全身散在黑色、深兰色及淡兰色小结节多个,左足跟见4cm×3.5cm黑痣。临床诊断:恶性黑色素细胞瘤。B超:①肝大,表面不光滑,实质内见多     

淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响

目的:探讨淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响。方法:回顾分析373例Dukes'B期及C期患者的临床病理特征与淋巴结检出数的关系,及不同淋巴结检出数对患者预后的影响。结果:全组患者淋巴结检出数为13.71±9.38枚,肿瘤部位、大小及肿瘤浸润深度是影响淋巴结检出数的主要因素,结肠癌患者淋巴结检出数为17.51±12.79枚,显著多于直肠癌患者的11.09±6.17枚(P=0.000)。淋巴结检出较少(0～10枚)的Dukes'B期大肠癌患者,其5年生存率仅为60.4%,而淋巴结检出较多(>10枚)的Dukes'B期患者,其5年生存率为74.5%,两者比较具有显著性差异(P=0.002)。但淋巴结检出数对Dukes'C期大肠癌患者的预后无影响(P>0.05)。将结、直肠癌患者分别分析表明,直肠癌患者淋巴结检出数<9枚,结肠癌患者淋巴结检出数<13枚时,其5年生存率显著降低(P<0.05)。结论:为保证分期的准确及指导适宜的术后辅助治疗,直肠癌患者术后至少应检出9枚淋巴结,结肠癌患者至少应检出13枚淋巴结。     

Number and anatomical extent of lymph node metastases in gastric cancer: analysis using intra-lymph node injection of activated carbon particles (CH40)

BACKGROUND: The long-term survival of 200 patients with gastric cancer who underwent radical gastrectomy was analyzed with respect to the number and anatomical extent of lymph node metastasis. All of the patients received intra-lymph node injection of fine activated carbon particle solution (CH40) during surgery. METHODS: The average number of resected lymph nodes increased in line with the anatomical level of lymph node dissection; 32.5 per patient in D1, 42.3 in D2, 3 and 66.3 in D4. The percentage of blackened lymph nodes without metastasis (42.4%) was slightly higher than that of lymph nodes containing metastasis (37.2%), but the difference was not statistically significant. Of the 200 patients, 61 (30.5%) had microscopic evidence of metastatic lymph node involvement. Twenty-two patients had between one and three metastatic lymph nodes, 19 had between four and nine and 20 patients had more than nine. The 5-year survival rate was 93.1% in patients without lymph node metastasis, 71.9% in patients with 1-8 metastatic nodes, 36.1% in patients with 4-9 nodes and 19.2% in patients with > 9 nodes. RESULTS: The 5-year survival rate according to the anatomical extent of metastatic lymph nodes was 93.1% in n0, 63.1% in n1, 37.9% in n2, 27.8% in n3 and 0% in n4. The number of metastatic lymph nodes and also their anatomical extent were identified as independent prognostic factors for survival by multivariate analysis. CONCLUSION: The number and anatomical extent of metastatic lymph nodes have similar impacts on prognosis in gastric cancer.     

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...     

Influence of the Number of Lymph Nodes Examined on the Prognosis of Patients with Dukes＇ B and C Colorectal Carcinoma

OBJECTIVE To analyze the influence of the number of lymph nodes examined on the prognosis of Dukes＇ B and C colorectal cancer patients. METHODS The relationship between the clinicopathologic features of 373 patients with Dukes＇ B and C colorectal cancer and number of the lymph nodes examined was retrospectively analyzed. The effect of the different number of nodes examined on the prognosis of the patients was appraised RESULTS The overall mean number of retrieved lymph nodes of the 373 patients with Dukes＇ B and C colorectal cancer was 13.71±9.38. The site and size of the tumor as well as the depth of tumor infiltration were the major reasons which influenced the number of lymph nodes retrieved. The mean number of lymph nodes examined in the colon-cancer patients was 17.51± 12.79, which was significantly more than the 11.09±6.17 （P = 0.000） examined in the rectal-cancer patients. The 5-year survival rate of the patients with Dukes＇ B large intestinal carcinoma, with fewer lymph nodes retrieved （0 to 10）, was only 60.4%, while those with more lymph node retrieved （≥10） had a 5-year survival of 77.5%. So there was a significant difference between the two groups. However the number of lymph nodes examined had no effect on prognosis of the patients with Dukes＇ C large intestinal carcinoma. Separate analysis of the colon and rectal cancers indicated that to improve the 5-year survival rate, the number of retrieved nodes in cases with rectal cancer should be at least 9, and with colon cancer cases at least 13. CONCLUSION In order to guarantee an accuracy of tumor staging for developing a possible postoperative treatment, at least 9 lymph nodes in rectal cancer patients or 13 in colon cancer patients should be harvested.     

The value of complete lymphadenectomy in radical treatment of cancer of the cervix, Stage IB

Two hundred ninety-three patients with Stage IB carcinoma of the uterine cervix were treated by intracavitary irradiation followed by radical hysterectomy and pelvic lymph node dissection in the 3-year period 1970 to 1972, inclusive. Preoperative lymphography was performed and intraoperative films were taken to obtain a lymphadenectomy that was as complete as possible. The number and location of remaining nodes were determined by postoperative films. No patients were lost to follow-up. The 5- and 10-year survival and recurrence rates were correlated to the number of remaining nodes. It is concluded that patients with four or more remaining nodes have a possible inferior prognosis compared with the rest of the patients. Meticulous and time-consuming search for a few remaining nodes was, however, not found to be justified.     

The location of positive nodes partly influences the prognostic value of the number of positive nodes in breast cancer patients

BACKGROUND: The aim was to determine whether the number of positive lymph nodes or the location of lymph node metastasis (location number) would permit a more accurate prediction of prognoses. METHODS: We compared the survival rates of 3922 patients with primary breast cancer in relation to the location number and the number of positive lymph nodes. Survival rates were calculated by the Kaplan-Meier method and analyzed using the log rank test. RESULTS: Within the n1 alpha group, the presence of one or two positive nodes was associated with significantly better survival than the presence of three positive nodes. These groups should therefore be distinguished. Within the n1 beta group, there was no significant difference in survival between patients with four and those with seven or more positive nodes. Comparisons of n1 beta and n2 patients after subgrouping by the number of positive nodes (4-9 and 10 or more) revealed a significantly poorer prognosis in the n2 group. CONCLUSIONS: When the prognosis of breast cancer is considered from the viewpoint of lymph node metastasis, the location number as described in the General Rules is an excellent classification. However, we should be aware of possible differences in the prognosis depending on the number of positive nodes, as this is masked by the location number.     

宫颈癌根治术后盆腔淋巴结转移的预后研究

背景与目的:盆腔淋巴结转移是影响宫颈癌预后的重要因素,但是淋巴结阳性数、淋巴结转移部位及术后辅助治疗与预后的关系,尚有待探讨。本研究拟探讨Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时影响预后的危险因素。方法:回顾性分析66例根治术后证实有盆腔淋巴结转移的Ⅰb～Ⅱb期(FIGO分期)宫颈癌患者的临床资料,对可能影响预后的有关因素进行Cox比例风险模型分析。结果:66例盆腔淋巴结转移患者的5年总生存率为40.7％。Cox比例风险模型分析结果显示:肿瘤分化程度、淋巴结转移数目和术后辅助治疗是影响预后的重要危险因素(P<0.05)。1枚淋巴结转移患者的5年总体生存率(56.5％)明显高于2枚或2枚以上淋巴结转移的患者(36.4％)(P<0.05),前者远处转移率(5.9％)低于后者(32.7％)(P=0.05),而两组患者盆腔复发率无显著性差异(P>0.05)。术后未予辅助治疗患者的5年生存率(12.6％)明显低于术后辅助治疗者(53.7％)(P< 0.05),而辅助放疗组、辅助化疗组与辅助放化疗组患者的5年生存率差异无统计学意义(P>0.05)。结论:Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时预后差,术后辅助治疗能提高患者生存率,减少盆腔复发和远处转移。     

国际抗癌联盟和日本胃癌协会胃癌淋巴结分期法与国人胃癌患者预后相关性的比较

目的 比较国际抗癌联盟(UICC)和日本胃癌协会(JGCA)两种胃癌淋巴结分期法与胃癌预后的相关性,评价其在胃癌预后评估中的指导意义和应用价值.方法 1996年1月至2005年12月间,经D2及以上胃癌根治手术,清扫淋巴结数目≥15枚,并有完整随访资料的395例胃癌患者为研究对象,分别以两种淋巴结分期法进行分期并绘制生存曲线.以Kaplan-Meier法进行生存率分析,Log rank检验评估组间的差异.结果 按UICC法分期后,各组间患者的生存率差异更明显.对T3期患者分别以两种方法分组并进行生存率比较显示,按照UICC法分期各组间的差异更明显.对两种分期后的N亚期以另一种标准相互再分期后,生存曲线显示,以UICC法对JGCA法分期后的各组再分期所产生的差异比以JGCA法对UICC法分期后的各组再分期后所产生的差异明显.在JGCA分期标准中,Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb和Ⅳ期患者的5年生存率分别为100.0%、96.9%、79.3%、54.2%、16.8%和11.2%;在UICC TNM分期标准中,其5年生存率分别为100.0%、96.9%、75.4%、51.8%、18.4%和10.5%.各期患者的5年生存率差异均无统计学意义(P>0.05).结论 UICC TNM胃癌分期标准与预后的相关性更好,对胃癌患者的预后评估和治疗方案的制定有更为客观的指导意义;而施行标准的D2胃癌根治手术和清扫至少15枚淋巴结是实行UICC分期法所必需的.     

Radical neck dissection for cancer of the oral cavity

160 radical neck dissections (RND) were performed on 154 patients with cancer of the oral cavity in which cancer of the tongue predominated. The 3-, 5- and 10-year survival rates of these patients were 62.9%, 58.3% and 36.2%, respectively. Those with advanced lesions or positive lymph nodes had poor prognosis. The lymph nodes commonly involved were the submaxillary and the upper deep cervical nodes but "jumping" metastasis to the lower cervical nodes was observed. Elective radical neck dissection is advised for cancer of the tongue. The Survival rate of the patients treated by preoperative irradiation plus RND is higher than that by surgery alone. Proper management of the postoperative complications and regular follow-up of the patients are suggested.     

Prognostic Factors of Ampulla of Vater Carcinoma after Radical Surgery

OBJECTIVE Ampullary carcinoma is a rare disease with better prognosis than other periampullary neoplasms.This study investigated the association between clinicopathologiC factors and prognosis after radical resection of ampulla of Vater carcinoma.METHODS Clinical data from 105 patients who underwent radical pancreaticoduodenectomy from January 1990 to December 2005 were retrospectively analyzed by the Kaplan-Meier method,log-rank test,and the Cox proportional hazard model.RESULTS The in-hospital mortalitv rate was 8.6%,the lymph node metastasis rate was 37.1%,and the five-year survival rate was 42.8%.Pancreatic involvement(P=0.027),tumor diameter(P =0.008),T stage(P=0.003),TNM stage(P<0.001),and number of metastatic lymph nodes(P<0.001)were associated with prognosis when the univariate analysis was used.Multivariate analysis showed that the number of lymph node metastases (P<0.001;OR:1.923;CI:1.367-2.705)and tumot diameter(P=0.03;OR:1.432;CI:1.035-1.981) were the independent prognostic factors.CONCLUSION The number of metastatic lymph nodes and tumor diameter are important pathologic factors predicting prognosis of ampulla of Vater carcinoma after radical resection,and lymph node dissection during the radical surgery effectively improves the survival rate.