胆囊腺鳞癌与胆囊腺癌的临床病理特征对比以及预后影响因素分析

目的对比胆囊腺鳞癌患者与胆囊腺癌患者的临床病理特征及分析预后影响因素。方法回顾性分析2018年1月至2022年12月宁波市医疗中心李惠利医院肝胆胰外科接受手术治疗的135例胆囊癌患者临床资料。最终入组122例患者, 其中男性55例, 女性67例, 年龄(68.0±9.8)岁。122例患者依据肿瘤病理类型不同, 分为胆囊腺鳞癌组(n=14)和胆囊腺癌组(n=108)。比较两组患者肿瘤最大径、肿瘤分化程度、肿瘤TNM分期等临床病理特征及预后。采用Kaplan-Meier法计算生存率, 生存率比较采用log-rank检验。进一步采用多因素Cox回归分析术后预后影响因素。结果胆囊腺鳞癌组肿瘤最大径、肝脏侵犯比例、肿瘤低分化比例以及TNM分期Ⅲ～Ⅳ期比例高于胆囊腺癌组, 差异均有统计学意义(均P<0.05)。两组肝切除范围比较, 差异有统计学意义(χ2=9.22, P=0.016)。胆囊腺鳞癌组术后1、2年累积生存率分别为28.6%、9.5%, 低于胆囊腺癌组的78.7%、60.5%, 差异有统计学意义(χ2=27.88, P<0.001)。胆囊腺鳞癌组中接受术后辅助治疗的患者(n=...     

肺鳞癌、腺癌纵隔淋巴结转移的特点

目的 研究原发肺鳞癌及腺癌纵隔淋巴结转移特点,探讨临床意义.方法 对353例原发肺癌施行同侧纵隔淋巴结廓清术,病理检测淋巴结转移频度.结果 清除淋巴结2380组,平均每例6.74组.N2 淋巴结转移率16.2%.T1、T2、T3间淋巴结转移率差异有统计学意义(P<0.01).N2转移率在鳞癌、腺癌分别为30.1%、44.1%.64.2% 鳞癌N2转移为某一组淋巴结,腺癌3组以上转移者46.2%.上叶肺癌跨区域N2转移占15.1%,下叶(包括中叶)肺癌跨区域转移占53.1%.跳跃式转移占N2转移的53.7%.结论 肺鳞癌及腺癌纵隔淋巴结转移具有多发性、跳跃性及跨区域性特点.     

T_1、T_2肺鳞癌及腺癌淋巴结转移特点及其临床意义

目的　研究T1、T2 肺鳞及腺癌淋巴结转移频度、分布范围及特点 ,为广泛清扫提供依据。　方法　按Naruke肺癌淋巴结分布图对 2 5 4例T1、T2 肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵隔淋巴结清扫术并对其进行统计分析。　结果　清除淋巴结 16 85组。N1淋巴结转移率 2 0 0 % ,N2 淋巴结转移率为 10 2 %。T1、T2 间淋巴结转移率差异有非常显著性意义 (P <0 0 1)。T1鳞癌无N2 转移 ,N2 转移在鳞癌、腺癌分别为 2 2 0 %和 40 9% ,差异有非常显著性意义 (P <0 0 1)。6 4 3%的鳞癌为某 1组N2 转移 ,腺癌≥ 3组转移占 46 2 % ,跳跃式转移占N2 转移的 5 7 5 %。N2 阳性上叶肺癌下纵隔转移占 13 6 % ,N2 阳性的下叶肺癌上纵隔转移占 5 1 6 %。　结论　随着瘤体增大 ,淋巴结转移频度增加 ,腺癌比鳞癌淋巴结转移更加活跃 ,任何部位的肺癌都可跨区域纵隔转移。除T1鳞癌外 ,只有广泛清扫同侧肺内及纵隔淋巴结才能达到根治。     

MTA1表达与胸中段食管鳞癌预后的相关性

目的 探讨MTA1表达与胸中段食管鳞癌预后的相关性.方法 回顾2002年1月至2004年1月间,手术治疗165例胸中段食管癌病人临床资料.采用免疫组化进行肿瘤转移相关基因1(metastasis-associated gene 1,MTA1)检测,采用Kaplan-meier法进行生存分析、用Cox回归分析判定独立预后因素.结果 T2和T3病例MTA1表达率分别为13.3%和50%,两组差异有统计学意义(x2=13.2,P=0.00).有、无淋巴结转移者MTA1表达率分别为53.4%和31.2%,两组差异有统计学意义(x2=8.2,P=0.04).有、无MTA1蛋白表达者的5年生存率分别为18.3%和45.7%,两组差异有统计学意义(P=0.00).T2病例中,有、无MTA1蛋白表达者5年生存率分别为25.0%和50.0%,两组差异无统计学意义(P=0.20);T3病例中,有、无MTA1蛋白表达者的5年生存率分别为15.6%和40.6%(P=0.01),两组差异有统计学意义.pN0者中,有、无MTA1蛋白表达病例5年生存率分别为29.2%和54.7%(P=0.03),两组差异有统计学意义;pN1者中,有、无MTA1蛋白表达者5年生存率分别为12.8%和34.1%(P=0.04),两组差异有统计学意义.Cox回归分析结果显示,N分类和MTA1蛋白表达是独立的预后危险因素.结论 食管鳞癌不同的T、N分类中MTA1蛋白表达存在差别;MTA1蛋白过度表达者5年生存率降低;淋巴结转移和MTA1蛋白过度表达是独立的不利预后因素.     

胆囊腺鳞癌29例临床诊治经验分析

目的回顾性分析胆囊腺鳞癌的临床病理特点及诊治经验,初步探讨男性和女性胆囊腺鳞癌患者发病及预后的差异。方法以2000年1月至2015年12月收治的29例胆囊腺鳞癌患者的临床资料为研究对象,分男女患者组对术前的影像学、实验室指标,术后病理特征;手术方式及生存时间进行统计分析。计量资料采用x珋±s表示,采用student’t检验(正态分布)或秩和检验(非正态分布);计数资料以百分比(%)表示,采用χ2检验或Fisher精确概率法。以SPSS统计软件18.0为分析手段,P0.05为差异有统计学意义。结果 29例患者中,26例行根治性手术,3例行姑息性手术,肿瘤标记物水平、肿瘤大小、分期、是否合并结石、局部侵犯和远处转移程度,男女组间差异均无统计学意义(P0.05),术后病理:Her-1阳性9例(9/11),Her-2阳性5例(5/11),CK18阳性8例(8/9),CK19阳性7例(7/8),VEGF 3例(3/3),Heptocyte阳性0例(0/5),术后总生存期为(4.56±1.67)个月,其中男患者组(3.63±1.54)个月,显著低于女患者组(5.42±1.30)个月,差异具有统计学意义(P=0.002)。结论胆囊腺鳞癌临床罕见、恶性程度高、临床表现缺乏特异性,多以局部侵犯为主,手术是目前主要的治疗手段,男女虽发病率无显著差异,但预后具有一定差异。     

胃腺癌淋巴结转移危险因素的分析

目的 探讨胃腺癌组织学类型及浸润深度与淋巴结转移的关系.方法 回顾性分析1615例胃腺癌的临床病理资料,对不同组织学类型和不同浸润深度以及淋巴结的转移率及转移个数进行统计分析.结果 平均每例取淋巴结28.62个,共46 227个,其中有转移的10 173个,平均转移率22.01%;1 615例胃腺癌有淋巴结转移的1 046例,转移率为64.77%.其中TNM分期T1(M),T1(SM),T2,T3的转移率分别为2.78%,13.61%,55.59%和84.84%;组织学高分化癌转移率50.25%,低分化癌转移率78.95%,差异均有统计学意义(均P＜0.001).结论 胃腺癌的转移率与组织学分类有关;随着浸润深度的增加,转移的危险性呈梯度增高.     

T1期食管鳞癌淋巴结转移及预后危险因素分析

目的探讨T1期食管鳞癌淋巴结转移及预后的危险因素。方法收集2013年3月至2018年3月在上海长海医院胸外科行外科手术治疗的387例T1期食管鳞癌患者的临床资料,其中男281例、女106例,中位年龄60(41,80)岁。将患者分为淋巴结转移组(n=77)和非转移组(n=310),分析淋巴结转移和预后的危险因素。结果 387例T1期食管癌患者中,77例(19.9%)发生淋巴结转移,T1a期淋巴结转移率为8.4%(8/95),T1b期淋巴结转移率为23.6%(69/292)。单因素分析显示肿瘤长度、分化程度、浸润深度和脉管有无癌栓与淋巴结转移有关(P0.05)。多因素logistic回归分析结果显示肿瘤浸润深度[OR=2.456,95%CI(1.104,5.463),P0.05]、脉管癌栓[OR=15.766,95%CI(4.880,50.938),P0.05]是T1期食管癌淋巴结转移的独立危险因素。中位随访时间41(12,66)个月,失访20例(5.2%),死亡51例。T1期食管癌患者1年、3年、5年生存率分别为98.71%、89.67%、86.82%。单因素分析显示死亡组与非死亡组之间肿瘤浸润深度、脉管癌栓、淋巴结转移差异有统计学意义(P0.05)。Cox回归分析显示淋巴结转移[OR=3.794,95%CI(2.109,6.824),P0.05]为预后的独立危险因素。结论 T1期食管鳞癌浸润至黏膜下层或存在脉管癌栓者淋巴结转移的风险较高。伴有淋巴结转移的T1期食管鳞癌预后相对较差。     

残胃癌的淋巴结转移特点及外科治疗

目的 探讨残胃癌的淋巴结转移特点及外科治疗效果.方法 回顾性分析1994年1月至2008年1月大连医科大学附属第一医院收治的42例残胃新生癌患者(研究组)和同期收治的56例胃上部癌患者(对照组)的临床资料.采用t检验、X2检验分析相关数据,Kaplan-Meier法和Log-rank检验分析两组患者的生存率及淋巴结转移率.结果 研究组和对照组患者的胃周围第1～3组淋巴结转移率相近,转移率为43%～61%,其差异无统计学意义(χ2=0.752,0.833,0.678,P>0.05);第7～9组淋巴结转移率分别为22%、18%、25%和46%、25%、30%,其差异有统计学意义(χ2=2.168,3.263,5.761,P<0.05);第10～14组淋巴结转移率分别为47%、36%、31%、20%、25%和33%、34%、19%、6%、0,其差异有统计学意义(χ2=3.225,1.883,3.945,4.137,6.823,P<0.05);第16组淋巴结转移率分别为0和23%;空肠系膜淋巴结转移率分别为27%和0.研究组和对照组患者总体5年累积生存率分别为38%和48%,两组比较差异有统计学意义(χ2=4.165,P<0.05).研究组和对照组根治度A、B患者的5年生存率分别为54%和57%,两者比较差异无统计学意义(χ2=0.622,P>0.05).结论 残胃癌有其独特的淋巴结转移规律;应采取积极的外科治疗,对于改善患者预后有积极的作用.     

D2根治术联合脾切除治疗T3期胃上部癌的疗效评价

目的 探讨D2根治术联合脾切除对T3期胃上部癌的疗效及预后分析.方法 1980年1月至2002年6月对613例T3期胃上部癌患者施行D2根治性手术,其中联合脾切除术者(切脾组)102例,未联合脾切除术者(保脾组)511例.对两组患者No.l0、11淋巴结转移率、术后5年生存率和复发率,及术后并发症的发生率和病死率进行对照分析.结果 切脾组和保脾组No.l0淋巴结转移率分别为23.5%、14.9%,差异具有统计学意义(P＜0.05).两组NO.11组淋巴结转移率相当.切脾组和保脾组术后5年生存率分别为39.8%、32.3%,复发率分别为55.9%、60.3%,差异均无统计学意义(P＞0.05).切脾组中No.l0淋巴结有转移的患者术后5年生存率与无转移的患者相似;切脾组和保脾组术后并发症的发生率和病死率分别为19.6%、4.9%和13.7%、3.1%,差异均无统计学意义(P＞0.05).结论 对于T3期胃上部癌患者,发生No.10淋巴结转移时,应施行联合脾切除术,彻底清扫No.l0、11淋巴结,以提高疗效,减少复发.联合脾切除术不会增加患者术后并发症发生率和病死率.     

放化疗在胆囊腺鳞癌治疗中的预后价值

目的 胆囊腺鳞癌的预后很差,本研究目的是寻找胆囊腺鳞癌预后的影响因素,评价放化疗对胆囊腺鳞癌预后的意义。方法 从SEER数据库中分析2004年1月至2015年12月214例胆囊腺鳞癌患者的临床病例资料,采用Kaplan-Meier法分析患者预后的影响因素,采用单因素和多因素Cox分析法探讨胆囊腺鳞癌的独立预后因素。结果 胆囊腺鳞癌患者中位生存时间为8个月,1年生存率为34.4%,3年生存率为17.1%。多因素分析结果表明,年龄（HR 1.407,95%CI 1.019~1.944,P=0.038）、M分期（HR 2.219,95%CI 1.595~3.086,P<0.001）、放疗（HR 1.609,95%CI 1.010~2.564,P=0.045）、化疗（HR 1.594,95%CI 1.101~2.307,P=0.013）是胆囊腺鳞癌患者预后的独立因素。42例患者同时接受了化疗和放疗,中位总生存期（OS）为16个月,明显优于未放化疗组（121例,中位OS为5个月）和仅化疗组（49例,中位OS为10个月）。放化疗可提高患者的生存时间（χ²=12.25,P<0.05）。在TNM分期II期和IV期亚组中,同时接受化疗和放疗的胆囊腺鳞癌患者OS比仅接受化疗的患者更长。结论 年龄、M分期、放疗、化疗是胆囊腺鳞癌患者的独立预后因素,放疗联合化疗可以有效改善胆囊腺鳞癌患者的预后。     

Squamous variant of gallbladder cancer: is it different from adenocarcinoma?

Background

Literature on squamous variants of gallbladder cancer (GBC) is limited.

Methods

This was a retrospective analysis of GBC patients operated on between August 2009 and March 2012. Patients with adenosquamous carcinoma or squamous cell carcinoma were compared with adenocarcinoma for clinicopathologic features and surgical outcomes.

Results

Of the primary GBC patients resected with curative intent, 14 had adenosquamous carcinoma (10) or squamous cell carcinoma (4) (group A), whereas 122 had adenocarcinoma (group B). Abdominal pain was the most common symptom in both groups; however, presentation with vomiting and an abdominal lump was more common in group A (P = .04 and <.01, respectively). Group A had a significantly larger tumor size (7.9 vs 4.8 cm, P = .01) and a higher incidence of adjacent organ involvement requiring extended resections (85.7% vs 26.2%, P < .01). Despite the higher T stage, node-negative disease was significantly higher in group A (42.9% vs 17.2%, P = .03). There was no significant difference in the median survival after curative resection between the 2 groups (28 vs 31 months, P = .24).

Conclusions

The squamous variant of GBC presented at an advanced T stage; however, nodal involvement and distant metastasis were less common. Despite the higher T stage, curative resection could be achieved in the majority with a comparable survival.     

食管鳞癌环周切缘的临床意义分析

目的:分析食管鳞癌环周切缘情况与患者术后生存预后的关系,并探讨其与临床病理特征的相关性。方法:收集河北医科大学第四医院2017年10月至2019年3月行食管癌根治性切除术后的患者资料,所有患者临床资料完整,术后病理均为进展期鳞癌。采集并分析患者性别、年龄、T分期、N分期、肿瘤位置、病变长度、大体病理类型、脉管瘤栓、神经...     

Surgical treatment of 48 primary peripheral, non-small cell lung cancers equal to or greater than 8 cm. Prognostic factors and 5 years' survival

In a series of 885 resections for lung carcinoma performed between 1976 and 1986, 48 (5.5%) were for large size tumors of 8 cm and over. Pneumonectomy was performed in 28 patients (58.3%), lobectomy in 17 (35.5%) and bilobectomy in 3 (6.2). Histological type of tumor was squamous cell in 27, adenocarcinoma in 9, large cell carcinoma in 10, and adenosquamous carcinoma in 2. The stage of the disease was stage I in 16 cases, stage II in 3 cases, and stage III in 29 cases. Total survival rate including perioperative mortality (3 deaths) was 30.5% at 3 years and 16.3% at 5 years. The best prognostic factors are: age under 60 (23% survival at 5 years, and no survival over 60, (p = 0.01), absence of weight loss (24% survival at 3 years, and 14% at 3 years in case of weight loss (p = 0.02), absence of symptoms (44% at 3 years) but no survival in case of symptoms (p = 0.02), no invasion of mediastinal lymph nodes (N0 and N1), and stage I and II of the disease (50% of survival at 3 years against 20% for stage III (p = 0.04). There was no relation to survival rate between T2 and T3, squamous and adenocarcinoma, and between lobectomy and pneumonectomy. Most of our patients died of post-operative metastasis (52%), related to the large size of the tumor.     

A clinical study of small advanced lung cancer with metastasis to mediastinal lymph node

From January 1981 through December 1989, 15 patients with small advanced lung cancer were treated surgically at the Tenri Hospital. In these cases, the diameter of peripheral lung cancer did not exceed 3.0 cm (T1) and mediastinal lymph nodes were proved to be N2 postoperatively by lymph node dissection or sampling. The histological types were as follows: 8 adenocarcinoma, 4 large cell carcinoma, 1 squamous cell carcinoma, 1 small cell carcinoma, and 1 adenosquamous carcinoma. All but one patient were received postoperative chemotherapy and/or radiotherapy. The survival rate was 44.5% at 3 years, and median survival time was 36 months. The mediastinal lymph node metastasis with small peripheral lung cancer (T1N2) was ominous, and it should be said that complete mediastinal lymph node dissection and adjuvant therapy were indispensable to small advanced adenocarcinoma of lung.     

Long-term survival of a patient with advanced adenosquamous carcinoma of the gallbladder after radical resection

Patients with adenosquamous carcinoma of the gallbladder tend to present with a bulky tumor that frequently displays involvement with adjacent organs, and diagnosis is usually made at an advanced stage. This may contribute to the poor prognosis of patients with adenosquamous carcinoma of the gallbladder compared to patients with adenocarcinoma. We present herein a patient with advanced adenosquamous carcinoma of the gallbladder who is doing well with no evidence of recurrence more than 5 years after radical resection. A 72-year-old woman complaining of generalized fatigue and loss of appetite was referred to our hospital with suspected cholelithiasis, following ultrasonography done at another hospital. On admission, abdominal ultrasonography and computed tomography revealed an irregularly shaped solid mass extending from the fundus of the gallbladder, and invasion of the stomach was strongly suspected. Gallbladder carcinoma was diagnosed, and radical resection, including partial gastrectomy, was performed. Histopathologically, adenosquamous carcinoma was diagnosed, and it was graded as si, hinf0, binf0, pv0, a0, t4, n0, and stage IVa.     

Poor prognosis after lung resection for patients with adenosquamous carcinoma of the lung

BACKGROUND: We evaluated the prognosis of adenosquamous carcinoma of the lung after lung resection in comparison with other types of carcinoma. METHODS: We retrospectively reviewed charts of patients who underwent lung resection for lung cancer. RESULTS: Surgical outcomes for 30 patients with adenosquamous carcinoma of the lung, who were treated between 1976 and 1998, were compared with the surgical results for 1,219 patients similarly treated for adenocarcinoma or squamous cell carcinoma during the same period. Adenosquamous carcinoma comprised only 2.1% of 1,408 lung cancer cases treated by resection. The overall cumulative 5-year survival rate was only 6.2% for the patients with adenosquamous carcinoma, indicating a significantly poorer prognosis than for adenocarcinoma or squamous cell carcinoma. CONCLUSIONS: The cumulative survival rate for patients with adenosquamous carcinoma in pathologic stages IA to IIB was similar to that of patients with stage IIIA adenocarcinoma or squamous cell carcinoma.     

原发性胃腺鳞癌和胃鳞癌的临床病理特点分析

目的 探讨原发性胃腺鳞癌和胃鳞癌的临床病理特点.方法 回顾性分析12例原发性胃腺鳞癌和胃鳞癌的临床病理资料,对腺鳞癌进行CK17及CK18免疫组化染色.结果 本组原发性胃腺鳞癌和胃鳞癌病例占同期全部外科治疗胃癌病例的0.28%,其中原发性胃腺鳞癌10例,胃鳞癌2例;男10例,女2例;平均年龄65岁.主要临床症状有上腹隐痛或胀痛不适,呕血及黑便.术前胃镜活检确诊率为33%(4/12).肿瘤直径≤5 cm 3例,>5 cm 9例.根治性切除8例,姑息性切除4例.TNM分期Ⅰ期1例,Ⅲ期5例,Ⅳ期6例.本组术后2年内死于肿瘤转移复发10例,其中4例腺鳞癌姑息切除患者存活少于半年,且鳞癌和腺癌所占瘤体成分均在30%以上.术后3年死于其他疾病1例,术后5个月存活1例.结论 原发性胃腺鳞癌和胃鳞癌在临床上少见,具有独特的临床病理特点,腺鳞癌预后较差可能与其兼有腺癌和鳞癌两种恶性生物学行为有关.     

胆囊腺鳞癌4例临床分析

目的:总结胆囊原发性腺鳞癌的临床病理特点及诊治经验。方法:回顾性分析1998年―2012年收治的4例胆囊腺鳞癌患者的临床资料。结果:4例患者中,3例行根治性手术,1例行姑息性手术;术后病理结果显示,癌组织中含有腺癌和鳞癌两种成分,CK8/18及CK5/64阳性;4例患者均于术后1年内死亡,中位生存期为180 d,均死于肿瘤复发或转移。结论:胆囊腺鳞癌非常罕见、恶性程度高、临床表现缺乏特异性,发现时分期已较晚;目前尚无有效的治疗方法,手术仍是目前主要的治疗手段,与胆囊腺癌相比总体预后较差。     

Outcome Following Surgery for Primary Lung Cancer with Interlobar Pleural Invasion

Purpose To determine whether interlobar pleural invasion into the adjacent lobe (interlobar P3) should be assessed as T3 according to the tumor-node metastasis classification.Methods Surgically treated patients with primary lung cancer (n = 322) were analyzed.Results Tumors with interlobar P3 had a significantly lower incidence of mass screening detection, a higher occurrence rate of squamous cell carcinoma, and a larger tumor diameter than tumors without interlobar P3. The lymph node metastatic rate did not differ between the patients with and without interlobar P3. The 5-year survival rate of patients with interlobar P3 was 63% and the rates of other patients were 56% with T1 disease, 57% with T2, 31% with T3, and 19% with T4. The survival rate for patients with interlobar P3 was higher than for those with T3 without interlobar P3 (P < 0.05). The 5-year survival rate of the patients with interlobar P3 was lower in adenocarcinoma (39%) than in squamous cell carcinoma (69%, P < 0.01). The results were similar when the analysis was restricted to patients without lymph node metastasis. In adenocarcinoma, the survival rate for interlobar P3 was between the rates for T2 (53%) and T3 (13%) without interlobar P3, whereas in squamous cell carcinoma, the survival rate for interlobar P3 was between the rates for T1 (88%) and T2 (54%) without interlobar P3.Conclusion Tumors with interlobar P3 should be classified as T2 only in squamous cell carcinoma.This study was presented at the 10th World Conference of the International Association for the Study of Lung Cancer, held in Vancouver, Canada, August 10–14, 2003