大肠癌术后淋巴结转移高危因素的预测

目的探讨结肠癌术后出现淋巴结转移相关的影响因素及其影响程度。方法随机回顾性收集该院进行大肠癌手术的295例患者,参考相关文献获取可能相关因素,进行Logistic回归分析和人工神经网络算法,得出具体影响术后淋巴转移的主要因素及其影响程度。结果经过双变量相关分析最终将肿瘤浸润深度、大体类型、组织学类型、肿瘤最大直径、性别、年龄、脉象、患高血压、病灶部位及淋巴结转移(N)10项相关因素进行分析。Logistics模型分析显示:肿瘤浸润深度、组织学类型、大体类型、病灶部位、患高血压与大肠癌淋巴结转移明显相关(P0.05)。人工神经网络预测模型获得的相关因子重要性及纳入顺序从高到低排序:肿瘤浸润深度组织学类型大体类型肿瘤最大直径病灶部位脉象患高血压年龄性别。两个预测模型对样本数据预测正确率相较不大,而人工神经网络模型表现出更好的预测效果。结论预测大肠癌淋巴结转移的高危因素可以帮助分析淋巴结转移情况,达到早期诊断治疗、提高患者生存率的目的。     

大肠癌淋巴结微转移及其临床价值

近年,随着分子生物学、免疫学技术的进步及对肿瘤淋巴转移规律研究的深入,大肠癌淋巴结微转移及其临床意义日益受到重视.本文就淋巴结微转移的基本概念,分子生物学机制,及大肠癌淋巴结微转移检测的临床意义作一综述.     

T2大肠癌淋巴结转移的相关临床病理因素

目的:探讨与T2期大肠癌淋巴结转移密切相关的临床病理因素,为其合理高效的个体化治疗提供指标.方法:收集1991-01/2006-08中国医科大学附属第一医院肿瘤外科行根治性手术的T2期大肠癌患者324例,回顾性分析其各临床病理因素与淋巴结转移的关系.结果: 肿瘤浸润深度(OR =3.841,95% CI: 1.581-9.329,P = 0.003)与组织分型(OR = 1.451,95% CI: 1.059-1.989,P = 0.023)是影响T2大肠癌淋巴结转移的主要因素.尤其是肿瘤浸及固有肌层上1/2即浅肌层(mp1)和下1/2即深肌层(mp2),淋巴结转移率差异显著.而性别、年龄、肿瘤部位、肿瘤大小、生长方式和淋巴管及血管浸润等因素与淋巴结转移的相关性不显著.结论:肿瘤的浸润深度及组织学类型是影响T2大肠癌淋巴结转移的主要因素.其中浸润深度尤为重要,可将mp1视为一道阻止癌细胞转移播散的屏障,一旦超过mp1水平,淋巴结转移风险将显著增加.     

大肠癌转移相关蛋白差异表达的研究进展

大肠癌转移是一个多步骤、多基因参与的复杂过程,明确大肠癌转移相关基因和蛋白质是现在大肠癌转移机制的研究热点.本文从不同转移潜能大肠癌细胞差异表达蛋白、大肠癌淋巴转移相关蛋白、大肠癌肝转移相关蛋白三个方面综述大肠癌转移相关蛋白.     

中老年早期胃癌淋巴结转移的Logistic多因素分析

目的分析中老年早期胃癌淋巴结转移的相关因素。方法选择早期胃癌患者148例作为观察对象,观察患者发生淋巴结转移情况。采用Logistic多因素分析影响中老年早期胃癌淋巴结转移的危险因素,收集资料包括性别、年龄、肿瘤位置、分化程度、肿瘤最大径、合并基础疾病、浸润深度、脉管瘤栓、组织学分型。结果纳入的148例早期胃癌患者中发生淋巴结转移35例(23.65%)。单因素分析表明,有无淋巴结转移两组的性别、年龄、肿瘤位置和合并基础疾病比较差异无统计学意义(P0.05);淋巴结转移组低分化比例明显高于无淋巴结转移组,肿瘤最大径≥2 cm比例明显高于无淋巴结转移组,浸润黏膜下层比例明显高于无淋巴结转移组,脉管瘤栓比例明显高于无淋巴结转移组,组织学未分化型比例明显高于无淋巴结转移组(P0.05)。将单因素分析差异具有统计学意义的因素纳入多因素Logistic分析,结果显示分化程度、肿瘤最大径、浸润深度、脉管瘤栓和组织学分型为影响早期胃癌淋巴结转移的危险因素。结论中老年早期胃癌淋巴结转移受多因素影响,其中分化程度、肿瘤最大径、浸润深度、脉管瘤栓和组织学分型为影响早期胃癌淋巴结转移的危险因素。     

进展期胃癌淋巴结转移的相关因素分析

目的探讨进展期胃癌淋巴结转移规律,指导手术清扫范围,以期提高根治效果。方法回顾性分析了119例进展期胃癌的住院资料、手术记录以及病理检查结果,按照性别、年龄、解剖部位、大体类型、肿瘤直径、分化程度以及临床病理分期进行统计学比较,分析淋巴结转移规律的相关因素。结果胃癌淋巴结转移与Borrm ann分型、肿瘤直径、浸润深度及分化程度明显相关浸润性胃癌淋巴结转移率高于限局型;肿瘤直径≥5 cm者淋巴结转移率高于直径〈5 cm者;pT3-pT4胃癌的淋巴结转移率显著高于pT1-pT2（P〈0.05）,未分化型的淋巴结转移率高于分化型（P〈0.05）。性别、年龄以及肿瘤部位不是胃癌淋巴结转移的相关因素。结论肿瘤呈浸润性生长、肿瘤直径≥5 cm、肿瘤浸润肠壁的深度、细胞分化程度是胃癌淋巴结转移的好发因素。手术应根据淋巴结转移规律合理地清除淋巴结,以尽大可能地去除转移的淋巴结和潜在的微转移灶。     

乳腺癌腋淋巴结转移相关因素分析

目的 探讨乳腺癌腋淋巴结转移的临床病理相关因素,为乳腺癌患者病情判断选择、合理手术方式提供依据.方法 应用单因素和多因素的分析方法,回顾性分析经手术治疗的134例乳腺癌患者与腋淋巴结转移相关临床病理资料.结果 单因素分析结果显示病理类型、肿瘤大小、肿瘤部位与乳腺癌腋淋巴结转移有关(P＜0.05);Logistic回归分析结果显示患者年龄越小,乳腺癌腋淋巴结转移的危险越大(OR=0.934);肿瘤越大,乳腺癌腋淋巴结转移的危险越大(OR=11.050);肿瘤部位越靠乳腺内侧,乳腺癌腋淋巴结转移的危险越小(OR=0.375).结论 乳腺癌腋窝淋巴结转移受病理类型、肿瘤越大和肿瘤部位等多种因素影响.     

早期胃癌淋巴结转移规律的临床病理因素研究

目的探讨早期胃癌临床病理因素与淋巴结转移规律的相关性。方法回顾性分析2012年1月—2018年12月期间在陆军军医大学第一附属医院经胃镜下活检病理确诊,并实施外科根治手术的早期胃癌病例,采用单因素分析及Logistic回归多因素分析相关临床病理因素与各组淋巴结转移的关系。结果164例早期癌患者中,34例出现转移。单因素分析显示病理分化程度、浸润深度、肿瘤最大径、脉管浸润与早期胃癌淋巴结转移相关(P均<0.05)。Logistic回归多因素分析结果显示:肿瘤最大径>2 cm(OR=3.2,95%CI:2.305~4.187)、浸润至黏膜下层(OR=2.5,95%CI:2.091~3.859)、病理分化不良(OR=1.7,95%CI:1.029~2.933)及脉管侵犯(OR=2.1,95%CI:1.817~3.176)是早期胃癌淋巴结转移的独立影响因素(P均<0.05)。上部癌中转移率较高的淋巴结依次是第1组(66.7%)、第3组(33.3%);中部癌中转移率较高的淋巴结依次是第3组(75.0%)、第4组(25.0%);下部癌中转移率较高的淋巴结依次是第6组(33.3%)、第3组(25.9%)、第4组(25.9%)及第7组(14.8%)。从转移站别看,分化良好且肿瘤直径≤2 cm的黏膜内早期癌,各部位癌第1站均未见淋巴结转移。结论早期胃癌肿瘤最大径>2 cm﹑浸润至黏膜下层﹑病理分化程度低及脉管受侵犯是淋巴结转移的危险因素。上、中、下部癌均有其各自的高发区域,早期胃癌的淋巴结胃周转移基本符合由近及远的规律。     

大肠癌淋巴结转移相关因素研究现况

大肠癌有无淋巴结转移是制定手术方案及术后辅助治疗方法的重要依据之一,也是影响患者预后的主要因素．我们概述了近年来大肠癌淋巴结转移相关因素的研究进展,试图找出大肠癌淋巴结转移的某些规律,以供临床参考．１　肿瘤生物学特性１．１　肿瘤浸润深度　Ｃａｗｔｈｏｒｎｅｔａｌ［１］对２７２例大肠癌进行了分析,认为肿瘤的浸润深度与淋巴结转移无关．Ｈｏｊｏｅｔａｌ［２］观察了３８９份直肠癌病例后认为肿瘤限于粘膜及粘膜下层者淋巴结转移率为５／２８（１７－９％）,侵犯肌层者为３１／８２（３７－８％）,侵犯浆膜下层者３…     

胸段食管癌淋巴结转移的相关因素

目的探讨胸段食管癌淋巴结转移的相关因素。方法回顾性分析该院2011年9月至2013年12月的264例胸段食管癌患者,比较淋巴结转移组(转移组)与淋巴结非转移组(非转移组)的关系,分析淋巴结转移的相关因素。结果胸段食管癌淋巴结转移与患者性别、年龄、肿瘤位置无明显相关性(均P0.05),与肿瘤长度、肿瘤浸润深度、肿瘤分化程度相关(均P0.05)。结论食管癌患者肿瘤长度≥5 cm,肿瘤为低分化癌以及肿瘤浸润深度为T2~T4是淋巴结转移的危险因素,应尽可能选择右胸入路胸腹腔镜下食管癌根治术并清扫双侧喉返神经淋巴结。     

Predictive Histopathologic Factors for Lymph Node Metastasis in Patients With Nonpedunculated Submucosal Invasive Colorectal Carcinoma

PURPOSE Risk factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma remain to be characterized. This study examines the relationship between lymph node metastasis and clinicopathologic factors in nonpedunculated submucosal invasive colorectal carcinoma.METHODS The study cohort comprised 155 patients who had undergone surgical treatment for nonpedunculated submucosal invasive colorectal carcinoma. The clinicopathologic factors investigated included gender, age, tumor location, macroscopic type, tumor size, histologic type and grade, intramucosal growth pattern, lymphatic invasion, venous invasion, degree of focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and the depth and width of submucosal invasion.RESULTS Lymph node metastases were found in 19 patients (12.3 percent). Univariate analysis showed that lymphatic invasion, focal dedifferentiation at the submucosal invasive front, status of the remaining muscularis mucosa, and depth of submucosal invasion all had a significant influence on lymph node metastasis. Multivariate analysis showed lymphatic invasion (P = 0.014) and high-grade focal dedifferentiation at the submucosal invasive front (P = 0.049) to be independent factors predicting lymph node metastasis. No lymph node metastasis was found in tumors with a depth of submucosal invasion of <1.3 mm.CONCLUSIONS Lymphatic invasion and high-grade focal dedifferentiation at the submucosal invasive front are important predictors of lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Depth of submucosal invasion can be used as an identifying marker for patients who do not require subsequent surgery after endoscopic resection.Supported in part by a grant-in-aid for cancer research from the Ministry of Health and Welfare of Japan.     

Risk Factors for Lymphatic Metastasis of Malignant Bone and Soft-Tissue Tumors: A Retrospective Cohort Study of 242 Patients

Metastasis to the lymph nodes is relatively rare in malignant bone and soft-tissue tumors, and its risk factors remains unknown, except for tumors of the lymphogenous histotype, including rhabdomyosarcoma, epithelioid sarcoma, and clear cell sarcoma. The purpose of this study was to identify the risk factors for lymph node metastasis of malignant bone and soft-tissue tumors.We retrospectively reviewed 242 patients with malignant bone and soft-tissue tumors. The predictors of interest for the risk of lymph node metastasis included age, sex, histopathological diagnosis, location(s) of the primary tumor(s), local recurrence, residual tumor(s), and the size of the primary tumors. To identify the risk factors for lymph node metastasis, Cox regression analyses were performed.Among the 242 patients with malignant bone and soft-tissue tumors in the current study, 60, 29, and 28 were detected to have lung, lymph node, and bone metastases, respectively. In the univariate analyses, the lymphogenous histotype and a primary tumor invading the subcutis were the risk factors for lymph node metastasis. In the multivariate analysis, the lymphogenous histotype (P < 0.01) and a primary tumor in the subcutis (P < 0.01) remained significantly associated with a higher risk of lymph node metastasis with 5.15 and 3.48 of hazard ratios, respectively.Lymph node metastasis was detected in malignant bone and soft-tissue tumors more frequently than that has been previously reported, and the risk factors for lymph node metastasis were the lymphogenous histotype and primary tumors invading the subcutis.     

Lymphatic Staging in Colorectal Cancer: Pathologic, Molecular, and Sentinel Node Techniques

PURPOSE Accurate staging in colorectal cancer is important to predict prognosis and identify patients who could benefit from adjuvant therapy. Patients with lymphatic metastasis, Stage III/Dukes C, are generally treated with adjuvant chemotherapy. Still, patients without lymphatic metastasis do have relapse as high as 27 percent in five years in Dukes B2. It is hypothesized that these patients have occult (micro)metastasis in their lymph nodes. If these (micro)metastasis can be identified, these patients might benefit from adjuvant therapy. We reviewed the literature on procedures to improve lymph node staging.METHODS An extensive literature search was performed in PubMed (www.pubmed.com). Using the reference lists, more articles were found.RESULTS We found 30 articles about sentinel node in colorectal cancer describing original series. Some groups reported several studies including the same patients. We reported their largest studies. For all other techniques, we only included key articles.CONCLUSIONS Many techniques to improve staging have been described. The finding of occult (micro)metastasis is of prognostic significance in most studies. The sentinel node technique has been recently described for use in colorectal cancer. Although it seems clear that this technique has prognostic potential, it is not yet been shown in a follow-up study. Furthermore, the finding of occult (micro)metastasis in any technique used has not been shown to be clinically significant. Whether to treat patients with adjuvant therapy if occult (micro)metastasis are found needs to be proven in future studies.     

癌相关成纤维细胞与食管鳞状细胞癌淋巴转移及淋巴管生成的相关性研究

目的探讨食管鳞状细胞癌中癌相关成纤维细胞浸润与淋巴转移及淋巴管生成的关系。方法本研究中收集53例手术切除并病理确诊的食管鳞状细胞癌新鲜组织,25例距癌灶>5 cm的正常食管黏膜新鲜组织,并统计患者性别、年龄、病理级别、浸润深度、淋巴结是否转移等临床病理资料,应用免疫组织化学染色法检测癌相关成纤维细胞标记蛋白α-SMA以及淋巴管内皮细胞标记蛋白D2-40。采用SPSS 21.0统计学软件对数据进行分析。结果食管鳞状细胞癌组织中癌相关成纤维细胞数量与微淋巴管密度均高于正常食管黏膜组织(P<0.05)。食管鳞状细胞癌组织中癌相关成纤维细胞数量与临床分期、浸润深度、肿瘤淋巴结转移密切相关(P<0.05),与性别、年龄无关。食管鳞状细胞癌组织中癌相关成纤维细胞数量与微淋巴管密度呈正相关(P<0.05)。结论癌相关成纤维细胞可能通过促进淋巴管生成参与食管鳞状细胞癌的浸润和转移,这可能为食管鳞状细胞癌的早期预防和靶向治疗提供新方向。     

CD44V6对实验性大肠癌肝转移影响的实验研究

目的:研究 CD44V6在大肠癌肝转移中的作用,探索一种有效的抗肿瘤转移方法。方法:应用大肠癌肝转移模型来研究 CD44v6单抗对大肠癌 HT29、Lovo 细胞裸鼠实验性肝转移的影响,分析 CD44V6单抗在抗大肠癌肝转移中的作用。结果:CD44V6单抗能有效阻断裸鼠实验性大肠癌肝转移的发生。