Expression of glycodelin protein and mRNA in human ductal breast cancer carcinoma in situ, invasive ductal carcinomas, their lymph node and distant metastases, and ductal carcinomas with recurrence

Glycodelin, previously known as PP14, has been localized in endometrial, ovarian and cervical carcinoma cells. Recently, glycodelin was demonstrated to be expressed in cancerous human breast tissue. In this study, paraffin-embedded slides of carcinoma in situ, invasive carcinomas without metastases, invasive carcinomas with corresponding lymph node metastases, invasive carcinomas with corresponding recurrence and invasive carcinomas with corresponding distant metastases were investigated for glycodelin protein and mRNA expression. Protein expression was found in all cases of carcinoma in situ, in invasive carcinoma without lymph node metastases in 90% of cases, in breast cancer with lymph node metastases in 50% of cases, in breast cancer with recurrence in 38% of cases and in breast cancer with distant metastases in 40% of cases. Results were confirmed by in situ hybridization showing reduced glycodelin expression as lymph node metastasis progressed, compared to carcinoma in situ. Glycodelin mRNA expression is not further reduced in carcinomas with distant metastasis and recurrence compared to carcinoma in situ. Results demonstrate that invasive breast carcinomas without metastases are more likely to express glycodelin. In contrast, cases of breast cancer with metastatic infiltration and recurrence show weak expression of glycodelin. On the basis of these results, we speculate that glycodelin could be used as a prognostic marker for breast cancer.     

Management of the Hepatic Lymph Nodes During Resection of Liver Metastases from Colorectal Cancer: A Systematic Review

The aim of this review is to assess the role of hepatic lymphadenectomy in patients undergoing liver resection for colorectal metastases. Meta-analysis of trials identified by a systematic literature search of the Medline, Embase and Central databases was performed. There were no randomized controlled trials which assessed the survival benefit to patients undergoing liver resection for colorectal metastases of either a routine or a ‘selective’ lymphadenectomy. The prevalence of nodal metastases after lymphadenectomy was 8.4 %. The overall 3-year and 5-year survival rates in patients with hepatic lymph node metastases undergoing hepatectomy were 21.8 % (63 of 288 patients) and 8.5 % (27 of 315 patients), respectively, compared with 58.2 % (1,366 of 2,346 patients) and 47.5 % (1,717 of 3,609 patients) in patients undergoing hepatectomy who had no hepatic nodal metastases. The odds ratios for 3-year and 5-year mortality in node positive disease compared with node negative disease were 4.54 (95 % confidence interval 3.15–6.54) and 6.33 (95 % confidence interval 4.28–9.36), respectively. In conclusion, long-term survival rates are low in patients undergoing hepatectomy with hepatic lymph node metastases. The poor outcome is irrespective of whether the nodal metastases are discovered following routine lymphadenectomy or are detected because of pathological enlargement. Further trials in this patient group are required.     

Heterogeneous expression and association of beta-catenin, p16 and c-myc in multistage colorectal tumorigenesis and progression detected by tissue microarray

Most colorectal carcinomas (CRCs) arise from adenomas through an archetypal pathogenic pathway, the adenoma-carcinoma-metastasis sequence. Aberrant expression of beta-catenin, p16, E-cadherin and c-myc appears to have played important roles in the development and/or progression of CRC, but their precise distribution pattern and associations in different pathologic loci along CRC's pathogenic pathway have not been thoroughly examined. In this study, a tissue microarray (TMA) containing 85 advanced CRCs in different Dukes stages was constructed. In each of 85 cases, tissue specimens from normal mucosa and primary carcinomas in different layers of the bowel wall were included in the TMA. Tissue specimens from matched adenoma, lymph node metastases and distant metastases were obtained from 22, 21 and 21 cases, respectively. Expression patterns of beta-catenin, p16, E-cadherin and c-myc were evaluated by immunohistochemistry. The results revealed that nuclear expression of beta-catenin, p16 and c-myc was quantitatively increased from normal mucosa to premalignant adenoma, primary carcinoma and lymph node metastatic carcinoma; the frequency of nuclear overexpression of beta-catenin and p16 in lymph node metastases was significantly higher than that in distant metastases (p < 0.05). These results suggest an association between nuclear overexpression of beta-catenin and/or p16 and CRC lymph node metastasis but not distant metastasis. The results also showed that correlative high nuclear expression of beta-catenin and c-myc was observed in primary carcinomas involving the serosa and lymph node metastases (p < 0.05) but not in other pathologic regions of CRCs, suggesting that the tumor microenvironment in different pathologic loci of colorectal tumorigenesis and progression may influence c-myc responsiveness to beta-catenin/Tcf activation.     

Management of endoscopically removed malignant colon polyps

The medical records of 87 patients with 89 malignant colorectal polyps removed endoscopically between 1971 and 1983 were reviewed retrospectively. Fifty-five polyps contained carcinoma-in-situ. Four polyps had "pseudo-invasion" by displaced mucosal glands. Thirty polyps contained invasive carcinoma. No patients with carcinoma-in-situ or "pseudo-invasion" had either local residual disease or metastatic disease at the time of colectomy or which was detected during subsequent follow-up. Four patients (14%) with invasive cancer would have been inadequately treated by polypectomy alone, since one had residual disease at the polypectomy site, one had nodal metastases, one had liver metastases at the time of colectomy, and one subsequently developed liver metastases. Three histologic criteria correctly predicted all four cases where residual or recurrent disease was present: involvement of the polypectomy resection margin, lymphatic invasion within the polyp, and poorly differentiated histology. Polyp size, histology (villous adenoma, adenomatous polyp, or villo-adenomatous polyp), or anatomic location did not identify those patients who warranted further therapy. We conclude that polypectomy alone is adequate treatment for polyps containing carcinoma-in-situ. Polypectomy alone is also adequate treatment for most polyps containing invasive carcinoma. However, patients with lymphatic involvement within the polyp, poorly differentiated cancer, or resection margin involvement should probably undergo colectomy.     

The sentinel node in colorectal carcinoma. Mapping technique,pathologic assessment,and clinical relevance

One of the most important prognostic factors in colorectal cancer is the presence or absence of regional lymph node metastases. In many instances, micrometastatic disease may not be found on routine pathologic analysis using hematoxylin and eosin staining, but may be discovered only with immunohistochemical methods or polymerase chain reaction assay. Lymphoscintigraphy with biopsy of the sentinel nodes, defined as the first nodal basin in the drainage pathway of a tumor, was developed to provide accurate staging without the morbidity associated with the classic lymph node dissections performed for melanoma or breast cancer. This concept has recently been applied to colorectal cancers, but the method used is unique because oncologic principles of resection are still adhered to for the primary tumor along with en bloc resection of the locoregional mesenteric nodes, some of which are sentinel nodes. Sentinel nodes are ideal for sensitive pathologic techniques of detecting micrometastatic disease, as they often reflect the status of the entire locoregional nodal basin. Gross metastatic nodes reveal significant prognostic information and guide the use of adjuvant therapy in affected patients. However, the detection of micrometastatic disease in sentinel nodes by sensitive pathologic methods has not been proven to result in poor prognosis or benefit from adjuvant therapy for colorectal cancer.     

The role of lymph node dissection in renal cell carcinoma: the pendulum swings back

The incidence of regional lymph node metastases in patients with renal cell carcinoma ranges from 13% to over 30%, and portends a poor prognosis in both locally advanced and metastatic settings. Patients with small, organ confined tumors are at low risk for regional lymph node metastases and lymph node dissection can be omitted in these patients. In contrast, patients with clinical evidence of regional lymph node metastases may derive therapeutic benefit from aggressive removal of all affected lymph nodes within the retroperitoneum. Patients with locally advanced primary tumors but no clinical evidence of lymphadenopathy can be selectively targeted for aggressive lymph node dissection as an adjunct to radical nephrectomy, based on their individual risk of harboring micrometastatic lymph node disease. Several predictive tools have been developed for prediction of occult retroperitoneal nodal metastases. Although early identification of micrometastatic nodal disease in this group of patients has not conclusively been shown to improve survival, accurate pathologic nodal staging allows for early implementation of adjuvant systemic therapies in these high-risk patients. No formal guidelines exist regarding the extent and boundaries of lymph node dissection at the time of radical nephrectomy; however, overwhelming evidence suggests that the staging accuracy of lymph node dissection can be markedly improved if extended template dissections, rather than limited node sampling, is implemented.     

Axillary lymph node metastases associated with small invasive breast carcinomas

BACKGROUND: Over the past 20 years the proportion of invasive breast carcinomas measuring < or = 1 cm has increased progressively. Information regarding the effect of clinical and histologic characteristics on the frequency of lymph node metastases associated with small invasive breast carcinomas is limited. METHODS: A review of Surveillance, Epidemiology, and End Results data was performed using cases diagnosed between January 1988 through December 1993. A total of 12,950 patients with invasive breast carcinomas measuring < or = 1 cm undergoing a resection of the primary tumor and an axillary lymph node dissection were included in this study. The effect of clinical and histologic characteristics on the frequency of lymph node metastases was reviewed. RESULTS: The frequency of lymph node metastases associated with T1a tumors was less than that observed from T1b tumors (9.6% vs. 14.3%; P < 0.001). Tumors with favorable histology (mucinous, papillary, and tubular carcinomas) had a lower frequency of lymph node metastases compared with all other histologic types (3.9% vs. 13.9%; P < 0.001). Increasing histologic grade was associated with an increased risk of lymph node metastases ranging from 7.8% in Grade 1 tumors to 21.0% in Grade 4 tumors (P < 0.001). Increasing patient age was associated with a progressively decreasing frequency of associated axillary lymph node metastases ranging from 22.6% in women age < 40 years to 10.2% in women age > or = 70 years (P < 0.001). CONCLUSIONS: Cases in which an axillary lymph node dissection can be avoided are those with an associated frequency of lymph node metastases < or = 5%, including T1a and T1b mucinous and tubular carcinomas, T1a papillary carcinomas, and T1a Grade 1 carcinomas.     

Submucosal Invasive Micropapillary Carcinoma of the Colon with Massive Lymph Node Metastases: A Case Report

Micropapillary carcinoma was originally reported to be an aggressive variant of breast carcinoma, and it is associated with frequent lymphovascular invasion and a dismal clinical outcome. It has subsequently been found in other organs; however, at present, only a limited number of cases of colorectal micropapillary carcinoma have been reported. We present a case of early colon cancer with extensive nodal metastases in a Japanese patient. An 82-year-old man was found by colonoscopy to have a 20-mm pedunculated polyp in his sigmoid colon. Endoscopic resection of the sigmoid colon tumor was performed, and pathological examination of the resected specimen revealed a poorly differentiated adenocarcinoma component and a micropapillary component. Despite the tumor being confined within the submucosa, massive lymphatic invasion was noted. Thereafter, the patient underwent laparoscopic sigmoidectomy with lymph node dissection, and multiple lymph node metastases were observed. Our case suggests that when a micropapillary component is identified in a pre-operative biopsy specimen, even for early colorectal cancer, surgical resection with adequate lymph node dissection would be required because of the high potential for nodal metastases.Key words: Lymph node metastases, Micropapillary carcinoma, Submucosal colonic cancer     

同时性结直肠癌肝转移临床病理因素分析

目的探讨结直肠癌发生肝转移与其临床病理因素的关系.方法分析比较有肝转移117例与Dukes C或D期无肝转移50例结直肠癌病人的临床特点、血清CEA水平、转移淋巴结、以及原发灶的病理类型和静脉侵犯.结果以肝转移灶为首诊原因的有21例,伴肝转移结直肠癌患者远距离淋巴结转移及镜下静脉侵犯发生率升高,与对照组比较差异显著(P＜0.05).结论要重视结直肠癌肝转移的早期诊断,远距离淋巴结转移或镜下静脉侵袭均预示大肠癌发生肝转移的危险性的增加.     

HER-2 status discrepancy between primary breast cancer and metastatic sites. Impact on target therapy

In this prospective study, we determined HER-2 status in primary breast invasive carcinomas and in the paired lymph node metastases (synchronous and metachronous), local recurrence and metachronous distant metastases, to verify the percentage of discordant cases. HercepTest and Fluorescence in situ hybridization (FISH) were used to determine HER-2 status on 119 cases of primary infiltrating breast carcinoma and paired metastases (45 cases with synchronous lymph node metastases, 9 cases with metachronous lymph node metastases, 30 cases with local recurrence, and 35 cases with metachronous distant metastases). A therapeutically significant HER-2 status discordance was demonstrated between primary carcinoma and synchronous lymph node metastases (6.7%), local recurrence (13.3%) and metachronous distant metastases (28.6%). In the first comparison, there was a normal HER-2 status in primary tumours and HER-2 amplification in paired metastases, in the second the opposite phenomenon was present, and both types of discordance were evident in the third comparison. Considering the cases of local recurrences and metachronous distant metastases all together, 14 out of 65 cases (21.5%) showed a therapeutically significant discordance of HER-2 status between the primary tumour and the paired metachronous recurrence or metastasis (p < 0.001), the 15.4% of cases showing normal HER-2 status in the primary tumour and HER-2 amplification in the neoplastic relapse. For the treatment of metastatic patients, the evaluation of HER-2 status should be performed in neoplastic tissue from metastatic site, whenever possible. This procedure could be also suggested in the patients that are metastatic at the time of diagnosis.     

Impact of prognostic factors on clinical outcome after resection of colorectal pulmonary metastases

Colorectal cancer is the second leading cause of cancer-related deaths in Western countries. Approximately 35% of patients will have metastatic disease at diagnosis, and an additional 25% of patients with resected stage II/III disease will develop recurrence. In approximately 30% of patients, metastatic disease will be restricted to a single organ, with the liver and lungs accounting for the majority of single organ-site metastases. In recent years, aggressive surgical resection of pulmonary metastases has become increasingly common with the recognition that this offers the best chance of long-term cure despite recent chemotherapeutic advances. Unfortunately, relapse after pulmonary resection remains approximately 70% despite advances in imaging and surgical technique. This review examines prognostic factors that influence survival after resection and repeat resection of pulmonary colorectal metastases and examines the impact of lymph node metastases, chemotherapy, and hepatic metastases on outcome. Pathologic markers that might determine outcome and current literature, which consists mainly of retrospective institutional reports, is reviewed.     

Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study

Depth of invasion in early invasive colorectal cancer is considered an important predictive factor for lymph node metastasis. However, no large-scale reports have established the relationship between invasion depth of pedunculated type early invasive colorectal cancers and risk of lymph node metastasis. The aim of this retrospective cohort study was to clarify the risk of lymph node metastasis in pedunculated type early invasive colorectal cancers in a large series. Patients with pedunculated type early invasive colorectal cancer who underwent endoscopic or surgical resection at seven referral hospitals in Japan were enrolled. Haggitt's line was used as baseline and the invasion depth was classified into two groups, head invasion and stalk invasion. The incidence of lymph node metastasis was investigated between patients with head and stalk invasion. We analyzed 384 pedunculated type early invasive colorectal cancers in 384 patients. There were 154, 156, and 74 endoscopic resection cases, endoscopic resection followed by surgical operation, and surgical resection cases, respectively. There were 240 head invasion and 144 stalk invasion lesions. Among the lesions treated surgically, the overall incidence of lymph node metastasis was 3.5% (8/230). The incidence of lymph node metastasis was 0.0% (0/101) in patients with head invasion, as compared with 6.2% (8/129) in patients with stalk invasion. Pedunculated type early invasive colorectal cancers pathologically diagnosed as head invasion can be managed by endoscopic treatment alone.     

可切除结直肠癌肺转移的预后因素分析

目的 探讨结直肠癌肺转移根治性切除术后的预后影响因素.方法 回顾性分析行根治性切除术的60例结直肠癌肺转移患者的临床资料.结果 全组患者肺转移瘤切除术后和结直肠癌切除术后的5年生存率分别为43.7%和74.0%.单因素分析结果显示,肺转移瘤数目和无瘤间期与结直肠癌术后患者的总生存率有关(均P＜0.05),肺转移瘤切除前癌胚抗原(CEA)水平、肺转移瘸数目、有无肺门和纵隔淋巴结转移与肺转移瘤切除术后患者的生存率有关(均P＜0.05).多因素分析结果显示,肺转移瘤数目和无瘤间期是结直肠癌术后患者预后的独立影响因素(OR=2.691,95% CI为1.072～6.754;OR=0.979,95% CI为0.963～0.994),肺转移瘤数目、有无肺门和纵隔淋巴结转移是肺转移瘤切除术后患者预后的独立影响因素(OR=3.319,95% CI为1.274～8.648;OR=3.414,95% CI为1.340～8.695).结论 经过严格选择的结直肠癌肺转移患者,尤其是单发肺转移及无肺门和纵隔淋巴结转移的患者,行根治性切除术后可获得长期生存.     

子宫内膜癌盆腔淋巴结转移的高危因素分析*

目的:回顾性分析子宫内膜癌患者淋巴结转移的情况,探讨子宫内膜癌盆腔淋巴结转移的高危因素。方法:对2000年12月～2004年12月中山大学附属第三医院、中山大学附属第二医院及中山大学附属肿瘤医院妇科收治的189 例子宫内膜癌病例进行回顾性分析,探讨年龄、病理类型、组织学分级、肌层浸润深度、附件转移等与淋巴结转移的关系。结果:术后病理类型中子宫内膜样腺癌、腺鳞癌、非子宫内膜样腺癌的淋巴结转移率分别是13.1% 、44.4% 、8.3% ,各病理类型间比较差异有统计学意义（P<0.05）;组织学分级G1、G2、G3 的淋巴结转移发生率分别是2.3% 、14.2% 、31.3% ,各分级间比较差异有统计学意义（P<0.01）;肌层浸润深度中无肌层浸润、浅肌层浸润、深肌层浸润的淋巴结转移率分别为0、8.0% 、35.4% ,三者比较有显著性差异（P<0.01）;有附件转移者与无附件转移者淋巴结转移率为51.5% 、6.4% ,两者比较有显著性差异（P<0.001）。 对单因素分析有意义的变量用Lo?gistic回归分析进行多因素分析,结果只有各肌层浸润深度及附件转移与否引起淋巴结转移的差异有统计学意义（P<0.01）。 结论:腺鳞癌、组织学低分化、深肌层浸润、附件转移者淋巴结转移率较高,肌层浸润深度及附件转移与否是影响盆腔淋巴结转移的独立高危因素。      

Outcome of local excision for locally invasive rectal carcinomas with special reference to histological features at the invasive margin

BACKGROUND: Several researchers reported promising results that local excision with or without postoperative chemo-radiation therapy is an alternative approach for sphincter preservation in patients with locally invasive rectal carcinomas. However, indications and long-term results have not yet been determined. METHODS: Demographic and pathological characteristics of eight patients with locally invasive tumors undergoing initially local excision were reviewed with reference to histological features at the invasive margin. RESULTS: All the tumors were well differentiated adenocarcinomas. In all but two tumors, the invasion was limited within the proper muscle layer. Radiation therapy was given preoperatively in one patient and postoperatively in two patients. Additional bowel resection was not attempted in these three cases. Among the remaining five patients, two received additional bowel resection with lymph node dissection. No lymph node metastasis was observed in these two patients. During the average follow-up period of 55 months, three patients had regional lymph node metastases at 7, 36 and 72 months, respectively. Another patient had regional lymph node and distant metastases at 5 months. Three out of five patients with moderate to severe grade of dedifferentiated histology at the invasive margin (H-inv) had regional lymph node metastases. On the other hand, one out of three patients with mild H-inv had lymph node metastases. CONCLUSIONS: H-inv may be useful as a clinical predictor of lymph node metastasis. However, more experience is needed to confirm the usefulness of H-inv in selecting invasive rectal cancer patients in whom local excision is safe and appropriate.      

舌鳞癌颈淋巴结转移的MRI诊断

背景与目的明确有无颈部淋巴结转移对舌癌的治疗与预后评价意义重大,单纯触诊诊断淋巴结转移的准确率难以令人满意,MRI越来越多地用于颈部淋巴结转移的评价。本研究旨在分析舌鳞癌颈淋巴结转移的MRI特点及规律,探讨MRI在诊断舌鳞癌颈部淋巴结转移中的作用。方法对92例舌鳞癌患者共448个颈部淋巴结区进行MRI鄄病理对照分析。结果448个淋巴结区中,166区(37.1%)病理为淋巴结转移,其中Ⅱ区最常受累,Ⅰ、Ⅱ区MRI诊断的假阳性率及假阴性率均较高。舌体鳞癌颈部淋巴结各区转移率与舌根鳞癌比较无统计学差异。76个淋巴结区有明确的淋巴结中央坏死,病理证实均为转移淋巴结。包膜外侵犯34区,MRI上淋巴结边缘不规则,周围脂肪带模糊、不完整,其中2例包绕颈内动脉。以淋巴结最小直径≥8mm,或中央坏死作为MRI诊断转移淋巴结的标准,敏感性79.5%,特异性90.4%,准确性86.4%。结论舌鳞癌颈部淋巴结转移以Ⅱ区最高,淋巴结的大小、有无中央坏死及边缘是否规则可作为MRI诊断的主要依据。MRI对于Ⅲ、Ⅳ及Ⅴ区诊断的淋巴结转移诊断准确性高,但对Ⅰ、Ⅱ区淋巴结转移诊断价值有限。     

Comparison of phenotypic and genotypic features in human primary large bowel carcinomas and lymph node metastases

In order to test the contention that metastasis is a selective process and that therefore metastases might show a more restricted pattern of phenotypic and genotypic characteristics than primary tumors, we compared the expression of carcinoembryonic antigen, Ca 19-9, secretory component, serotonin, and mucin production as well as flow cytometric data on DNA content and percentage of S-phase cells in 87 primary large bowel carcinomas and their lymph node metastases. In a majority of the cases primary tumors and their metastases were largely identical with regard to the examined phenotypic features. In discrepant cases, however, metastases did not invariably show a more restricted pattern than primary tumors, indicating high differentiational plasticity of primary and metastatic colorectal cancer cells. In contrast, in a number of cases genotypic discrepancies were observed. We conclude that phenotypic characteristics of colorectal cancer cells cannot be used to study the pathogenesis of lymph node metastasis. Genotypic studies, however, suggest that lymphogenic metastasis may be a selective event.     

Sentinel lymph node mapping in colorectal cancer: a feasibility study

AIMS AND BACKGROUND: Sentinel lymph node (SLN) biopsy is currently used and investigated in melanoma and in breast cancer. Its utility in gastrointestinal malignancies is still under debate. The prognosis of colorectal cancer patients is strongly related to the lymphatic involvement. The aim of this study was to evaluate the feasibility of SLN mapping in colorectal cancer and to assess its impact on pathological staging and treatment. METHODS AND STUDY DESIGN: We injected blue dye in 11 colorectal cancer patients during surgery. After resection the tumor specimen was examined to identify blue-stained lymph nodes and these lymph nodes were sent separately to the pathologist. Routine hematoxylin-eosin examination was performed on all nodes (including blue ones). No other techniques (eg immunohistochemistry or PCR) were performed. RESULTS: Sentinel lymph nodes were successfully identified in 10 of the 11 patients. We observed only one false negative result (10%) and the agreement between SLN and other lymph node status was 80% (8/10). One patient was upstaged: SLN was positive for metastases while the other lymph nodes were negative. CONCLUSIONS: Lymphatic mapping using patent blue dye is feasible in colorectal cancer. The identification of lymph nodal metastases by this technique led to upstaging of one patient, who may benefit from adjuvant therapy. These initial results prompt further investigation of this procedure as an accurate, minimally invasive staging approach in early colorectal cancer. We proceed with our study to evaluate the role of SLN mapping in colorectal cancer management.     

Axillary node metastasis from T1N0M0 breast cancer: possible avoidance of dissection in a subgroup

BACKGROUND: Axillary lymph node dissection is now no longer considered to be the standard treatment in all patients with invasive breast cancer. We have attempted to identify a sub-group of patients with invasive breast carcinoma who may not need to undergo axillary lymph node dissection. METHODS: Patients (n = 823) with T1 N0M0 invasive breast cancer treated at our hospital between 1970 and 1994 were studied. We investigated the relationship between positive axillary lymph nodes and the following clinico-pathological factors: patient age, menopausal status, contralateral breast cancer (synchronous or asynchronous), tumor location, tumor size (T:cm), histopathology, histological grade, presence or absence of malignant microcalcification or spiculation on mammography and estrogen receptor status. RESULTS: The incidence of axillary lymph node metastases in patients with T1N0M0 invasive breast cancer was 25% (208/823). The node-negative group was significantly older than the node-positive group. Premenopausal patients had a higher rate of lymph node metastases although this was not significant. The frequency of nodal metastases when related to the tumor size was as follows: T< or =1.0 cm, 17%; T< or =1.5 cm, 25%; T< or =2.0 cm, 29%. Mammography revealed that patients with malignant calcification or spiculation had a significantly higher rate of nodal metastases than those without these findings. Certain tumor types (medullary, mucinous and tubular carcinomas) had lower positive rates for lymph node involvement. With regard to the histological grade, lymph node positivity increased significantly with high-grade tumors. No correlation was observed between any other factors and the presence or absence of lymph node metastases. CONCLUSIONS: It may be possible to avoid axillary lymph node dissection in postmenopausal patients (50 years or older) where the histological type is favorable when the tumor diameter is < or =1.0 cm and when microcalcification or spiculation is absent on mammography.      

双侧腹股沟淋巴结转移对淋巴结阳性阴茎癌预后评估的价值

目的探讨双侧腹股沟淋巴结转移在淋巴结阳性阴茎癌预后评估中的价值。方法回顾性分析60例淋巴结转移阳性阴茎鳞状细胞癌患者资料。所有患者均接受区域淋巴结清扫手术。Kaplan-Meier法绘制无复发生存曲线并通过Log—rank检验加以分析,COX回归模型进行多因素生存分析。结果60例患者中18例有双侧腹股沟淋巴结转移,其3年无复发生存率（26．7％）显著低于单侧腹股沟淋巴结转移患者（65．3％）,差异有统计学意义（x^2=10．6,P=0．001）。经多因素生存分析,阳性淋巴结数目和双侧腹股沟淋巴结转移均是独立的生存预后因素（均P〈0．05）。生存曲线比较显示双侧腹股沟淋巴结转移且阳性淋巴结数〉2个的患者预后差。结论在考虑了淋巴结阳性阴茎癌阳性淋巴结数目的影响后,双侧腹股沟淋巴结转移仍是其重要预后指标。