多原发结直肠癌的临床病理特点

目的 总结多原发结直肠癌的临床病理特点.方法 回顾性分析2001年1月至2008年3月北京大学人民医院收治的30例多原发结直肠癌和580例单发结直肠癌患者的临床资料,30例多原发结直肠癌患者中同时性多原发癌(SC)16例,异时性多原发癌(MC)14例.计数资料采用x2检验,生存分析采用Kaplan-Meier法,生存率的比较采用Log-rank检验.结果 MC首发癌发病年龄早于SC和单发结直肠癌,而MC第二原发癌与SC和单发结直肠癌发病年龄接近.SC多位于左半结肠;MC首发癌以直肠、乙状结肠为多,第二原发癌以升结肠为主.SC和MC首发癌均行根治性切除,MC第二原发癌行根治性手术9例.除3例SC患者和2例MC患者未行化疗外,其余患者术后均接受FCF或FOLFOX或XELOX化疗方案治疗.单发结直肠癌患者中行根治性手术512例,姑息性手术68例,术后化疗519例,以FOLFOX或FCF或XELOX作为一线化疗方案.MC首发癌术后累积生存率明显高于单发结直肠癌(x2=17.289,P＜0.05),第二原发癌术后累积生存率与单发结直肠癌比较,差异无统计学意义(x2=1.731,P＞0.05).SC累积生存率与单发结直肠癌比较,差异无统计学意义(x2=0.800,P＞0.05).结论 MC预后优于单发结直肠癌,而SC预后与单发结直肠癌相当.

Abstract：

Objective To investigate the clinicopathological features of multiple primary colorectal carcinoma. Methods The clinical data of 30 patients with multiple primary colorectal carcinoma and 580 patients with single colorectal carcinoma who were admitted to the Peking University People's Hospital from January 2001 to March 2008 were retrospectively analyzed. There were 16 patients with multiple synchronous carcinoma and 14with multiple metachronous carcinoma. The survival of the patients was analyzed using Kaplan-Meier method and the survival rates were compared using Log-rank test. All data were analyzed using the chi-square test. Results The onset age of multiple metachronous primary carcinoma was younger than that of multiple synchronous carcinoma and single colorectal carcinoma, while the onset age of multiple metachronous secondary carcinoma was close to that of multiple synchronous carcinoma and single colorectal carcinoma. Most of the synchronous carcinoma located at the left colon; while most of the metachronous primary carcinoma located at the rectum and sigmoid colon, and most of the metachronous secondary carcinoma located at the ascending colon. Patients with multiple synchronous carcinoma or multiple metachronous primary carcinoma received radical resection. Of the 14 patients with multiple metachronous carcinoma, 9 received radical resection for secondary focus. Except for three patients with multiple synchronous carcinoma and two patients with multiple metachronous carcinoma, all patients received postoperative chemotherapy with FCF, FOLFOX or XELOX regimen. Of the 580 patients with single colorectal carcinoma, 512 received radical resection, 68 received palliative operation, and 519 received postoperative chemotherapy. The cumulative survival rate of patients with multiple metachronous primary carcinoma was significantly higher than that of single colorectal carcinoma (x2 = 17. 289, P ＜ 0. 05). There was no significant difference in the cumulative survival rate between patients with single colorectal carcinoma and those with multiple metachronous secondary carcinoma or multiple synchronous carcinoma (x2 = 1.731, 0. 800, P ＞ 0. 05). Conclusion The prognosis of patients with colorectal multiple metachronous carcinoma is better than those with single colorectal carcinoma, and the prognosis of colorectal synchronous carcinoma is similar to those with single colorectal carcinoma.     

肝外恶性肿瘤对合并肝癌的多原发癌患者生存影响的Meta分析

目的：评价肝外恶性肿瘤对合并肝癌的多原发癌患者生存率的影响。方法系统回顾公开发表的比较合并肝癌的多原发癌患者和单患肝癌患者生存率且随访严密的临床研究,评估原始研究的质量,对符合条件的研究结果进行Meta分析,计算多原发癌相对单患肝癌死亡危险的优势比（OR）,评价肝外恶性肿瘤对患者生存期的影响。结果共6篇文献符合入选标准,总样本量2431例。包括肝癌合并多原发癌病例207例,死亡136例;单患肝癌组2224例,死亡1598例;合并OR=0.93,95％CI为0.67～1.28。结论肝外肿瘤既没增加也没降低死亡危险,合并肝癌的多原发癌并不意味预后更差,采取积极的治疗是患者获得长期生存的关键,相对于肝外肿瘤需要优先治疗肝癌。     

Clinicopathological characteristics of gastric carcinoma in young patients

Background and aims Gastric carcinoma is a common disease that usually affects older patients, rarely younger patients. Although the relationship between prognosis and the age of patients with gastric carcinoma is controversial, most investigators have suggested that young patients have a poorer prognosis. This study examined the clinicopathological features of young patients with gastric carcinoma.Patients and methods We retrospectively reviewed the hospital records of 1,833 patients with gastric carcinoma to compare the clinicopathological findings in young (aged <36 years) and older (aged 36 years) patients during the period 1988 to 1998 in a tertiary referral center in Gwangju City. Overall survival was the main outcome measure.Results Of the 1,833 patients, 137 (7.5%) were in the young age group. There were no significant differences in depth of invasion, lymph node invasion, hepatic metastasis, peritoneal dissemination, tumor stage or rate of curative resection. A significantly higher percentage of young patients had poorly differentiated histology (P=0.0001). The young patients with curatively resected gastric carcinoma had a better survival rate than young patients with non-resected gastric carcinoma (P<0.001). The 5-year survival rates of young and older patients did not differ statistically (39.6% vs 42.4%; P=0.254).Conclusion Young patients with gastric carcinoma do not have a worse prognosis than older patients. The important prognostic factor was whether the patients underwent curative resection.     

多原发同时结直肠癌39例临床病理分析

目的探讨多原发同时结直肠癌的临床病理特征。方法回顾性分析39例多原发同时结直肠癌的临床资料,并与同期528例单发结直肠癌患者的临床资料进行比较。结果多原发同时结直肠癌在Dukes分期上,主癌分期明显较合并癌晚;且主癌的局部淋巴结转移及脉管浸润较合并癌多见;在病理类型上,主癌分化程度较合并癌差。多原发同时结直肠癌的腺瘤性息肉发生率（59.0%）明显高于单发结直肠癌患者（25.0%,P〈0.01）。手术前结肠镜明确为同时多原发癌的阳性率为76.9%,明显优于钡灌肠与术中探查（P〈0.01）。多原发同时癌患者的5年生存率（5.1%）明显低于单发癌者（28.2%）（P〈0.05）;行根治性手术的多原发同时癌患者5年总生存率则与单发癌患者相似（P〉0.05）;多原发同时癌接受根治性手术者的生存期明显高于姑息性手术者（P〈0.01）。Cox多因素分析显示,Dukes分期、淋巴结转移、脉管瘤栓、手术方式是影响患者生存的独立预后因素。结论多原发同时结直肠癌与单发结直肠癌的临床病理特征及预后是不尽相同的,提高多原发同时结直肠癌患者生存率的关键在于早期诊断和及时进行根治性手术切除。     

Is palliative resection necessary for gastric carcinoma patients?

Background and aims The benefit of palliative resection for gastric carcinoma patients remains controversial. We thus evaluated the survival benefit of palliative resection in advanced gastric carcinoma patients. Materials and methods We reviewed the hospital records of 466 gastric carcinoma patients who had palliative resection and compared the clinicopathologic findings to those of patients who underwent a bypass or exploration from 1986 to 2000. Results Cox’s proportional hazard regression model revealed only one independent statistically significant prognostic parameter, the presence of peritoneal dissemination (risk ratio, 0.739; 95% confidence interval, 0.564–0.967; P < 0.05). The 5-year survival rate of patients who had palliative resection was higher than that of patients who did not (7.03 vs 0%, P < 0.001). When the 5-year survival rates of patients with peritoneal dissemination were examined, the rate was higher for those who underwent resection (4.43 vs 0%, P < 0.001). Conclusion The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.     

乳腺-甲状腺多原发癌的临床分析

目的探讨乳腺-甲状腺多原发癌的临床特点。方法收集2010-05—2016-05间在郑州大学第二附属医院诊断为乳腺-甲状腺多原发癌患者24例,对其临床资料进行回顾性分析。结果 (1)24例乳腺-甲状腺多原发癌均为女性。(2)同时癌9例,异时癌15例。乳腺癌首发12例,甲状腺癌首发3例。(3)两原发癌发生间隔时间在3a内的18例,占75%。(4)乳腺多原发癌与乳腺单癌发病诊断年龄无统计学差异,甲状腺多原发癌发病诊断年龄与甲状腺单癌发病诊断年龄比较,差异无统计学意义(P0.05)。(5)多原发癌中乳腺首发癌浸润性癌占80.95%;再发癌以导管内癌为主,占66.66%。多原发癌中甲状腺癌均为乳头状癌,其首发癌与再发癌中乳头状微小癌分别为83.33%、91.66%。(6)乳腺多原发癌ER阳性率为62.5%,乳腺单发癌ER阳性率52.63%,差异无统计学意义(P0.05)。(7)24例多原发癌中,乳腺癌与甲状腺癌,均获得根治性手术机会,预后良好。结论乳腺-甲状腺多原发癌的第二原发癌好发于3a内,其再发癌肿瘤分化好,临床分期较早。早发现、早诊断,治疗效果好。     

残胃癌的临床病理学特征和预后

目的探讨残胃癌的临床病理学特征和外科治疗的效果及其预后。方法回顾性分析大连医科大学附属第一医院普通外科收治的42例残胃癌患者的临床资料。结果本组患者残胃癌发生部位以吻合口居多,组织学类型以低分化型癌为主。原手术方式为BillrothⅠ（BⅠ）式9例,BⅡ式33例。残胃癌的淋巴结转移,BⅠ式时No．1、No．3、No．10、No．11转移率大于30．0％,No．12转移率为22．2％;BⅡ式No．1、No．2、No．3、No．4及第2站的No．10、No．11、N0．12转移率均高于30．0％,No．14为25．0％。空肠系膜淋巴结转移率27．3％。BⅠ式患者胰腺浸润为66．7％．肝十二指肠韧带为33.3％;BⅡ式患者横结肠浸润为25．0％,胰腺浸润为75．0％。本组患者5年累计生存率为0．38：其中Ⅰ期0．86,Ⅱ期0．50,Ⅲ期0．13,Ⅳ期0,差异具有统计学意义（P〈0．05）。结论残胃癌的淋巴结转移和周围脏器浸润有其独特的方式和规律．外科手术是有效的治疗手段。     

老年人胃癌临床病理分析

目的探讨老年人胃癌的临床及病理特点,旨在为其合理诊治提供依据。方法将经手术治疗的324例胃癌病人（≥60岁）人选老年组,81例青年（〈44岁）胃癌病人作为对照。对比分析两组在临床特点及组织、病理学方面的差异。结果两组在临床症状、肿瘤部位、浸润深度、病理分期方面差异无统计学意义（P〉0．05）;在性别构成、病史长短、术前合并症、术后并发症、手术类型、住院时间等方面差异有统计学意义（P〈0．05）。根治性手术后,老年组与青年组3年生存率差异无统计学意义（P〉0．05）。结论老年胃癌病人在临床及病理学方面并未显示出比青年病人更差的结果。老年人胃癌预后的改善仍依赖于早期诊治水平的提高。     

Clinicopathological features of patients with Borrmann type IV gastric carcinoma

Background: To determine whether there is a specific pattern of clinicopathological features that could be used to distinguish ­Borrmanntype IV gastric carcinoma from other types of gastric carcinoma. Methods: We retrospectively analysed the clinicopathological features of patients with Borrmann type IV carcinoma of the stomach.The results were compared with the features of patients who had other types of gastric carcinoma. Results: The incidence of Borrmann type IV gastric carcinomawas 11.0% (199 patients). A poorly differentiated tumour was found in 120 out of 199 patients (60.3%) with Borrmanntype IV gastric carcinoma. The positive lymph node metastasis was found in 150 out of 199 patients (75.4%) with Borrmanntype IV gastric carcinoma (P < 0.0001).The incidence of serosal invasion (91.5%) and peritoneal dissemination (37.7%) was significantly higher in these patients. Of the patients with Borrmann type IV gastric carcinoma,161 patients (80.9%) were classified as either stage IIIor IV at initial diagnosis. The curative resection rate of patientswith Borrmann type IV gastric carcinoma was lower than that of patients with other types of gastric carcinoma (P < 0.001).The survival rate was higher in patients with a curative resection(P < 0.001). The 5‐year survival rate of patients with Borrmann type IV tumour was lower than that of patients with other types of gastric carcinoma (P < 0.001).The 5‐year survival rates were 90.9% for stage I patients with Borrmann type IV gastric carcinoma and 39.5%, 18.6% and8.7% for stages II, III and IV, respectively (P < 0.001). Conclusion: Improving the prognosis for patients with Borrmanntype IV gastric carcinoma requires early detection and a curative resection.     

Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer

BACKGROUND: The intention of this study was to evaluate the outcome of patients with gastric stump cancer (GSC) in comparison with patients treated for primary proximal gastric cancer (PPGC). METHODS: Nineteen patients with GSC undergoing surgery between January 1989 and August 2005 were compared with 194 PPGC patients treated during the same time period. Various factors such as epidemiologic data, type of treatment, and histopathologic data were evaluated in the analysis. RESULTS: The overall 5-year disease-specific survival was 42% for resected GSC patients in comparison with 37% for resected PPGC patients. There was no statistically significant difference in the survival rate detected between these 2 groups. On multivariate analysis the infiltration of the gastrojejunal anastomosis by the carcinoma was shown to be a significant predictor for the outcome of patients with GSC. CONCLUSIONS: In summary, no significant difference in the outcome between GSC and PPGC has been detected.     

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目的分析和总结老年胃癌的临床特点.方法老年胃癌病人入院后,对可能增加手术风险的因素,尽可能在术前予以纠正.必要时,在术后继续处理.术中、术后严密观察病人全身情况,发现问题及时处理.结果318例老年胃癌病人,238例(74.84%)患有高血压、心脏病、糖尿病等老年人常见病.术后发生并发症共71例次,死亡13例.手术前有共存病者,术后并发症的发生率为25.63%;而手术前无共存病者,术后并发症的发生率为12.50%,两者差异有非常显著性意义(P<0.01).结论老年胃癌病人常患有高血压、心脏病、糖尿病等疾病.加强围手术期处理,可提高手术的安全性,减少并发症的发生.     

残胃癌的临床病理特征及治疗

目的　探讨残胃癌的临床病理特征 ,以提高早期诊断率及根治性切除率。方法　回顾性分析我院近 5年来收治的 14例残胃癌。结果　残胃癌多见于男性 (13∶1) ;初次手术行BillrothⅡ式胃大部切除术 12例 ;初次手术距残胃癌的诊断时间平均为 15 .5年 ;临床表现主要有上腹饱胀、腹痛、吞咽困难、上消化道出血等。残胃病变有 7例在吻合口。11例施行手术 ,其中 2例行根治性残胃全切除术 ,7例行捷径手术及造瘘手术。病理检查有 8例为印戒细胞癌或低分化腺癌。结论　残胃癌多发生于初次胃部分切除术后 10年以上 ,多发生于BillrothⅡ式胃大部切除术后 ,病变主要位于吻合口附近 ,男性多于女性。当胃切除术后 10年以上 ,出现胃痛症状 ,上腹不适、饱胀、消瘦 ,或不明原因的贫血、上消化道出血 ,以及出现不明原因的呕吐等 ,应考虑到残胃癌的可能。争取早期诊断 ,早期施行根治性手术。     

原发性胃癌中DCC抑癌基因杂合性丢失的研究

目的：探讨原发性胃癌组织中结直肠癌缺失基因（deleted in colorectal carcinoma.DCC)杂合性丢失（loss of heterozygosity,LOH)的情况及其与胃癌临床病理学间的关系。方法：用多聚酶链反应－单链构相多态性（PCR－SSCP）银染法分析49例原发性胃癌组织中DCC的杂合性丢失。结果：D18S484位点发生LOH的频率为26．6％（12／45），D18S487为23．9％（11／46），DCC发生LOH的频率为36．7％（18／49）。36．8％（7／19）的肠型胃癌发生DCC LOH，24．0％（6／25）的弥漫型胃癌发生DCC LOH，而100％（5／5）的混合型胃癌为DCC LOH（P＜0．05）。在淋巴结有转移的胃癌中，52％（13／25）的原发性胃癌发生DCC LOH，无转移者中为20．8％（5／24）（P＜0．05）；发生远处转移者，原发性胃癌DCC LOH为100％（3／3），而无转移者为32．6％（15／46）（P＜0．05）；在TNM Ⅲ、Ⅳ期中DCC LOH为50．0％（12／24），有高于TNM I、Ⅱ期（24％，6／25）的趋势（P＝0．059）。DCC LOH与病人的性别、年龄、肿瘤发生部位、大小、组织学分级均无统计学意义（P＞0．05）。结论：DCC的杂合性丢失可能在胃癌的发展和转移中起重要作用，是胃癌发展后期的重要分子事件。     

Early gastric carcinoma in Japanese patients under 30 years of age

The clinicopathological characteristics of early gastric carcinoma (EGC) in 23 Japanese under 30 years of age were reviewed and the findings compared with data on 53 patients over age 70. In the young patients, there was a female preponderance, a macroscopic solitary lesion and the cancer was of the poorly differentiated type without intestinal metaplasia in the surrounding mucosa. In the old patients, there was a male preponderance; about half the number of patients had macroscopically elevated lesions and 10 of the 53 had a multifocal gastric carcinoma. Here, most lesions were well to moderately differentiated types with intestinal metaplasia in the surrounding area. Growth patterns of EGC in the young patients were analysed. Curative operations with dissection of regional lymph nodes were done in all the young patients. Metastases to the regional lymph nodes were present in only 2 of 23. Twenty of twenty-three followed for 5 years or longer are well.     

肝癌重复癌的外科治疗

报道我院1968～1997年收治的并经手术治疗的肝癌重复癌5例，均经病理检查证实。其中同时性2例，异时性3例。异时性3例中第一癌和第二癌确诊时间相隔最长18年，最短2年。文章重点讨论了肝癌重复癌的诊断、手术治疗及预后的问题。     

原发性肝透明细胞肝癌的临床病理学特点及预后分析:附43例

目的 探讨原发性肝透明细胞肝癌(PCCCL)的临床病理学特点,评价PCCCL的预后以及透明细胞比例与其预后的关系.方法 回顾性分析天津医科大学肿瘤医院2000年1月至2003年12月手术治疗的43例PCCCL病例临床病理学资料.对其发病特点,临床病理情况和术后预后情况进行分析.结果 X2检验提示PCCCL组HCVAb阳性率为14.0%,有包膜形成的占88.4%,远高于同期手术的597例普通类型的肝细胞肝癌(common hepatocellular carcinoma,CHCC)组的1.2%、65.0%,两者差异有统计学意义(P=0.000和0.005).同时,PCCCL组病人发生血管浸润的比例为53.4%,较CHCC组(65%)低,但是差异无统计学意义(P=0.129).单因素生存分析提示PCCCL组病人术后1、3、5年生存率分别为81%、53%和39%,而CHCC组病人术后1、3、5年生存率分别为76%、46%和32%,PCCCL组预后好于CHCC组,差异有统计学意义(P=0.021);多因素生存分析提示PCCCL组病人预后与肿瘤有无包膜、是否发生血管浸润、肝硬化背景和透明细胞比例相关;透明细胞＜75%组(A组)和≥75%组(B组)病人术后1、3、5年生存率分别为80%、43%和23%与85%、77%和68%.高透明细胞比例组预后好于低透明细胞比例组,差异有统计学意义(P=0.011).结论 PCCCL组病人有较高的HCV感染率,肿瘤容易形成包膜,较少的发生血管浸润,预后更好,且与透明细胞占肿瘤细胞的比例相关.     

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目的 总结肝脏与胃肠道同时存在甩块的处理原则。方法 分析１２例肝脏与胃肠道同时有肿块而术中或术后病理检查证实并非癌肿转移关系者的临床资料。结果 ７例为同时性双重癌,３例为肝脏癌肿并胃肠道良性疾病,１例为结肠癌伴套迭而肝脏病灶来自胰腺囊实性氏度恶性）,另１例肝脏与胃肠道均为良性疾病。结论 肝脏与胃肠道同时存在的肿块并不一定是癌肿转移,可能为同时性双重癌或伴发良性肿物,非团长 变的治疗与转移性癌截然不     

胃癌术后66例辅助化疗临床分析

目的　为总结胃癌辅助化疗的临床意义 ,探索胃癌治疗的有效方法及途径 ,提高胃癌治愈率。方法　采用FAM、UFTM或ELF方案全身化疗及 5 Fu、DDP腹腔内化疗辅助治疗 6 6例胃癌术后患者 ,进行随访观察。结果　随访率 90 .9% ,失访时间作死亡时间计 ,1、3、5年生存率分别为 92 .4%、47.0 %和 19.7%。化疗反应较轻 ,患者一般能够耐受。结论　胃癌辅助化疗可以降低术后复发率或延迟术后复发时间 ,对预后产生显著影响 ,尤其对低分化癌与浸透肌层及有淋巴结转移的病例显得更为重要。     

上皮钙黏素及埃兹蛋白在胃癌和淋巴结转移灶中的表达及其意义

目的 检测胃腺癌组织和淋巴结转移灶中细胞骨架相关蛋白上皮钙黏素(E-cad)及埃兹蛋白(Ezrin)的表达,观察其与胃腺癌侵袭和转移的关系,探讨胃腺癌的浸润和转移机制.方法 用SP免疫组织化学法检测80例胃癌和40例淋巴结转移灶中E-cad和Ezrin的表达.结果 E-cad和Ezrin在癌旁正常胃黏膜上皮为胞膜表达,而在胃腺癌组织中E-cad出现胞膜、胞质两种表达形式,Ezrin在肿瘤细胞中则为胞质表达.在胃腺癌原发灶中,E-cad、Ezrin的表达与胃腺癌的分化程度相关.E-cad的膜表达及Ezrin的表达随分化程度降低而下降(P＜0.01;P＜0.05),E-cad的浆表达随分化程度降低而升高(P＜0.01).E-cad浆表达的升高与浸润深度、淋巴结状态相关且在原发灶显著高于转移灶(P＜0.01;P＜0.05;P＜0.01).在淋巴结转移灶中,E-cad的膜表达在淋巴结转移的早期阶段高于晚期阶段(P＜0.05).另外,E-cad膜表达及Ezrin的表达呈正相关(P＜0.01).结论 胃腺癌中E-cad的表达异常导致了细胞之间的黏附力下降,从而在胃腺癌的侵袭和转移中发挥重要作用.埃兹蛋白参与调节胃腺癌细胞的分化,可能通过与E-cadherin/catenin作用来调控肿瘤细胞的黏附和侵袭.     

A better prognosis for Merkel cell carcinoma of unknown primary origin

Background

There is limited evidence that Merkel cell carcinoma (MCC) arising from a nodal basin without evidence of a primary cutaneous (PC) site has better prognosis. We present our experience at 2 tertiary care referral centers with stage III MCC with and without a PC site.

Methods

Fifty stage III MCC patients were identified between 1996 and 2011. Clinical data were analyzed, with primary endpoints being disease-free survival and overall survival.

Results

Of stage III patients, 34 patients presented with a PC site and 16 patients with an unknown primary (UP) site. Treatment strategies varied; of patients with UP vs PC sites, 25% vs 44% underwent combined regional lymphadenectomy and radiation, with an additional 25% vs 15% receiving chemotherapy. The median disease-free survival for a UP site was not reached vs 15 months for a PC site (hazards ratio = .48, P = .18). The median overall survival for a UP site was not reached vs 21 months for a PC site (hazards ratio = .34, P = .03). Multivariate analysis showed that UP status was a significant factor in overall survival (P = .002).

Conclusions

Stage III MCC with a UP site portends a better prognosis than MCC with a PC site.