Microinvasive carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics Stage IA)

In 1985 the International Federation of Gynecology and Obstetrics (FIGO) subdivided Stage IA cervical cancer and specified metric criteria to demarcate Stage IA from Stage IB. Early stromal invasion (Stage IA1) denotes the first invasive protrusions of a carcinoma in situ into the stroma. Microcarcinomas (Stage IA2) are small cancers a number of orders of magnitude larger than Stage IA1 lesions and with a maximum depth of invasion of 5 mm and a maximum horizontal spread of 7 mm; larger lesions are classified as Stage IB. This study reviews 486 patients previously classified as having Stage IA disease. This yielded 344 Stage IA1 and 101 Stage IA2 lesions; 41 cancers were reclassified as Stage IB. Three hundred nine, 89, and 38 patients were followed for greater than or equal to 5 years. One (0.3%) patient with Stage IA1 disease re-presented with Stage IIB disease 12 years after conization. Five (5.6%) patients with Stage IA2 lesions developed invasive recurrences; three died. None of the 38 patients reclassified as having a Stage IB lesion, including 16 who were treated conservatively, developed a recurrence. The FIGO classification is not a guideline for treatment. Stage IA1 lesions can be treated conservatively, but treatment in Stage IA2 must be individualized. Risk factors such as vascular space involvement and confluency are of high sensitivity but low specificity.     

Univariate and multivariate analyses of 5-year survival, recurrence, and inguinal node metastases in stage I and II vulvar carcinoma

Ninety-seven patients with FIGO stage I and II vulvar carcinoma were analyzed for 5-year survival, inguinal node metastases (N = 61), and recurrence. Factors analyzed included stage, tumor grade, depth of invasion, presence or absence of tumor cell confluence, presence or absence of lymphatic/vascular space invasion, lesion size, and lymph node metastases. It was concluded that conservative surgery in patients otherwise suitable for surgery should consist of a wide, local excision of the vulvar lesion in conjunction with ipsilateral inguinal node resection if the tumor measured less than or equal to 1 cm in diameter and had a depth of invasion of less than or equal to 1 mm. All other stage I or II patients require radical vulvectomy and bilateral inguinal lymphadenectomy.     

宫颈癌患者淋巴结转移的影响因素分析

目的探讨宫颈癌患者淋巴结转移的分布规律、高危因素。方法选取均经活检或手术病理证实的71例宫颈癌患者为研究对象,对影响淋巴结转移的因素采用Logistic多因素回归分析。结果71例宫颈癌患者中有14例患者发生淋巴结转移,转移率为19．7％;单因素分析结果显示肿瘤直径、SCCAg水平、FIGO分期、病理分型、肌层浸润深度、脉管侵犯、分化程度与淋巴结转移相关（P〈0．05）,而年龄、手术切缘与淋巴结转移不具相关性（P〉0．05）;Logistic多因素回归分析结果显示治疗前SCCAg水平、脉管侵犯、FIGO分期、肌层浸润深度以及分化程度5个因素是淋巴结转移的独立危险因素。结论治疗前SCCAg〉4ng／ml、宫颈浸润深度≥肌层1／2、脉管侵犯、FIGO分期较晚及细胞分化程度较高是宫颈癌盆腔淋巴结转移的主要危险因素。     

Adenocarcinoma of the uterine cervix. Prognostic significance of pretreatment serum CA 125, squamous cell carcinoma antigen, and carcinoembryonic antigen levels in relation to clinical and histopathologic tumor characteristics

The prognostic value of the pretreatment serum CA 125, squamous cell carcinoma antigen (SCC), and carcinoembryonic antigen (CEA) levels in relation to tumor type, vascular invasion by tumor cells, and lymph node metastases was investigated in 77 patients with cervical adenocarcinoma. In Stage IB (International Federation of Gynecology and Obstetrics [FIGO]), the five-year actuarial survival of patients with pretreatment serum CA 125 levels greater than 16 U/ml was 52.4% versus 95.6% when normal serum CA 125 levels were determined (P less than 0.01). Pretreatment serum SCC or CEA levels had no substantial prognostic value. In Stage IB (FIGO), 42% of the patients with elevated serum CA 125 levels had lymph node metastases versus 4% when normal levels were found (P = 0.012). The presence of vascular invasion (P = 0.01) or lymph node metastases (P = 0.001) was associated with an increased risk for recurrent disease. Adenosquamous tumors showed a higher incidence of vascular invasion (P = 0.05) and a higher incidence of elevated serum CA 125 levels (P = 0.03). Particularly in Stage II, adenosquamous tumors were found to have a poorer prognosis than adenocarcinomas (P = 0.0566). We conclude that in cervical adenocarcinoma serum CA 125 is an important prognostic factor and an implicit indicator of tumor virulence.     

A case of bilateral pelvic lymph node involvement in stage 1a1 squamous cell carcinoma of cervix and a review of the literature

Stage1a1 cervical cancer has been established to define a subset of the disease in patients who may safely be managed more conservatively and who have an excellent prognosis. Recently, however, a number of stage 1a1 cases with lymph node metastasis have been reported. Some of these cases had positive lymphovascular space invasion (LVSI), which some studies have identified as a negative prognostic factor. There is still, however, disagreement between the International Federation of Gynecology and Obstetrics (FIGO) and the Society of Gynecologic Oncologists (SGO) regarding whether LVSI may be used as a staging criterion. We report a 36-year-old patient with stage 1a1 cervical cancer who was diagnosed with multiple pelvic and parametrial lymph node metastases. Histopathology showed extensive LVSI. While stage 1a1 cases may still be managed conservatively, physicians must consider the possibility of lymph node metastasis, particularly in patients with positive LVSI, and counsel patients accordingly.     

子宫内膜癌临床病理特征与盆腹腔淋巴结转移的相关性分析

目的:探讨子宫内膜癌临床病理特征与盆腹腔淋巴结转移的相关性。方法:选取162例子宫内膜癌患者,分析临床病理资料,探讨盆腹腔淋巴结转移的相关因素。结果:162例子宫内膜癌患者中,9例发生盆腔淋巴结转移,7例发生腹主动脉旁淋巴结转移。非内膜样腺癌、FIGO Ⅲ 期、脉管浸润、治疗前CA125高于正常水平的患者盆腔淋巴结转移率高,差异有统计学意义;FIGO Ⅲ 期、脉管浸润、肿瘤直径>2 cm、治疗前CA125水平高于正常及盆腔淋巴结阳性的患者腹主动脉旁淋巴结转移率高,差异有统计学意义。多因素COX回归分析:FIGO分期、病理类型、脉管浸润为淋巴结转移的高危因素。结论:非子宫内膜样腺癌、FIGO分期、脉管浸润、治疗前CA125高水平与子宫内膜癌盆腔淋巴结转移存在相关性,FIGO分期、脉管浸润、肿瘤直径、治疗前CA125水平、盆腔淋巴结与子宫内膜癌腹主动脉旁淋巴结转移存在相关性。     

Histologic subtype has minor importance for overall survival in patients with adenocarcinoma of the uterine cervix: a population-based study of prognostic factors in 505 patients with nonsquamous cell carcinomas of the cervix.

BACKGROUND: The incidence of adenocarcinoma of the uterine cervix is increasing. For better prognostic information, the authors studied all nonsquamous cell carcinomas (non-SCCs) in the Norwegian population over a total of 15 years. METHODS: All non-SCCs from three 5-year periods (1966-1970, 1976-1980, and 1986-1990) were reviewed and classified according to the World Health Organization classification system, and histopathologic and clinical parameters were registered. Tissue blocks were available from all patients. RESULTS: Of 505 patients, 417 had tumors classified as adenocarcinoma, and 88 had tumors classified as other non-SCC. The mean ages were 53 years and 52 years for patients with adenocarcinoma and non-SCC, respectively. Sixty-two percent of the staged patients had clinical Stage I disease according to the classification system of the International Federation of Gynecology and Obstetrics (FIGO). In univariate analyses, histology, architectural and nuclear grade, extension to the vagina or corpus uteri, tumor length (> 20 mm) or tumor volume (> 3000 mm(3)), infiltration depth (in thirds of the cervical wall), thickness of the remaining wall (< 3 mm), vascular invasion, lymph node metastases, treatment, and patient age were significant variables in patients with FIGO Stage I disease. Variables with no significance in patients with Stage I disease were number of mitoses, state of resection margins, infiltration to ectocervix, tumor thickness, lymphoid reaction, earlier or concomitant cervical intraepithelial neoplasia, stump carcinoma, DNA ploidy or DNA index, or time period. Multivariate analyses of patients with FIGO Stage I disease identified small cell carcinoma, corpus infiltration, vascular invasion, and positive lymph nodes as independent prognostic factors. CONCLUSIONS: Small cell carcinoma was the only histologic subgroup of independent importance for prognosis in patients with non-SCC of the uterine cervix. No significant difference between major subtypes of adenocarcinoma favored a simplified classification. Extension to the corpus in patients with early-stage disease was of independent significance and should be acknowledged in planning treatment.     

早期宫颈癌FIGO分期与手术病理分期的差异性及淋巴结转移危险因素的分析

目的 比较宫颈癌临床分期（FIGO分期）与手术病理分期的差异性,探讨影响淋巴结转移的危险因素。方法 收集2010年1月至2014年1月在新疆医科大学第一附属医院经手术治疗的181例早期宫颈癌（FIGO分期ⅠA～ⅡB）患者的临床病理资料进行回顾性分析,比较FIGO分期与手术病理分期的差异,用卡方检验和Logistic回归模型分析影响淋巴结转移的危险因素。结果 ⅠA、ⅠB、ⅡA、ⅡB各临床分期与手术病理分期的符合率分别为57.9％、73.6％、52.1％和39.5％,临床分期总的符合率为59.1％ （107／181）。ⅠA、ⅠB、ⅡA、ⅡB各期的淋巴结转移率分别为10.5％、13.1％、27.1％和50.0％。单因素分析显示鳞状细胞癌抗原（SCCA）、FIGO分期、肿瘤直径、新辅助化疗、肌层浸润深度、脉管内瘤栓及宫旁组织浸润与盆腔淋巴结转移有关（P＜0.05）;多因素分析显示SCCA、FIGO分期、肌层浸润深度及脉管内瘤栓是影响宫颈癌淋巴结转移的独立危险因素,新辅助化疗可减少淋巴结的转移（P＜0.05）。结论 随着FIGO分期的升高,两种分期的符合率呈下降趋势,淋巴结转移率升高。结合临床病理因素,分析影响宫颈癌患者淋巴结转移的相关高危因素,可为制定其合理个体化的治疗方案提供依据。     

Stage I serous papillary carcinoma of the endometrium

From 1973 to 1987, 16 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I serous papillary endometrial carcinoma were evaluated and treated at the University of Kentucky Medical Center (Lexington, KY). All patients were 60 years of age or older, and all were postmenopausal. Patients were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and paraaortic lymph node sampling, and 38% were noted to have more extensive disease than appreciated clinically. Nine patients were given adjuvant postoperative radiation. Seven patients (44%) developed recurrent cancer with liver, lung, and upper abdomen being the most common sites of spread. Prognosis was most directly related to the presence of lymph vascular space invasion and the depth of myometrial penetration. No patient with serous papillary carcinoma confined to the endometrium developed recurrent cancer. In contrast, the recurrence rate of patients having myometrial invasion was 70% (P less than 0.03). Hormonal therapy was of limited value in the treatment of recurrent disease. This data suggests the need for adjuvant systemic therapy in the treatment of patients with Stage I serous papillary carcinoma of the endometrium who have myometrial invasion.     

Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy.

Three hundred forty-five patients with invasive carcinoma of the uterine cervix, Stages Ib (211 patients) and II (134 patients), underwent radical hysterectomy and pelvic lymphadenectomy. The influence of histologic factors including histologic subtype, maximum depth of cervical stromal invasion, degree of stromal invasion, longitudinal tumor diameter, lymph-vascular space invasion, corpus invasion, parametrial invasion, vaginal invasion, and pelvic lymph node (PLN) metastases on survival were examined by multivariate analysis. Univariate analysis revealed that all the variables except corpus invasion and vaginal invasion were significant in survival (P less than 0.05). Among these variables, however, PLN metastases, histologic subtype, and longitudinal tumor diameter were identified as independent and significant prognostic factors by multivariate analysis using Cox regression models. The prognostic index (PI), defined by the model (an indicator of the patient's place in the prognostic spectrum), was able to divide the patients into three prognostic groups. The key factors in the definition of these groups were (1) squamous cell carcinoma, small tumor diameter, and no PLN metastases for the good prognostic group and (2) PLN metastasis in two or more node groups, adenocarcinoma with one positive PLN group, or squamous cell carcinoma with one PLN group and large diameter for the poor prognostic group. These prognostic findings could predict the prognosis more precisely than that of clinical staging.     

子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义

目的 分析子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义.方法 选取子宫内膜癌患者71例为研究对象,行盆腔加腹主动脉旁淋巴结切除术,分析患者术后临床特征,以及影响患者盆腔及腹主动脉旁淋巴结转移的危险因素.结果 对盆腔及腹主动脉旁淋巴结患者行切除术后淋巴结转移率较低,分别为21.2%和23.9%,且患者术后并发症较少,仅为7例;线性回归分析提示,影响盆腔淋巴结转移的独立危险因素有肿瘤中低分化、深度肌层浸润、临床分期及脉管浸润,而影响腹主动脉旁淋巴结转移的独立危险有肿瘤低分化、非子宫内膜样癌、深度肌层浸润、盆腔淋巴结转移及淋巴管浸润;71例患者随访1年生存率为87.32%,且发生盆腔加腹主动脉旁淋巴结转移患者的生存率明显低于无淋巴结转移者.结论 盆腔加腹主动脉旁淋巴结切除,有利于提高子宫内膜癌患者的临床治疗效果,而且安全性较高,值得临床推广应用.     

miRNA-367在子宫内膜癌组织中的表达及其与临床病理参数的关系

目的:应用逆转录实时荧光定量聚合酶链反应(real-time PCR)检测子宫内膜癌组织miR-367表达水平,并探讨不同病理分期、组织分化、肌层浸润深度、淋巴转移及脉管浸润等临床病理参数之间的关系及临床意义.方法:本实验分别收集了61例子宫内膜癌组织及56例正常子宫内膜组织,运用定量real-time PCR检测miR-367在子宫内膜癌组织中及正常子宫内膜组织的表达量的差异,并运用统计学方法分析miR-367与临床病理参数之间的相关性.结果:在子宫内膜癌组织及正常子宫内膜组织之间发现miR-367存在显著差异性表达,其中占85.25%的子宫内膜癌组织miR-367的表达水平低于正常内膜组织(P<0.05);在子宫内膜癌病例中,miR-367表达水平与肿瘤病理分期(FIGO分期)、组织分化程度及肌层浸润深度三种临床病理参数之间存在着统计学联系:miR-367低水平表达的病例通常表现出分化程度更低(P=0.001<0.05)和对肌层浸润程度更深(P=0.000 3<0.05)的特点.与年龄、淋巴转移、脉管浸润及远处转移无关(P>0.05).统计学分析,还得出在FIGO分期Ⅲ-IV期子宫内膜癌病例中miR-367的表达水平显著低于FIGO分期I、II期内膜癌(P<0.05).结论:在子宫内膜癌组织中miR-367在癌组织和正常组织之间有统计学差异;miR-367表达水平与子宫内膜癌临床病理参数中的病理分期、组织分化程度及肌层浸润深度有统计学差异,并且它可能作为子宫内膜癌发生及发展的生物学标志.     

Early cervical cancer

Opinion statement Early cervical cancer includes a broad range of disease, from clinically undetectable microinvasive cancer to large, bulky tumors that replace the entire cervix. Further subgrouping of this category is therefore necessary to define the optimal treatment approach for individual cases. The International Federation of Gynecology and Obstetrics (FIGO) staging system stratifies stage I tumors into two broad categories, stage IA (microinvasive) and stage IB (gross tumor). Management of women with stage IA disease is controversial. In the United States, patients with stromal invasion of less than 3 mm and no lymphvascular involvement are usually treated conservatively with simple hysterectomy. In selected patients who desire fertility, cone biopsy with negative surgical margins is also considered. Patients with invasion of more than 3 mm or lymphvascular space involvement are at risk for pelvic lymph node metastasis and are most often treated with radical hysterectomy and pelvic lymphadenectomy. Stage IB1 cervical cancer is managed by either radical surgery or radiotherapy with equivalent recurrence and survival rates. In patients with tumors less than 4 cm in diameter, the decision between radical surgery and radiotherapy is guided by patients’ overall health and treatment preferences. For younger women, radical surgery is preferred because ovarian function can be preserved and vaginal stenosis secondary to radiation can be avoided. Radiation therapy is preferred for women who may not tolerate radical surgery. We always prefer primary radiation therapy for patients with tumors larger than 4 cm in diameter. Recent data convincingly demonstrate that the addition of cisplatin-based chemotherapy significantly improves overall survival rates in cervical cancer patients who undergo radiation therapy.     

The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases—a literature review

Correct identification of patients with lymph node metastasis from cervical cancer prior to treatment is of great importance, because it allows more tailored therapy. Patients may be spared unnecessary surgery or extended field radiotherapy if the nodal status can be predicted correctly. This review captures the existing knowledge on the identification of lymph node metastases in cervical cancer. The risk of nodal metastases increases per 2009 FIGO stage, with incidences in the pelvic region ranging from 2% (stage IA2) to 14–36% (IB), 38–51% (IIA) and 47% (IIB); and in the para-aortic region ranging from 2 to 5% (stage IB), 10–20% (IIA), 9% (IIB), 13–30% (III) and 50% (IV). In addition, age, tumor size, lymph vascular space invasion, parametrial invasion, depth of stromal invasion, histological type, and histological grade are reported to be independent prognostic factors for the risk of nodal metastases. Furthermore, biomarkers can contribute to predict a patient’s nodal status, of which the squamous cell carcinoma antigen (SCC-Ag) is currently the most widely used in squamous cell cervical cancer. Still, pre-treatment lymph node assessment is primarily performed by imaging, of which diffusion-weighted magnetic resonance imaging has the highest sensitivity and 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission computed tomography the highest specificity. Imaging results can be combined with clinical parameters in nomograms to increase the accuracy of predicting positives nodes. Despite all the progress regarding pre-treatment prediction of lymph node metastases in cervical cancer in recent years, prediction rates are not robust enough to safely abandon surgical staging of the pelvic or para-aortic region yet.

     

Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma.

BACKGROUND: Gastric carcinoma invading the submucosa is often accompanied by lymph node metastasis. However, the relation between the depth of submucosal invasion and the status of metastasis has not been investigated. The objective of this study was to clarify the relation between lymph node status and the histologic features of gastric carcinoma invading the submucosa. METHODS: The histopathology of 118 patients who underwent gastrectomy and lymph node dissection for gastric carcinoma invading the submucosa was examined. These pT1 tumors with invasion of the submucosa were confirmed by histologic examination of the resected specimens. Tumor size, depth of submucosal invasion, histologic type, and macroscopic type were investigated in association with presence or absence of and anatomic level of lymph node metastasis. RESULTS: Among the 118 patients, 16 (14%) had lymph node metastasis, and the status of metastasis significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis to perigastric lymph nodes and extragastric lymph nodes was 0% and 0% for < or =1-cm tumors, 5% and 1% for 1- to 4-cm tumors, and 46% and 15% for >4-cm tumors, respectively. There was no lymph from a node metastasis in tumors with less than 300 microm of submucosal invasion. The frequency of lymph node metastasis for tumors with 300-1000 microm and >1000 microm of submucosal invasion were 19% and 14%, respectively. CONCLUSIONS: Tumor size and depth of submucosal invasion serve as simple and useful indicators of lymph node metastasis in early stage gastric carcinoma. Optimal lymph node dissection levels are as follows: 1) local resection (D0) for lesions < or =1 cm, 2) limited lymph node dissection (D1) for 1- to 4-cm lesions, and 3) radical lymph node dissection (D2) for lesions >4 cm. When submucosal invasion of a locally resected tumor is more than 300 microm, additional gastrectomy and lymph node dissection are necessary.     

Microinvasive squamous carcinoma of the vulva

The clinico-pathologic aspects of 15 cases of microinvasive squamous cell carcinoma of the vulva are analyzed and the literature on this subject is reviewed. Three patients in this group and 12.5% of the 279 reported cases, all with 5 mm or less depth of invasion, have had lymph node metastases and/or recurrences or have ultimately died of their disease. The prognostic value of lymphatic/vascular permeation, the degree of cellular anaplasia, the pattern as well as the depth of invasion, all have been alluded to, and the latter is popularized. It is noted, however, that the arbitrarily chosen 3 or 5 mm depth of invasion alone does not allow for consistent identification of individuals with a negligible risk for groin lymph node metastasis. There is indeed documentation of nodal metastases in 20 of 178 (11%) of the reported cases with 1–3.5 mm invasion. It is suggested that the level of invasion, as determined by Clark's classification, which provides a histologic reference point, may correlate better with the incidence of groin nodal metastasis, and its use may allow for individualized therapy and eventually aid in identifying cases of microinvasive carcinoma of the vulva that could safely be treated without lymphadenectomy.     

宫颈癌MMP-9表达与肿瘤血管生成、癌细胞增殖及侵袭转移的关系

背景和目的：基质金属蛋白酶－9（matrix metalloproteinase-9,MMP-9）在肿瘤血管生成及肿瘤侵袭转移过程中起重要调节作用。本研究探讨MMP－9在早期宫颈癌的表达和临床意义。方法：采用免疫组织化学SP法检测75例早期宫颈浸润癌（invasive carcinoma of cervix,ICC）、18例宫颈上皮内瘤样病变（cervical intraepithelial neoplasm,CIN)和15例正常宫颈上皮（normal cervical epithelium,NCE）中MMP－9的表达情况,并检测其微血管密度（microvessel density,MVD)(CD34标记）和癌细胞增殖标记指数（Ki-67标记）。结果：在宫颈癌中,MMP－9主要表达于癌细胞膜和／或细胞浆;Ki-67主要表达于癌细胞核;CD34主要表达于间质血管内皮细胞。从正常宫颈上皮到宫颈上皮内瘤样病变再到宫颈浸润癌,MMP－9、Ki-67的阳性表达率和MVD均逐步显著升高（P＜0．05）。MMP－9在ICC中表达与MVD显著正相关（γ=0.287,P＜0．05）。MMP－9在ICC中表达与盆腔淋巴结转移、脉管浸润、间质浸润、FIGO分期、组织学分级和Ki-67表达有关（P＜0．05或P＜0．01）;而与年龄和组织学类型无关（P＞0．05）。有盆腔淋巴结转移、脉管浸润、突破深层间质浸润、FIGO分期为Ⅱ期、组织学分级为Ⅲ级及Ki-67高度表达者,其MMP－9阳性表达率分别显著高于无盆腔淋巴结转移、无脉管浸润、浸润深度在浅层间质以内、FIGO分期为I期、组织学分级未超过Ⅱ级及Ki-67表达在中度以内者（P＜0．01或P＜0．05）。结论：MMP－9阳性表达可能在宫颈癌血管生成、癌细胞增殖和侵袭转移中起重要作用。MMP－9过度表达者,宫颈癌血管生成能力显著增强、癌细胞增殖活跃、更易发生侵袭转移,但并非惟一决定因素。检测宫颈癌中MMP－9表达对进一步了解宫颈癌生物学行为和判断其预后有一定的价值。     

胸段食管癌淋巴结转移规律的探讨

目的:探讨胸段食管癌淋巴结转移规律及影响淋巴结转移的因素。方法:对140例胸段食管癌临床资料进行分析和统计学处理。结果:胸上段食管癌主要向颈部淋巴结转移;胸中段食管癌主要向颈部、纵隔、腹部淋巴结转移;胸下段食管癌主要向纵隔、腹部淋巴结转移;各段食管癌均存在淋巴结跳跃性转移;各段食管癌淋巴结转移度无显著性差异(P>0.05);鳞状细胞癌与腺癌、低分化癌之间,肿瘤长度之间淋巴结转移率无显著性差异(P>0.05),浸润深度之间淋巴结转移率有显著性差异(P<0.01)。结论:胸段食管癌淋巴结转移与浸润深度相关,与肿瘤长度,细胞分化程度无关;跳跃性淋巴结转移是食管癌淋巴结转移的一个特点。     

直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素分析

目的 探讨直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素.方法 回顾性研究2017年2月至2018年6月于安徽省胸科医院行手术切除的257例直径≤3 cm浸润性肺腺癌患者,分析脉管侵犯组及非脉管侵犯组的临床资料、术前薄层CT及病理学资料的差异.结果 单因素分析结果表明,直径≤3 cm浸润性肺腺癌脉管侵犯与患者术前CEA水...     

食管癌淋巴结转移特点分析

目的:探讨食管癌淋巴结转移特点。方法:回顾性分析1 791例手术治疗的食管癌患者临床病理资料,分析淋巴结的转移规律及特点。结果:1 791例食管癌患者的淋巴结转移率为35.18%,淋巴结转移度为8.33%。基底细胞样鳞癌及腺鳞癌的淋巴结转移率及转移度与鳞癌无明显差异（均P>0.05）,而腺癌及神经内分泌癌的淋巴结转移率及淋巴结转移度明显高于鳞癌（均P<0.05）。肿瘤分化、病变长度、T分期及是否有脉管癌栓是淋巴结转移率的独立影响因素（均P<0.05）,并且肿瘤分化、T分期及是否有脉管癌栓是影响N分期的独立影响因素（均P<0.05）。上段食管癌的颈部淋巴结转移率要高于中、下段食管癌（P=0.002）,而纵隔及腹腔淋巴结转移率在不同部位之间无显著性差异（均P>0.05）。结论:肿瘤分化、T分期及是否有脉管癌栓是影响食管癌淋巴结转移率及N分期的重要因素;上段食管癌更容易发生颈部淋巴结转移;无论肿瘤位置都应加强对腹腔淋巴结的清扫。