63例Ⅰ~Ⅲ期肾细胞癌患者术后辅助治疗疗效及预后因素分析

目的研究肾细胞癌术后辅助治疗的疗效及影响患者远期生存的因素。方法回顾性分析63例肾细胞癌患者术后辅助治疗的效果,多因素分析影响生存期的因素。结果全组5年生存率为71.0%;病理分期Ⅰ、Ⅱ和Ⅲ期患者5年生存率分别87.7%、70.3%和42.9%（χ²=11.629,P=0.003）,T1、T2和T3期患者的5年生存率分别为88.7%、63.9%和37.0%（χ²=11.850,P=0.003）,N0和N1患者的5年生存率分别为78.0%和35.6%（χ²=8.599,P=0.003）,有、无静脉瘤栓的患者5年生存率分别为31.3%和76.0%（χ²=8.108,P=0.004）。全组局部复发率和远处转移率分别为15.9%（10/63）和23.8%(15/63)。多因素分析表明T分期（P=0.021）、N分期（P=0.040）、手术切除（P=0.032）、术后生物化疗（P=0.022）、术后放疗（P=0.042）是影响患者总生存期的独立预后因素。结论TNM分期是患者能否远期生存的决定性因素,术后辅助生物化疗和辅助放疗可提高总生存率,但需要进一步大样本随机对照研究。     

影响晚期胃癌患者疗效和预后的相关因素分析

目的 分析影响晚期胃癌患者疗效和预后的相关因素。方法 回顾性分析临床病理特征、接受不同化疗方案的治疗情况及HER-2基因表达等因素对晚期胃癌患者疗效和预后的影响。结果 2008年12月至2011年8月共纳入192例晚期胃癌患者,182例接受联合方案一线治疗,其中156例可评价疗效,有效率（RR）为19.9％,三药方案的有效率优于两药方案（27.0％ vs.15.1％,P=0.008）,三药方案中含靶向药物优于不含靶向药物（33.3％ vs. 14.3％,P=0.012）;108例接受二线治疗,其中69例可评价疗效,RR为13.0％,单药方案与多药方案的有效率、中位疾病进展时间差异均无统计学意义。接受二线治疗者较仅行一线治疗者的中位生存时间明显延长（14.1个月 vs.7.3个月,P＜0.001）。HER-2阳性患者接受含曲妥珠单抗方案治疗的有效率显著高于单纯化疗方案,其中一线治疗的RR分别为45.4％和11.0％（P=0.008）,二线治疗的RR分别为50.0％和10.0％（P=0.009）。Cox多因素回归分析显示,ECOG评分、HER-2表达、肿瘤负荷以及是否接受二线治疗是晚期胃癌患者的预后独立因素。Logistic多元回归分析提示靶向治疗对疗效有显著影响。结论 一线治疗应用含靶向药物的三药联合方案可显著提高晚期胃癌的疗效,二线治疗使晚期胃癌的预后明显改善。HER-2表达情况将影响治疗的选择,从而影响患者的预后。     

PIN1在胃癌组织中的表达及其预后意义

目的 探讨肽基脯氨酰顺反异构酶（PIN1）在胃癌中的表达及其与临床病理学特征及预后的关系。方法 应用组织芯片、免疫组化技术检测134例胃癌组织及对应癌旁组织中PIN1蛋白的表达情况,分析其与临床病理特征及预后的关系。结果胃癌组织中PIN1阳性表达率为33.6％（45／134）,癌旁组织为21.6％（29／134）,差异有统计学意义（P＜0.05）。PIN1表达与胃癌患者TNM分期和远处转移有关（P=0.007,P=0.010）,与其他临床病理特征无关（P＞0.05）。PIN1阳性患者的5年生存率为35.7％,阴性患者为50.6％,差异有统计学意义（P＜0.05）。Cox多因素分析显示,PIN1表达不是胃癌的独立预后因素,而pTNM分期和Lauren分型是胃癌的独立预后因素。结论 胃癌组织中存在PIN1阳性表达,并与TNM分期和远处转移及预后密切相关,可能是潜在的胃癌治疗靶点。     

S100P在胃癌中的下调表达及意义

目的探讨S100P在胃癌组织中的表达情况及与胃癌临床病理参数间的关系。方法选取93例胃癌石蜡组织标本及相对应的部分冻存胃癌组织及其配对正常组织为研究对象,应用免疫组织化学、RT-PCR、Western Blot方法检测S100P在胃癌及癌旁组织中的表达。结果免疫组织化学分析表明,胃癌中S100P蛋白主要定位于胞质和胞核,在52.7% (49/93)的胃癌组织和几乎所有的正常胃黏膜中可检测到表达,与正常胃黏膜相比,胃癌组织中的表达明显下调,其下调表达与患者肿瘤的侵袭深度(P=0.006)及肿瘤的大小相关(P=0.001)。同时,S100P在核酸和蛋白水平的表达具有相关性（P=0.030）,不能够作为独立的预后因素（P=0.347）。结论S100P在胃癌组织中表达下调,其表达与肿瘤的侵袭转移及肿瘤大小相关,并可以作为判断患者预后的辅助指标。     

直肠肛管癌选择经括约肌间切除术的多因素分析

目的探讨影响超低位直肠/直肠肛管癌经括约肌间切除术（Intersphincteric resection, ISR）选择的临床病理因素。方法回顾性分析由同一组专业医师共同完成的超低位直肠癌（肿瘤距肛缘≤5cm 或距齿状线≤3cm）切除术患者156例。纳入指标包括：年龄、性别、肿瘤分化程度、肿瘤距肛缘距离、病理TNM分期、术前CS分期和新辅助治疗。 结果共有63例患者接受ISR,93例患者未接受此术式。单因素分析表明肿瘤病理T分期(P=0.038)、N分期(P=0.044)和术前CS分期(P<0.001)与ISR选择有关。多因素分期显示肿瘤病理T分期、N分期和CS分期是影响直肠肛管癌ISR选择的独立因素。 结论超低位直肠癌患者是否可行经括约肌间切除术与肿瘤局部浸润程度、淋巴结受累情况有关,而与肿瘤距肛缘距离、肿瘤分化程度及新辅助化疗无关。直肠指检仍是决定是否可行经括约肌间切除术的有效方法。     

骨肉瘤血清肿瘤坏死因子-α水平测定及临床意义

目的 探讨骨肉瘤患者治疗前血清肿瘤坏死因子-α（TNF-α）的水平及其与预后的关系。方法 采用酶联免疫吸附法（ELISA）分别测定56例骨肉瘤患者治疗前和50例健康对照者血清中TNF-α水平,分析骨肉瘤患者血清中TNF-α水平与临床病理特征及预后的关系。结果 56例骨肉瘤患者治疗前血清TNF-α为（32.08±19.68） pg／ml,显著高于健康对照者的（18.00±19.88）pg／ml,差异有统计学意义（P=0.04）。骨肉瘤患者治疗前血清TNF-α水平与碱性磷酸酶水平（P=0.002）及肿瘤分期（P=0.026）有关。治疗前血清TNF-α升高患者（n=44）的中位生存时间为22.2个月,TNF-α水平正常者（n=12）为32.1个月,差异有统计学意义（P=0.037）。结论 骨肉瘤患者治疗前血清TNF-α水平明显升高,且与预后相关,该指标对判断预后及指导治疗具有一定的参考价值。     

60例青年肺癌患者的临床特征及预后分析

目的探讨青年肺癌的临床特征及影响预后的因素。方法回顾性分析60例40岁以下肺癌患者的临床资料,分别对性别、年龄、吸烟史、病理类型、肿瘤部位、肿瘤大小、TNM分期、有无肿瘤家族史及治疗方法进行预后分析。Kaplan-Meier法计算生存率,Log-rank进行生存率显著性检验,Cox比例回归风险模型进行单因素、多因素分析,评价各因素对预后的影响。结果全部青年肺癌患者的1、2、3年生存率分别为：69.1％、50.0％、20.0％。单因素分析显示：病理类型（P=0.001）、吸烟史（P=0.0461）、TNM分期（P=0.0383）、治疗方法的选择（P=0.011）是影响预后的因素。多因素分析则显示：病理类型和TNM分期是影响预后的独立因素。结论青年肺癌的临床表现无特异性,提高对青年肺癌的认知程度,争取早期正确诊断,选择正确的治疗方法,是提高生存率的方法。     

45例间变性大细胞淋巴瘤临床病理特点及疗效分析

目的 分析间变性大细胞淋巴瘤（ALCL）的临床病理特点、远期效果和影响预后的因素。方法 回顾性分析2000年1月—2008年12月我院收治的45例ALCL患者的临床资料,并分析远期疗效, 用Cox模型分析预后因素。结果 原发皮肤和系统性ALCL分别有7例（84.4%）和38例（15.6%）。20例（44.4%）伴有B症状者,乳酸脱氢酶升高者8例（21.6%）,低危组、中低危组共31例（68.9%）,28例（62.2%）ALK阳性。26例（57.8%）为T细胞来源,6例（13.3%）为B细胞来源,11例（22.2%）T细胞和B细胞标记均为阴性,为null型,2例T细胞和B细胞标记均为阳性。原发皮肤和系统性ALCL治疗后的有效率分别为100%和92.1%,5年OS率分别为83.3%和63.9%（χ²=0.707,P＝0.401）。ALK阳性和阴性患者的5年OS率分别87.5%和46.9%（χ²=10.992,P＝0.01）。单因素分析ALK表达状况（P＝0.01）、国际预后指数评分（P＝0.000）、临床分期（P＝0.005）对生存期的影响有统计学意义,ALK的表达状况（P＝0.012）和国际预后指数评分（P＝0.000）是影响总生存期的独立因素。结论 ALCL中约80%为原发系统性,近期和远期疗效较好,约60%的患者ALK阳性,ALK和国际预后指数为独立的预后因素。     

化疗相关性白细胞减少等因素对小细胞肺癌生存期的影响

目的 探讨影响小细胞肺癌（small cell lung cancer,SCLC）患者生存期的因素。方法 回顾性研究123例SCLC患者的临床资料,利用SPSS15.0统计软件Cox回归模型分析性别、年龄、吸烟、合并症、临床分期、ECOG评分、治疗方法、CEA、化疗相关性白细胞减少（chemotherapy induced leucopenia,CIL ）9个预后因素对生存期的影响。结果随访1～52月,死亡103例。6月、1年、2年、3年、4年存活率分别为70.7%、34.1%、8.94%、2.4%、0.8%,中位生存期11月[95%CI(9.328, 12.627)]。Cox回归多因素分析显示,影响预后的独立因素是：ECOG评分（P=0.000）、化疗联合放疗（P=0.000）、临床分期（P=0.024）、CIL(P=0.013)。结论临床分期早、ECOG评分低、接受化疗联合放疗且出现CIL的SCLC患者生存期长、预后好。     

影响ⅡB期骨肉瘤术前化疗疗效的多因素分析

目的探讨和分析相关因素在影响骨肉瘤术前化疗疗效中的意义。方法分析40例骨肉瘤患者的性别、年龄、部位、病程、肿瘤体积、AKP和LDH、化疗前骨肉瘤Pgp表达、化疗方案、化疗后白细胞和淋巴细胞最低值以及X线类型等因素的特点,行多因素Logistic回归分析上述因素对TCNR的影响。结果40例中24例的TCNR＞90%（60%）;通过单因素分析及多因素非条件Logistic回归分析发现肿瘤体积、化疗后AKP、白细胞最低值及化疗方案与TCNR有相关性（P=0.020,P=0.024,P=0.034,P=0.034）,并得出了相关回归方程。结论肿瘤体积、化疗后AKP、化疗后白细胞最低值和化疗方案是影响骨肉瘤术前化疗疗效的最主要因素。肿瘤体积大及化疗后AKP水平高是术前化疗疗效差的危险因素;化疗后白细胞下降的程度可以间接反映术前化疗疗效;DIA方案的疗效优于MMIA方案。     

血清肝细胞生长因子水平与胃癌关系的研究

目的 探讨胃癌患者血清肝细胞生长因子(hepatocyte growth factor,HGF)水平变化的临床意义.方法 采用酶联免疫吸附实验法检测60例胃癌患者血清HGF水平,其中40例行胃癌根治术,12例因有远处转移而未手术,8例为胃癌术后复发,同时选取15例良性胃病患者以及12例门诊健康体检者作为对照,分别检测其血清HGF的水平,并进行比较分析.结果 胃癌组血清HGF水平高于良性胃病组和正常对照组(P＜0.05);胃癌术后复发组血清HGF水平明显高于良性胃病组和正常对照组(P＜0.01);40例胃癌术前组血清HGF水平明显高于胃癌术后组(P＜0.01);胃癌复发组血清HGF水平明显高于胃癌手术组和非手术组(P＜0.01).结论 HGF在胃癌的发生发展过程中可能起重要作用,血清HGF水平的检测可成为胃癌病情程度监测和预后判断的客观指标.     

128层螺旋CT对胃癌可切除状况的评估价值

目的探讨128层螺旋CT对胃癌可切除状况的评估价值。方法选择诊治的胃癌患者120例作为研究对象,所有患者都给予128层螺旋CT检查,评估胃癌可切除性并记录影像学特征。结果在120例患者中,螺旋CT诊断为Ⅰ期66例、Ⅱ期24例、Ⅲ期18例、Ⅳ期12例,与病理分期有较好的一致性,临床分期诊断准确率为95.0%。CT评价胃癌可切除68例,实际采用手术切除治疗65例,CT对胃癌可切除状况的评估敏感性、特异性分别为98.5%和98.1%。全胃切除35例,胃部分切除30例,都顺利完成手术,围手术期无严重并发症发生。结论128层螺旋CT在胃癌中的应用可准确判断临床分期,具有很好的影像学特征,有利于指导与评估手术切除治疗。     

进展期胃癌新辅助化疗的临床疗效观察

目的 评价进展期胃癌新辅助化疗的疗效及对预后的影响.方法 回顾性分析45例确诊进展期胃癌患者通过新辅助化疗后再行手术治疗的疗效及预后,并与60例同期收治的未经新辅助化疗的胃癌手术患者进行对照.结果 新辅助化疗组临床有效率RR(CR+ PR)为68.9％ (31/45),其中CR 6.7％(3例),PR62.2％ (28例),SD 28.9％(13例),PD 2.2％(1例),术后1例在病理水平达到完全缓解(pCR),缓解率为2.2％ (1/45).不良反应主要为Ⅰ及Ⅱ度白细胞减少、恶心、脱发、呕吐及黏膜炎,其中Ⅲ及Ⅳ级的白细胞减少及胃肠道反应6例(13.3％),无严重感染和死亡病例.新辅助化疗组手术根治性切除率为84.4％,对照组的手术根治性切除率为66.7％,两者差异有统计学意义(P＜0.05).与对照组比较,新辅助化疗组的术后生存期明显延长(P＜0.05),且两组术后并发症无明显差异.结论 手术切除较为困难或根治率低的局部晚期胃癌患者,术前配合新辅助化疗,可显著提高胃癌切除率,并且最终可明显提高胃癌患者的术后生存期.     

Treatment strategy for marginally resectable gastric cancer

It has been postulated that preoperative chemotherapy might promote tumor regression, eradicate nodal metastases, and improve resectability in patients with marginally resectable gastric cancer.For a marginally resectable tumor of gastric cancer, we selected the advanced gastric cancer patients with metastases and recurrences to the abdominal para-aortic lymph node (PAN), liver and invasion to the pancreas head and/or the duodenum.Patients with positive peritoneal cytology(P0, CY1)or localized peritoneal metastasis(P1), and Stage IV gastric cancer patients, were also considered candidates in this category. The strategy and results of surgical treatment for marginally resectable gastric cancer were explained as the dissection of PAN, hepatic resection, pancreaticoduodenectomy, perioperative chemotherapy for P0CY1 or P1, and neoadjuvant chemotherapy for Stage IV gastric cancer, which was still considered an experimental approach, although its use may be justified in unresectable or marginally resectable GC.The result of the resection of a marginally resectable gastric cancer is poor, but when there are no other non-curative factors, extended surgical resection should be performed because complete response is difficult at present with chemotherapy alone.In conclusion, there was no evidence suggesting that extended surgical procedures are effective, but a strategy of multidisciplinary treatment including extended surgical approach should be verified based on randomized controlled trials.     

Endoscopic mucosal resection for early gastric cancer.

Progress in the detection of early gastric cancer has made endoscopic mucosal resection (EMR) possible for the treatment of gastric cancer instead of only conventional surgical resection. The most commonly employed modalities include strip biopsy, double snare polypectomy, and resection with combined use of highly concentrated saline and epinephrine, and resection using a cap. The indications should be strictly limited to the differentiated IIa type (the slightly elevated type) that is smaller than 2 cm, or the differentiated IIc type (slightly depressed type) without ulcer formation and smaller than 1 cm. Both of these entities are thought to have a negligible risk of lymph node metastasis. Prognosis after this treatment is comparable that of surgical resection for early gastric cancer in completely resected cases. EMR also permits local resection in elderly patients with various complications who would be at risk for conventional surgical operations. EMR should be encouraged for treatment of gastric cancer if the indications are strictly chosen.     

局部晚期胃癌FDP方案新辅助化疗的疗效观察

目的:评估进展期胃癌患者新辅助化疗后再手术的临床疗效。方法:选择局部晚期胃癌患者44例分为两组:常规手术组和新辅助化疗+手术组,各22例,入院后行CT检查,新辅助化疗+手术组患者进行2个周期的新辅助化疗,再行CT复查,对比后进行手术治疗。结果:常规手术组肿瘤切除率为81.8％(18／22),获得根治性切除率为45.5％(10／22),剖腹探查率为18.2％(4／22);新辅助化疗+手术组肿瘤切除率为90.9％(20／22),获得根治性切除率为72.7％(16／22),剖腹探查率为9.1％(2／22)。两组均无手术死亡病例,并发症发生率差异无显著性。结论:进展期胃癌患者在新辅助化疗后,再进行手术治疗,可以提高手术根治率和切除率。     

Outcome after Simultaneous Resection of Gastric Primary Tumour and Synchronous Liver Metastases: Survival Analysis of a Single-center Experience in China

Background: The optimal surgical strategy for the treatment of synchronous resectable gastric cancer livermetastases remains controversial. The aims of this study were to analyze the outcome and overall survival ofpatients presenting with gastric cancer and liver metastases treated by simultaneous resection. Materials andMethods: Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastasesfrom gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepaticmetastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed.Results: The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 yearsafter surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developedcomplications during the peri-operative course. Univariate analysis revealed that patients with the presenceof lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastasessuffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases weresignificant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively).Conclusions: The presence of lymphovascular invasion of the primary tumor and multiple liver metastases aresignificant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion andwith a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resectionof both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictlyselected patients.     

Evaluation of surgical submucosal resection for an early stage gastric cancer

In the present study, we demonstrated a surgical submucosal resection (SSR) with an early stage gastric cancer for 212 patients. We assessed the results of SSR in 212 patients based on the outcome of surgery, recurrent cases and prognoses. RESULT: The mean operation time was 93 +/- 36 minutes, bleeding volume was 34.6 +/- 12.0 mL, and postoperative hospitalization in days was 11 +/- 4 days. Pathological examination revealed a tumor invasion of the mucosal layer in 155 cases, submucosal layer in 55 cases, and proper muscle in 2 cases. There were 14 cases (6.6%) of incomplete resection. We performed a curative resection for 6 cases and a frequent follow-up for 7 cases of incomplete resection. There was one gastric cancer death case in incomplete resection. There were no recurrent cases in complete resection. However, we found 3 missing diagnosis cases of synchronous multiple gastric cancer and 10 metachronous multiple gastric cancer cases. CONCLUSION: SSR is a useful option of minimally invasive surgery for an early stage gastric cancer.     

Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases

BackgroundThe benefit of surgical resection of liver metastases from gastric cancer has not been well established. The aim of this study was to evaluate the rationale for hepatic resection in patients with hepatic metastases from gastric cancer.MethodsAmong 10 259 patients diagnosed with gastric adenocarcinoma in the Yonsei University Health System from 1995 to 2005, we reviewed the records of 58 patients with liver-only metastases from gastric cancer who underwent gastric resection regardless of hepatic surgery.ResultsThe overall 1-year, 3-year, and 5-year survival rates of 41 patients who underwent hepatic resection with curative intent were 75.3%, 31.7%, and 20.8%, respectively, and three patients survived >7 years. Of the 41 patients, 22 had complete resection and 19 had palliative resection. Between the curative and palliative resections, survival rates after curative intent were not different. The number of liver metastasis (solitary or multiple) was a marginally significant prognostic factor for survival.ConclusionsSurgery for liver metastases arising from gastric adenocarcinoma is reasonable if complete resection seems feasible after careful preoperative staging, even if complete resection is not actually achieved. Hepatic resection should be considered as an option for gastric cancer patients with hepatic metastases.     

Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups?

BACKGROUND: Patients who present with stage IV gastric cancer are not commonly managed with surgical resection as effective palliation can usually be accomplished with systemic chemotherapy, endoscopic stenting, or surgical bypass procedures. Given the inherent morbidity and mortality associated with gastrectomy, palliative resection for stage IV gastric cancer should be reserved for ideal surgical candidates who are most likely to benefit from the procedure. The purpose of this study is to review outcomes following resection for stage IV gastric cancer, and to identify criteria predictive of improved outcomes following gastrectomy in this setting. METHODS: A retrospective review of a prospective GI oncology database was conducted. Sixty-three patients with stage IV gastric cancer managed with surgical resection between 1989 and 2001 were identified. Variables including demographic data, patterns of distant spread (ex: peritoneal, lymphatic, hematogenous), location of tumor, and type of gastrectomy were utilized to conduct survival analyses. RESULTS: Actuarial survival for all patients at one and 3-year intervals was 52% and 12%, respectively. Improved survival was observed for patients of East Asian race (median survival 20 vs. 12 months, P < 0.05, students t-test) and age less than 60 years (median survival 15 vs. 12 months, P < 0.05). This trend was also illustrated by Kaplan-Meier survival analysis. Other variables including pattern of distant spread, location of tumor, and type of gastrectomy were not associated with a significant difference in survival. Both East Asian race and age less than 60 years were statistically significant predictors of improved survival when assessed by univariate regression analysis. When variables were analyzed in a multivariate regression analysis, Asian race and age <60 both lost their statistical significance as independent predictors of improved survival. CONCLUSIONS: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Patient specific variables including East Asian race and age less than 60 years appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. However, multivariate regression analysis failed to demonstrate these factors as independent predictors of improved outcome. In conclusion, highly selected acceptable risk surgical candidates with stage IV gastric cancer should be considered for management with surgical resection in clinically appropriate scenarios.