N_0期食管鳞癌术后预后因素及术后放疗价值探讨

目的探讨影响N0期食管鳞癌根治术后的预后因素,并评价术后预防性放疗价值。方法分析1993年1月~2006年11月本院食管癌根治术后病理诊断证实均为鳞癌,无淋巴结转移及远处转移N0期患者859例,其中单纯手术760例,术后放疗99例。术后3~4周开始放疗,照射中位总剂量50 Gy,分25次,2 Gy/次,5次/周,5周完成。结果全组1、3、5、10年生存率分别为93.4%、81.5%、72.9%和65.5%,影响预后的单因素分析是性别、年龄、病变长度和pT分期,多因素分析显示年龄和pT分期是影响预后的独立因素。术后放疗较单纯手术可提高pT4期和病变长度>5 cm的生存率,5年生存率分别为67.1%、34.6%和81.3%、70.2%,差异有统计学意义(P<0.05),并能降低pT4期瘤床复发率;而对病变长度≤5 cm、不同病变部位、食管残端癌、脉管癌栓和pT1-3期患者术后放疗的生存率没有提高,差异均无统计学意义(P>0.05)。结论年龄和肿瘤侵润深度是影响N0期食管鳞癌根治术后预后的重要因素,术后预防性放疗可明显提高pT4期及病变长度>5 cm的生存率和降低pT4期瘤床复发率。     

Color Doppler sonographic findings in patients with transitional cell carcinoma of the bladder and renal pelvis.

The purposes of this study were (1) to evaluate the color Doppler sonographic findings in patients with transitional cell carcinoma of the bladder and renal pelvis, (2) to determine if color Doppler sonography could predict tumor grade and stage, and (3) to determine whether tumor vascularity is related to size. A total of 15 patients with 16 bladder transitional cell carcinomas and one patient with renal pelvic transitional cell carcinoma were evaluated prospectively with transabdominal color Doppler ultrasonography. The presence or absence of visible vascularity and the resistive index were correlated with tumor size, cytologic grade, and tumor stage. Statistical analysis was performed with Fisher's exact test. Seven (41%) of 17 tumors had visible vascularity: five (45%) of 11 high-grade transitional cell carcinomas were vascular, whereas two (33%) of six low-grade transitional cell carcinomas were vascular (P = 1.00). Three of five (60%) of the invasive lesions were vascular, but the vascularity was not predictive of tumor stage (P = 0.593). The vascular high-grade tumors tended to have more numerous and larger visible vessels than the vascular low-grade lesions. No tumor smaller then 23 mm was vascular, but the size of the tumor was not predictive of the vascularity (P = 0.1172). The resistive index was measurable in six tumors, but it was not predictive of grade or stage. Color Doppler ultrasonography is not helpful clinically in the evaluation of transitional cell carcinoma as tumor grade, stage, and size are not related to vascularity.(ABSTRACT TRUNCATED AT 250 WORDS)     

胃癌新辅助治疗后不同肿瘤退缩分级系统的预后预测价值

目的 探讨不同肿瘤退缩分级（tumor regression grade，TRG）标准（Mandard-TRG、Becker-TRG及JGCA-TRG）与局部进展期胃癌患者新辅助治疗术后病理特征的关系，并比较其预后预测价值。方法 回顾性收集行新辅助治疗及胃癌根治术的局部进展期胃癌患者，根据Mandard-TRG、Becker-TRG及JGCA-TRG对术后组织标本进行重新评价，分析各肿瘤退缩分级标准与临床病理特征的关系及对预后的预测价值。结果 共纳入198例接受过新辅助治疗的局部进展期胃癌患者，其中男性152例，女性46例。三种TRG标准划分的不同肿瘤退缩分级间肿瘤直径、ypT、ypN、脉管浸润、神经侵犯的构成比例均具有统计学差异。Kaplan-Meier分析显示不同Becker分级或JGCA分级之间的OS具有统计学差异（p=0.019，p=0.035），而不同Mandard分级之间的OS差异不显著（p=0.146）。进一步比较Becker 1a-2级和Becker 3级患者的生存情况，Becker 1a-2级患者的预后显著优于Becker 3级患者（p=0.002），JGCA 2-3级患者的预后亦显著优于JGCA 0-1b级患者（p=0.006）。COX回归分析显示三种肿瘤退缩分级均非新辅助治疗后胃癌患者的独立预后因子。三种分级预测5年生存状态的ROC曲线下面积分别为0.608、0.624和0.611。结论 Becker-TRG对于接受新辅助治疗的胃癌患者的预后预测价值略优于JGCA-TRG和Mandard-TRG，仍需探索更加全面精准的胃癌新辅助治疗后病理评价标准。     

Pathology of breast carcinoma

The pathologist examines biopsy material obtained at surgery or preoperatively by core biopsy to make a definitive diagnosis of malignancy and to determine the type and grade of the tumour. Additional prognostic information is provided to the clinician, and this includes the true tumour size and the relative contribution of the in situ and invasive components. Other important factors include multifocality, vascular invasion and the presence and extent of axillary nodal metastases. For optimal use of this important information, close cooperation between the members of the multidisciplinary team is essential.     

Correlation between expression of S100A4 and VEGF-C, and lymph node metastasis and prognosis in gastric carcinoma

This semiquantitative immunohistochemical study investigated the clinical significance of S100A4 and vascular endothelial growth factor C (VEGF-C) protein expression in gastric carcinoma. Correlations between S100A4 and VEGF-C immunoreactivity and clinicopathological characteristics were evaluated using 108 gastric carcinoma specimens and 20 specimens of tissue adjacent to gastric carcinoma. S100A4 and VEGF-C expression in carcinoma was higher than that in adjacent tissues. S100A4 expression was significantly related to tumour size and lymph node metastasis, whereas VEGF-C expression was associated with invasion depth, lymph node metastasis and tumour, node, metastasis (TNM) stage. A significant correlation was found between S100A4 and VEGF-C expression. Patients expressing S100A4 or VEGF-C showed no significant reduction in 5-year survival rate compared with those not expressing these proteins. Sex, age, tumour size, invasion depth, lymph node involvement, TNM stage, S100A4 expression and VEGF-C expression had a common effect on carcinoma prognosis but none was an independent prognostic factor.     

Cyclooxygenase-2 and survivin in superficial urothelial carcinoma of the bladder and correlation with intratumoural microvessel density

This study was designed to investigate the protein levels of cyclooxyogenase-2 (COX-2) and survivin in superficial urothelial carcinoma (UC) and their correlation with microvessel density (MVD). High-grade UC was positive for both COX-2 and survivin protein, and the proportion of tumours positive for both proteins increased with increasing tumour grade. The presence of COX-2 protein was significantly correlated with the presence of survivin protein. Both COX-2 and survivin positivity were significantly correlated with MVD in all patients regardless of tumour grade, but there was no correlation between MVD and COX-2 and survivin positivity by individual tumour grade. Although there was no significant difference in the proportion of COX-2-positive tumours when patients were stratified by tumour stage, a significantly higher proportion of patients with pT1 stage tumours were survivin-positive compared with patients with pTa stage tumours. COX-2 and survivin positivity were significantly correlated in all patients regardless of tumour grade or stage. COX-2 and survivin were significantly correlated in patients with pTa, but there was no correlation in pT1 tumours. These findings demonstrate that together, COX-2, survivin and MVD may play an important role in UC.     

原发性胃淋巴瘤临床病理特征及预后独立危险因素分析

目的分析原发性胃淋巴瘤（PGL）组织分型及围手术期相关因素对预后的影响。 方法对中国医科大学附属第一医院胃肠肿瘤外科1988年9月至2011年7月期间收治的53例PGL患者的临床病理资料进行回顾性分析,通过Kaplan-Meier生存曲线计算累积生存率,采用Log-rank检验单因素分析和Cox模型多因素分析分析其临床特征及围手术期相关因素对预后的影响,并通过单因素分析法分析不同病理分型,其影响预后相关因素是否存在差异。 结果53例PGL患者发病年龄21~78岁（平均年龄54岁,中位年龄58岁）。本组病例组织分型：黏膜相关淋巴组织淋巴瘤（MALT）占64.2%（34/53）、弥漫性大B细胞淋巴瘤（DLBCL）22.6%（12/53）。Ann Arbor临床分期：ⅠE期22例（41.5%,22/53）、ⅡE期19例（35.8%,19/53）、ⅢE期1例（1.9%,1/53）、ⅣE期10例（18.9%,10/53）。随访资料完整的53例患者中,1、3、5年生存率分别为81.1%、47.2%、32.1%,总体中位生存期为35个月。单因素分析显示：影响预后的相关因素中性别（P=0.021）、年龄（P=0.028）、肿瘤大小（P=0.004）、手术根治度（P<0.001）、侵犯脏器（P<0.001）、病理组织分型（P=0.006）、Ann Arbor分期（P=0.029）方面差异具有统计学意义;多因素分析显示：手术根治度（OR=3.611）、病变组织分型（OR=1.729）、Ann Arbor分期（OR=1.509）是影响预后的独立因素。影响MALT预后相关因素中性别（P=0.028）、手术根治度（P<0.001）、侵犯脏器（P<0.001）以及Ann Arbor分期（P=0.003）方面差异具有统计学意义。而DLBCL预后与患者胃肠道炎性病变、溃疡等良性疾病史存在相关性（P=0.003）。 结论肿瘤根治度、侵犯脏器、原发性胃淋巴瘤的组织分型是影响原发性胃淋巴瘤预后的独立因素;患者性别、手术根治度、侵犯脏器、Ann Arbor分期与MALT的预后存在相关性;患者胃肠道疾病史与DLBCL预后存在相关性。     

Status of surgery in therapy of cervix cancer

Between 1969 and 1980 296 patients with cervical cancer were treated by surgery in our department and some were given postoperative irradiation. The five-year survival rate was 96.2% in stage I a cases and 85.2% in stage Ib. The surgically obtained specimens were evaluated for tumour extension and lymph node spread. These parameters were examined for their prognostic value. The tumour size correlated with the five-year survival rate. Lymph node spread was found in 1% of stage Ib cases. Intraoperative complications were seen in 2.4% of patients. Postoperative complications appeared in 44%. Late complications were found in 19.1%. Diagnostic conisation is of predominant value for the adequate surgical management of cervical cancer stage Ia and borderline stage Ib cases. Our own results and comparable data of other authors allow the following guidelines to be laid down for the operative treatment of early invasive cervical cancer: In stage I a: When the tumour volume is less than 1 mm3 (early stromal invasion according to Lohe) simple hysterectomy (in special cases possible only conisation) is sufficient. Microcarcinoma (tumour size less than 10 X 10 X 5 mm) is best treated by the conventional Wertheim operation. When tumour invasion of blood or lymph vessels is diagnosed, additional lymphadenectomy must be performed. In stage Ib-IIa: Radical operation according to the Latzko technique is advisable.     

Breast cancer in the catchment area of the Graz Institute of Pathology. Evaluation of morphologic parameters based on 1,510 cases]

The patient's age, tumour size, histological type and degree of differentiation as well as involvement of axillary lymph nodes are decisive for prognosis and therapy of breast cancer. Moreover these parameters reflect the achievement of early diagnosis and the surgical standard of treatment of breast carcinomas. Therefore we retrospectively reviewed 1510 cases diagnosed from 1984-1987. Non-invasive carcinomas were diagnosed in 4%. 75% of them were classified as intraductal carcinoma and 25% as lobular carcinoma in situ. 96% of the tumours were invasive at time of diagnosis. Invasive ductal carcinoma (NOS-type) was found in 70.2%, invasive lobular carcinoma in 12.3%. 3.2% of the tumours showed both ductal and lobular differentiation and 2.3% corresponded to invasive ductal carcinoma with a predominantly intraductal component. Medullary and mucinous carcinomas were detected in 2.1% and 2% of cases, respectively. Papillary carcinomas were observed in 0.9%, the frequency of other histological types was less than 1%. 44% of the tumours corresponded to UICC-category pT1, 38% to pT2, 6% to pT3 and 8% to pT4. A meaningful correlation of tumour size and axillary lymph node involvement was possible in only 906 cases, in which 10 or more lymph nodes were verified histologically. Lymph node metastases were detected in 23% of tumour category pT1 and in 47% of category pT2. PT3- and pT4-tumours metastasized to axillary lymph nodes in 77 and 86% of cases, respectively.     

Cathepsin L is associated with proliferation and clinical outcome of urothelial carcinoma of the bladder

Increasing evidence suggests that the activity of cysteine proteases, including cathepsin L, is important in cancer cell invasion and metastasis. This study was designed to investigate the clinicopathological and prognostic significance of cathepsin L in human urothelial carcinoma of the bladder (UCB). Standard immunohistochemistry was used to determine the presence of cathepsin L and Ki-67 (a marker of proliferation) in paraffin-embedded specimens of 82 human UCB cases. Cathepsin L protein was localized in the cytoplasm of the malignant UCB cells, and was significantly associated with the pathological tumour stage (invasiveness), tumour grade, survival, local tumour recurrence during follow-up, the occurrence of distant metastasis during follow-up and the presence of Ki-67 protein. Multivariate analysis using the Cox proportional hazards model revealed that cathepsin L immunopositivity and pathological tumour stage (invasiveness) were independent significant prognostic factors for overall survival. This study showed that cathepsin L provides significant prognostic information and that it might be a useful therapeutic target in the future.     

Serum immune complexes and rheumatoid factors in superficial bladder tumours

Serum immune complex (IC) and rheumatoid factor (RF) levels of 39 patients with a transitional cell tumour of the bladder were analyzed using 4 different IC and 2 RF assays. Elevated serum immune complex and rheumatoid factor levels were observed in the majority of the patients (95%). Conglutinin-binding (KgB), C1q-binding (C1qB), platelet iodinated protein A test (PIPA) and RF-enzyme immunoassay (RF-EIA) gave positive results in 31%, 62%, 23% and 31% of the cases, respectively and separated cancer sera from normal blood donors (p less than 0.001). Elevated titers were also observed with platelet aggregation test (PAT) and latex agglutination for RF in 23% and 67% of the cases, respectively. A negative correlation (p less than 0.01) was observed with the stage of the disease and RF-values. Other IC tests did not correlate significantly with stage, histological grade or progression of the disease. The best prognostic marker was the histological grade of the tumour. Males had more undifferentiated tumours than females. Multivariate analysis was carried out to correlate several laboratory parameters simultaneously with clinical variables and it revealed that elevated IC tests values (KgB, C1qB and PIPA) and low RF-values correlated to stage (p = 0.009) but not to histological grade or progressive course of the disease.     

组织蛋白酶B在膀胱移行细胞癌中的表达及意义

目的探讨组织蛋白酶B(CB)在膀胱移行细胞癌(TCC)中的表达以及其与TCC浸润的关系。方法取TCC标本40例,TCC分级Ⅰ级23例,Ⅱ～Ⅲ级17例;表浅型TCC(Tis,Ta,T1期)25例,浸润型TCC(T2～4期)15例。另取10例正常膀胱组织作为对照。用链霉素抗生物素蛋白-过氧化物酶连接法行CB免疫组织化学染色观察并计算CB阳性细胞百分率。结果正常膀胱组织中基质无明显着色;在TCC癌组织中,CB可为细胞染色,部分基质亦有染色,部分毛细血管内皮细胞及部分成纤维细胞CB表达阳性,在癌周血管内皮细胞的阳性着色CB表达增强。CB在分级和分期高的癌组织中多为弥散阳性染色。TCC分级Ⅰ级组、TCC分级Ⅱ～Ⅲ级组、TCC分期表浅型组、TCC分期浸润型组及正常对照组的CB阳性细胞百分比分别为10.53%±3.76%、21.52%±3.58%、11.32%±2.69%、20.57%±3.25%、0.11%±0.18%,TCC各组均高于正常对照组(P<0.01);TCC分级Ⅱ～Ⅲ级组高于TCC分级Ⅰ级组,TCC分期浸润型组高于TCC分期表浅型组,差异均有统计学意义(P<0.01)。结论 CB可能成为判断TCC进展和预后的重要指标。     

宫颈绒毛腺管状腺癌的临床病理

  目的  探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。  方法  分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现, 临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics, FIGO)分期、治疗方式及随访结果, 病理表现包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异型性、核分裂及伴随病变。  结果  10例患者平均发病年龄为39岁; 8例FIGO分期Ib1, 1例IIa, 1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/卵巢活检术; 术后平均随访29个月, 8例健康生存, 1例复发, 1例失访。大体观察, 5例呈息肉样或菜花状外生性肿物, 直径5~25 mm; 4例呈乳头状或细绒毛样粗糙区, 面积25 mm×14 mm至35 mm×20 mm; 1例术后转移病例表现为溃疡型肿物, 直径25 mm。镜下肿瘤浸润深度2~12 mm, 浸润宽度5~26 mm, 1例累及阴道后穹窿; 9例有轻-中度核异型性, 术后转移1例病例呈中-重度核异型性; 核分裂平均48个/10高倍视野(HPF); 9例伴有宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasia Ⅲ, CIN Ⅲ)和/或原位腺癌(adenocarcinoma in situ, ACIS), 2例同时伴有高分化黏液腺癌; 1例观察到宫颈壁内个别淋巴脉管内瘤栓。10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。  结论  宫颈绒毛腺管状腺癌的预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外, 还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。     

Experiences in the treatment of advanced nonseminomatous testicular tumor

48 patients with nonseminomatous testicular tumours were treated between 1980 and 1984. 19 patients had bulky stage II c or disseminated disease; according the Royal Marsden staging classification 5 patients had stage II c, 2 patients III and 12 patients stage IV. The pT stage of the primary tumour showed no correlation to low stage disease, but pT was only found in advanced disease. In disseminated disease histological examination revealed more cases of malignant teratoma undifferentiated (MTU) and malignant teratoma trophoblastic (MTT) than malignant teratoma intermediate (MTI). Before therapy 14 patients had elevated serum markers, whilst in 5 patients markers were negative. Combination chemotherapy with Vinblastin, Bleomycin and Cisplatin (Einhorn) was given and afterwards 13 patients had to undergo operation to remove a residual mass. Scarring was found in 4 patients (31%), teratoma in 6 (46%) and active tumour in 3 (23%). At a median survival time of 3 years 16 of 19 patients (84%) are alive. The two patients with elevated tumour markers before operation are also alive and disease-free. Altogether out of 48 patients with advanced nonseminomatous testicular tumours 94% of the patients are alive.     

Management and extended outcome of patients with synchronous bilateral solid renal neoplasms in the absence of von Hippel-Lindau disease

OBJECTIVE: To gain information regarding long-term follow-up in patients with synchronous bilateral solid renal neoplasms in whom renal-preserving surgery is imperative. PATIENTS AND METHODS: We examined our surgical experience and the survival outcome, as evaluated by Kaplan-Meier and log-rank analysis, of 94 patients (64 men and 30 women) who presented to the Mayo Clinic in Rochester, Minn, from 1973 to 1998 with bilateral synchronous solid renal neoplasms in the absence of von Hippel-Lindau disease. Follow-up of these patients ranged from 1 to 25 years, with a mean of 5.86 years and a median of 4.18 years. Tumors were staged according to the TNM classification. Pathologic staging and grading were usually performed on the kidney with the most extensive cancer. The Cox proportional hazards model was used to assess the relationship of grade (1-4), tumor size, and enucleation as opposed to extended (1 cm) partial nephrectomy on overall, cancer-specific, local recurrence-free, and metastasis-free survival. RESULTS: Seventy-one patients (76%) had bilateral synchronous renal cell carcinoma, and 14 patients (15%) had a unilateral renal cell carcinoma with a contralateral benign solid neoplasm. Nine patients (10%) had bilateral benign solid lesions. Sixty-six patients (70%) underwent a single procedure, whereas 28 (30%) underwent staged surgical procedures. Fifty-one patients (54%) are alive, and 43 (46%) have died. Twenty patients (21%) died of metastatic disease, and 5 (5%) had a local recurrence. Cancer-specific survival of the 85 patients with at least 1 renal cell carcinoma still under observation was 81% (+/- 4.9% SE) and 59% (+/- 8.1% SE) at 5 and 10 years, respectively, and survival to local recurrence was 96% (+/- 2.6% SE) at 5 years and 93% (+/- 3.7% SE) at 10 years with 14 patients still under observation. Grade 3 was a statistically significant factor for metastasis (P < .001). A significant difference in metastasis-free survival and cancer-specific survival was noted dependent on pathologic T stage (P < .001 and P = .02, respectively), with patients with local pT3 disease having a higher rate of metastasis and cancer-specific death. Multivariate analysis revealed that tumor grade was associated with metastasis-free survival (P = .002) and tumor size with cancer-specific survival (P = .04). There was no statistical significance on survival outcome end points according to procedure performed, i.e., enucleation vs extended partial nephrectomy. CONCLUSION: Long-term results of renal-preserving procedures for a series of patients with bilateral solid renal neoplasms indicate that grade, stage, and tumor size are significant predictors of outcome. Mean follow-up of over 5 years supports nephron-sparing techniques in selected patients because local recurrence was infrequent compared with distant metastasis.     

淋巴脉管间隙浸润对早期宫颈癌预后的影响

目的评价淋巴脉管间隙浸润（LVSI）对早期宫颈癌预后的影响,探讨早期宫颈癌合并LVSI优选治疗方案。方法收集1999年6月至2011年6月经手术治疗的ⅠB～ⅡA期宫颈癌合并LVSI 252例及相对应于年龄、期别、病理类型无差异的无LVSI 253例入组本研究,分析两组间肿瘤大小、间质浸润深度、组织分化、淋巴结转移、术前、术后治疗的差异及其对预后的影响。结果LVSI组的宫颈间质受侵深度〉1／2例数、淋巴结转移率、低分化所占比例、术后接受辅助治疗患者数明显高于无LVSI组,差异具有统计学意义。5年总存活率（OS）LVSI组79．8％,无LVSI组95．7％,5年无瘤存活率（DFS）LVSI组79．8％,无LVSI组94．6％,复发转移、死亡：LVSI组复发39例（15,5％）,死亡24例（9．5％）,无LVSI组复发13例（5．1％）,死亡2例（0．8％）,两组间的差异有统计学意义（P=0．000）。全组5年总存活率、无瘤存活率为93．6％、87．7％,单因素分析示临床期别、病理类型、淋巴结转移、脉管间隙浸润影响5年总存活、无瘤存活,肿瘤大小、术后治疗仅影响5年总存活率。多因素分析病理类型、淋巴结转移、脉管间隙浸润是5年总存活、无瘤存活的独立预后因素。结论LVSI与多种不良预后因素相关,早期宫颈癌中病理类型、淋巴结转移、脉管间隙浸润是5年总存活、无瘤存活的独立影响因素。合并LVSI需术后辅助治疗。     

Prognostic urinary miRNAs for the assessment of small renal masses

BackgroundRenal cell carcinoma (RCC) is often detected incidentally as a small renal mass (SRM; pT1a, ≤4 cm). It is clinically challenging to predict progression in patients with SRMs. This is largely due to the recent recognition of clinically progressive and non-progressive RCC-SRMs. It is critical to accurately stratify SRM patients according to risk to avoid unnecessary treatment. This is especially significant for elderly and infirm patients, where the risk of surgery outweighs mortality from SRMs.MethodsWe employed a qRT-PCR array-based approach and targeted qRT-PCR to identify and validate early, non-invasive diagnostic and prognostic biomarkers of RCC-SRMs. In total, we evaluated eighty urine samples, including 30 renal oncocytoma (≤4 cm) cases, 26 progressive and 24 non-progressive clear cell RCC-SRM (ccRCC-SRM) cases.ResultsWe identified nine urinary miRNAs which displayed significantly elevated expression in ccRCC-SRMs (pT1a; ≤4 cm) relative to renal oncocytoma (≤4 cm). Additionally, miR-328-3p displayed significantly down-regulated expression in progressive relative to non-progressive ccRCC-SRMs. Patients with elevated miR-328-3p expression had significantly longer overall survival (HR = 0.29, 95% CI = 0.08–1.03, p = 0.042) compared to patients with low miR-328-3p expression. We also found no significant association between miR-328-3p expression levels and gender, age, laterality, tumor size, or grade, suggesting that miR-328-3p is an independent prognostic biomarker.ConclusionsOur in-depth miRNA profiling approach identified novel biomarkers for early-stage ccRCC-SRMs. Pretreatment characterization of urinary miRNAs may provide insight into early RCC progression and could potentially aid clinical decision-making, improving patient management and reducing overtreatment.     

T2 mapping评估直肠腺癌预后相关因素北大核心CSCD

目的观察T2 mapping评估直肠腺癌预后相关因素的价值。方法回顾性分析83例经手术病理证实的单发直肠腺癌患者,术前均接受盆腔高分辨T2W、弥散加权成像(DWI)及T2 mapping扫描,比较不同病理分化、T分期、N分期、CRM及EMVI状态肿瘤T2值及表观弥散系数(ADC)的差异。采用受试者工作特性(ROC)曲线,计算曲线下面积(AUC),分析T2值及ADC评估直肠腺癌预后相关因素的效能。结果83例中,15例黏液腺癌,68例普通腺癌。68例普通腺癌中,51例中分化腺癌,17例中-低分化腺癌;28例早期(pT1~2期),40例晚期(pT3~4期);46例pN0期,22例pN1~2期;15例CRM阳性,53例CRM阴性;12例EMVI阳性,56例EMVI阴性。直肠黏液腺癌的T2值[(184.59±47.79)ms]及ADC[(1.75±0.27)×10^(-3) mm^(2)/s]均高于普通腺癌[(96.85±17.86)ms、(0.99±0.12)×10^(-3) mm^(2)/s,t=-3.655、-5.562,P=0.034、0.011]。直肠普通腺癌中,不同N分期病灶的T2值、CRM阴性与阳性病灶间T2值及ADC差异均有统计学意义(P均<0.05),其余T2值及ADC差异均无统计学意义(P均>0.05)。T2值及ADC鉴别直肠黏液腺癌与普通腺癌的AUC分别为0.984及0.994,T2值评估淋巴结转移的AUC为0.806;T2值及ADC评估CRM的AUC分别为0.751及0.647。结论T2 mapping有助于评估包括病理类型、淋巴结转移及CRM在内的直肠腺癌预后相关因素。     

Characteristics of thyroid carcinomas in aging patients

BACKGROUND: To investigate the clinical features of thyroid cancer in aging patients and to present the results of treatment. From this we can provide bases for earlier diagnoses and better treatment of thyroid malignancies in older patients. MATERIALS AND METHODS: In this study a retrospective analysis was performed with 204 thyroid cancer patients aged 60 years or older (132 women, with a mean age of 68.3 +/- 6.6 years; 72 men, with a mean age of 67.0 +/- 5.3 years). RESULTS: Of the 204 patients, 142 had well-differentiated thyroid carcinomas (96 papillary thyroid carcinomas, 43 follicular carcinomas, three Hürthle cell carcinomas) and three medullary carcinomas. Sixty-nine (33.8%) of the 204 patients died after treatment. Of these, three patients died of causes not related to thyroid cancer. For well-differentiated thyroid carcinomas, male gender, follicular carcinoma, and a larger tumour size indicated a poor prognosis. Of the 59 non-well-differentiated thyroid carcinomas, 39 were anaplastic thyroid carcinomas, nine metastatic cancers of the thyroid, seven lymphomas, and four squamous cell carcinomas. After treatment, 40 (67.8%) of the 59 patients died. In multivariant analysis of the differences in clinical parameters between aging and younger thyroid cancer patients, the current status, tumour size, follow-up period, sex, and stage at diagnosis were independent factors. From this data the delayed diagnosis of aging patients with thyroid cancer was of note when compared with younger patients. CONCLUSION: Thyroid cancer in older patients is not a benign clinical disorder. Early diagnosis and urgent aggressive treatment are recommended courses of action for this type of cancer, especially for non-well-differentiated thyroid cancers.     

499例子宫内膜癌预后及随访资料分析

目的：总结分析子宫内膜癌临床特点、治疗方法的疗效及与各预后高危因素之间的关系,以提高临床诊疗水平。方法：回顾性分析我院1998年1月～2005年12月收治住院的子宫内膜癌患者499例的临床病理资料,总结患者的一般情况、临床特点并进行随访,分析内膜癌高危因素对预后的影响。采用寿命表法计算患者生存率,Wilc-oxon（Gehan）比分法及Cox比例风险模型分析预后因素。结果：（1）手术-病理分期I、Ⅱ、Ⅲ期患者5年生存率分别为94%、100%、75.3%,IV期患者1年生存率57.1%、2年生存率11.4%。（2）单因素分析显示：病理类型、手术-病理分期、组织学分级、肌层浸润深度、淋巴结转移和是否行淋巴结切除术是影响预后的高危因素。（3）多因素分析显示：病理类型、手术-病理分期、组织学分级和肌层浸润深度是影响患者预后的独立危险因素。结论：（1）对具有高危因素的患者,如特殊病理类型、手术-病理分期期别晚、组织学分级为G3和深肌层浸润,应辅以术后治疗以提高生存率。（2）分期越晚,生存率越低（P〈0.05）。