左右半结肠癌患者临床病理特征分析

目的 分析左、右半结肠癌临床及病理特征。方法 回顾性分析我院2015年1月至2017年6月收治的570例经结肠镜检查与病理学证实为结肠癌患者的临床及病理资料，根据结肠癌发病部位分为左半结肠癌组与右半结肠癌组，比较两组患者临床及病理特征。 结果 临床特征方面，右半结肠癌患者与左半结肠癌患者在年龄、体重下降、便血、大便异常、腹胀腹疼、腹部包块、CEA和CA199方面比较，差异均有统计学意义（P<0.05）。病理学特征方面，右半结肠癌患者肿瘤直径≥5 cm的比例大于左半结肠癌患者（χ²=11.235，P=0.031）；右半结肠癌患者隆起型、溃疡型、浸润型分别占4.0%、81.7%、14.3%，而左半结肠癌患者分别占17.8%、61.8%、20.4%，两组病理分型分布比较，差异有统计学意义（χ²=15.956，P=0.025）；右半结肠癌患者黏液腺癌、印戒细胞癌、未分化癌所占比例高于左半结肠癌患者，两组组织分型分布比较，差异亦有统计学意义（χ²=14.597，P=0.027）。结论 右半结肠癌较左半结肠癌分化更差，浸润和转移更强，恶性程度更高，临床应加以筛查和诊断。     

结直肠癌肝和/或肺转移患者的预后影响因素分析:一项基于SEER数据库的回顾性研究

目的:分析初诊结直肠癌肝和/或肺转移患者的临床特点,探讨临床病理特征和预后之间的关系。方法:收集SEER数据库中2010年至2015年病理诊断为结直肠癌并伴有肝和/或肺转移的患者共21 845例,分为肝转移组、肺转移组以及肝和肺转移组。比较不同分组的临床病理特征,绘制生存曲线。采用单因素和多因素Cox回归模型分析预后影响因素。结果:肝转移组、肺转移组以及肝和肺转移组的基线特征均有统计学差异（P＜0.05）,且中位生存期分别为18、21、11个月。多因素Cox显示:患者的年龄≥65岁、种族（黑种人vs白种人）、婚姻状况（单身/丧偶vs已婚）、肿瘤原发部位（横结肠/右半结肠vs左半结肠）、肿瘤分化等级（Ⅱ/Ⅲ/Ⅳ vs Ⅰ）、T分期（T4 vs T1）、N分期（N2/Nx vs N0）、肿瘤直径≥5 cm、淋巴结性质阳性、原发部位未手术、未接受放疗以及化疗、转移位置（肝和肺vs肝）是患者生存的独立危险因素（HR＞1,P＜0.05）。结论:转移位置是影响结直肠癌患者预后的重要危险因素,肺转移患者预后较好。根据肿瘤的临床病理特征来预测疾病进展趋势,有助于判断患者预后。     

Paget's病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究

目的:分析佩吉特氏病伴浸润性导管癌（Paget's disease with invasive ductal carcinoma,PD-IDC）患者的临床病理特征、治疗和预后情况。方法:通过美国 SEER*Stat 软件搜集2010至2014年病理明确诊断为PD-IDC及浸润性乳腺癌（invasive ductal carcinoma,IDC）并接受手术治疗的患者分别550例和207 221例。用SPSS 21.0进行统计学分析和绘制生存曲线。结果:与IDC相比,PD-IDC患者男性乳腺癌比例更大,可能有更大的体积、更多的淋巴结受累、更高级别以及更晚期的肿瘤（P均<0.05）;且更可能是激素受体（HR）阴性［ER阴性（37.3% vs 18.5%）、PR阴性（52.0% vs 28.5%）］和Her-2阳性（53.3% vs 15.4%）;在治疗方案中更有可能接受乳房切除术（85.8% vs 43.9%）和腋窝淋巴结清扫术（45.1% vs 29.5%）（P均<0.05）;但预后更差,死亡率更高,且乳腺癌相关死亡率（BCSM）更高。此外,Cox回归分析显示肿瘤分级和Her-2状态与PD-IDC患者的总生存时间（OS）显著相关（P<0.05）,而患者性别和肿瘤分级与PD-IDC患者的BCSM相关（P<0.05）,且Her-2阳性者相较于阴性者（OS:HR=0.019,P=0.009;BCSM:HR=0.000,P=0.623）与PD-IDC患者的OS显著相关,淋巴结手术方式也与PD-IDC患者的OS有一定的相关性。结论:与IDC相比,PD-IDC患者更可能是HR阴性和Her-2阳性且预后较差。同时,淋巴结的处理在PD-IDC的治疗中有一定的必要性。     

青年与老年结直肠癌患者的病理资料对比分析

[目的]探讨青年结直肠癌患者内镜特点及病理特征。[方法]比较青年结直肠癌患者（n=61）与老年结直肠癌患者（n=213）的内镜资料与病理特征。[结果]青年患者结直肠各部位均可发病,右半结肠发病率为40%（25/61）,高于老年组的28.2%（60/213）（P〈0.05）;大体病变形态青年组浸润型较多（52.5%,32/61）,老年组隆起型为多（50.2%,107/213）（P〈0.05）;在病变侵及肠管周径上,两组无差异（P〉0.05）;组织病理学上,青年组以低分化腺癌、黏液腺癌较多,老年组以中、高分化腺癌为多。[结论]青年结直肠癌患者病灶位置分布均匀,多为浸润型,组织分化较差。     

Ⅰ期卵巢交界性肿瘤剥除术后复发危险因素分析

目的：探讨年轻卵巢交界性肿瘤患者行肿物剥除术后复发的危险因素。方法回顾性分析49例行卵巢肿瘤剥除术,年龄﹤35岁,术后病理为Ⅰ期的卵巢交界性肿瘤（BOT）患者的临床及随访资料,分析术后复发的危险因素。结果随访患者中共7例复发,5年生存率为100%,无复发生存率为91.8%,不同年龄、分期、是否存在间质浸润患者术后复发情况比较,差异无统计学意义（P﹥0.05）;黏液性肿瘤及微乳头型卵巢交界性肿瘤患者复发比例高于浆液性肿瘤及非微乳头型肿瘤患者,差异有统计学意义（P﹤0.05）。结论Ⅰ期BOT单侧病变患者,若术中冰冻结果为黏液性或微乳头型肿瘤,宜行患侧附件切除术;双侧病变患者,若无上述危险因素可行双侧卵巢肿物剥除术,若存在上述危险因素可行单侧附件切除术+对侧卵巢肿物剥除术。     

SiewertⅡ型和Ⅲ型局部晚期胃食管交界处腺癌根治术后淋巴结复发规律分析

目的：探讨胃食管交界处腺癌根治术后淋巴结复发规律,为高危淋巴引流区照射范围的设计提供依据。方法回顾分析本院2009—2013年初治、病例资料完善的局部晚期胃食管交界处腺癌患者78例,纳入条件为接受根治性手术;病理证实为T3、T4期或淋巴结转移阳性胃食管交界处腺癌;结合内镜、上消化道造影、术中所见及病理大体标本记录,明确为SiewertⅡ、Ⅲ型;未行术前或术后放疗;影像学诊断为术后淋巴结复发,具有可调阅的CT图像并可清楚、完整显示复发位置。结果中位复发时间为10个月（1～48个月）,90％复发为术后2年内。复发最高危部位为第16b1组（39％）、16a2组（37％）、9组（30％）和11p组（26％）淋巴结。 SiewertⅡ、Ⅲ型在各淋巴引流区的复发率相近（ P＝0．090～1．000）。 N3期患者最多见（＞15％）复发部位为第16b1、16a2、9、16b2、11p、7组淋巴结,非N3期患者最多见（＞15％）复发部位为第11p、16b1、16a2、9、8、7组淋巴结;两者腹主动脉旁（第16a2－b2组）复发率更高（67％∶33％,P＝0．004;OR＝4．00,95％ CI为1．54～10．37）。结论腹腔干、脾动脉近端及腹膜后（16a2、16b1区）是SiewertⅡ、Ⅲ型局部晚期胃食管交界处腺癌患者淋巴结复发最高危区域,且N3期患者具有更高的腹膜后复发风险,术后放疗靶区设计应考虑涵盖上述部位。     

合并2型糖尿病的乳腺癌患者临床病理特征及预后分析

目的:分析合并2型糖尿病乳腺癌患者的临床病理学特征及其与预后的关系。方法:收集西安交通大学第二附属医院肿瘤科2012年1月至2014年12月收治的合并2型糖尿病的乳腺癌患者102例作为糖尿病组,按照1∶2的原则选取同期就诊于西安交通大学第二附属医院肿瘤科的非糖尿病乳腺癌患者204例作为对照组,比较两组临床病理特征以及预后。结果:糖尿病组相比对照组,糖尿病组50岁以上人群比率显著高于对照组（76.5% vs 57.8%,P<0.05）,糖尿病组绝经后患者的比率显著高于对照组（69.6% vs 53.9%,P<0.05）;糖尿病组和对照组相比,其中T2期及以上患者所占比例（79.4% vs 66.2%）、淋巴结阳性患者比例（68.6% vs 55.4%）、Ⅱ/Ⅲ期患者所占比例（82.8% vs 67.6%）糖尿病组更高,差异具有统计学意义（P<0.05）。糖尿病组5年复发转移率为14.9%。结论:2型糖尿病是乳腺癌发生发展和淋巴结转移的不良危险因素,乳腺癌合并2型糖尿病患者的病理T分期和临床分期偏晚,淋巴结转移更多,其复发转移率较高,合并2型糖尿病的乳腺癌患者可能预后更差,应更加注重术后定期复查及随访。     

原发性年轻结直肠癌患者的病理特征及预后分析

目的:年轻结直肠癌患者（≤40岁）的发病率呈上升趋势,但是这部分患者的临床病理特征及生存预后尚存在争议,因此本研究旨在探讨原发性年轻结直肠癌患者的临床病理特征及预后。方法:收集了南京鼓楼医院2011年1月至2015年12月及美国SEER数据库2011年1月至2013年12月原发性结直肠癌患者。将入组患者根据发病年龄分别分为:年轻组（年龄≤40岁）和中老年组（年龄>40岁）。对两组患者的临床病理特征及生存期进行分析。结果:总共收集了97 369例原发性结直肠癌患者。年轻结直肠癌患者更多的位于直肠及左半结肠、中晚期为主、黏液腺癌比例高、分化程度低、淋巴结转移率高、远处转移率高、脉管及神经侵犯率高。肿瘤相关生存期年轻组明显长于中老年组,同一分期年轻组生存期亦高于中老年组,差异有统计学意义。结论:年轻结直肠癌患者恶性程度更高、分期偏晚,但是预后却较好。     

可手术年轻乳腺癌92例临床分析

[目的]探讨可手术年轻乳腺癌的临床病理特点及诊治策略。[方法]回顾分析92例年龄≤40岁的可手术乳腺癌患者（年轻组）的临床资料,随机抽取年龄在41—69岁的年长乳腺癌患者（年长组）92例与年轻组作临床病理特点分析比较。[结果]年轻组肿块长径0．8～6．5cm,平均2．8era。浸润性导管癌82例,导管内癌、导管内癌微浸润、髓样癌各2例,导管内乳头状瘤原位癌、黏液腺癌、浸润性导管癌伴灶区黏液腺癌、混合性癌各1例。淋巴结分期Nn19例,N1 51例,N2及以上22例。浸润癌组织学分级Ⅰ-Ⅱ级47例,Ⅲ级42例。免疫组化：ER／PR阳性57例,Her-2阳性30例;三阴性乳腺癌22例;有癌栓者33例。病理分期0期3例,Ⅰ期28例,Ⅱ期35例,Ⅲ期26例。与年长组比较,年轻组在高组织学分级、Her-2阳性、伴有癌栓三者比例较高,差异有统计学意义（P值分别为0．048、0．044、0．022）;而在肿瘤大小、是否为浸润性癌、淋巴结分期、激素受体阳性比例、是否三阴性乳腺癌及病理分期上与年长组均无明显差异（P〉0．05）。[结论]年轻乳腺癌有独特的病理学特点,恶性程度更高,应早诊断、早治疗。     

IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究

目的：回顾性分析国际肺癌研究协会(IASLC)分级系统与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性及与患者预后的关系。方法：回顾性分析2015年1月至2018年12月就诊于天津市胸科医院的204例Ⅰ期浸润性非黏液型肺腺癌患者的临床病理资料及随访资料,根据IASLC分级系统对患者分组,采用单因素方差分析、χ²检验和Fisher精确检验分析IASLC分级与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性,及与肺腺癌患者预后的关系。通过Kaplan-Meier法计算浸润性非黏液型肺腺癌患者总生存率(overall survival,OS)、无复发生存率(recurrence-free survival,RFS);采用Log-rank法比较不同组间的差异性。使用单因素Cox回归、多因素Cox回归分析独立危险因素。结果：204例患者中IASLC分级为Ⅰ级108例,Ⅱ级66例,Ⅲ级30例。IASLC分级与性别(P=0.022)、吸烟史(P=0.041)、脉管侵犯(P=0.004)、胸膜累及(P=0.001)、病理分期(P<0.001)、肿瘤直径(P<0.001)均显...     

非黏液型细支气管肺泡癌与肺腺癌组织中VEGF-C的表达及临床意义

目的探讨非黏液型细支气管肺泡癌侵袭转移能力。方法收集43例非黏液型细支气管肺泡癌新鲜手术标本为实验组,对照组包括黏液型细支气管肺泡癌17例、肺腺癌22例和癌旁肺组织10例;分别采用免疫组织化学法和半定量RT-PCR检测VEGF-C蛋白和mRNA表达。结果非黏液型细支气管肺泡癌组织中VEGF-C的阳性表达率显著高于癌旁肺组织和黏液型细支气管肺泡癌组织(P<0.01）,但与肺腺癌组织相比差异无统计学意义(P>0.05）。非黏液型细支气管肺泡癌组织中淋巴结转移率显著高于黏液型细支气管肺泡癌组织(P<0.01）,但与肺腺癌组织相比差异无统计学意义(P>0.05）,非黏液型细支气管肺泡癌组织中20例有淋巴结转移组VEGF-C蛋白的阳性率明显高于23例无淋巴结转移组(P<0.05）。非黏液型细支气管肺泡癌组织中VEGF-C mRNA表达显著高于癌旁肺组织及黏液型细支气管肺泡癌组织(P<0.01）,但显著低于肺腺癌组织(P<0.01）。结论 VEGF-C蛋白表达上调提示非黏液型细支气管肺泡癌可能具有与肺腺癌相同的侵袭转移特性;非黏液型细支气管肺泡癌较黏液型细支气管肺泡癌更易发生淋巴结转移。     

Does the efficacy of regorafenib differ in chemotherapy refractory metastatic colorectal cancer patients who had mucinous pathology compared to those who had non-mucinous pathology?

Purpose: To investigate the importance of mucinous histopathology on the assessment of tumor response in patients with metastatic colorectal cancer (mCRC) receiving regorafenib. Materials and method: All patients diagnosed with histologically confirmed mCRC in 2 oncology centers between 2013 and 2018 were retrospectively analyzed. Among 678 patients diagnosed with mCRC, 103 patients were treated with regorafenib. Ninety-four of these patients who had used at least 2 cycles of regorafenib and evaluable for treatment response were included in the analysis. Histopathologically, 18 patients with mucinous adenocarcinoma and 76 patients with nonmucinous adenocarcinoma were compared in terms of response rate and survival durations. Results: Median follow-up duration of 6 months, median age of the patients was 61 (34-77) years. While 19.1% of the patients had mucinous histology, 80.9% had nonmucinous histology. The overall response rate was significantly lower in the mucinous subgroup than the nonmucinous subgroup (5.6% vs 43.4%, respectively, P = 0.003). Similarly, both progression-free survival (3.0 vs 4.0 months, respectively, P = 0.011) and overall survival duration were shorter in the mucinous subgroup (3.0 vs 7.0 months, P = 0.016, respectively) compared with the nonmucinous subgroup. Conclusion: The histological subgroup may predict tumor response in mCRC patients receiving regorafenib. Its efficacy on nonmucinous histology had significantly more favorable than mucinous subtype.     

Prognostic significance of mucinous carcinoma of colon and rectum: a prospective case-control study

BACKGROUND AND OBJECTIVES: The clinical meaning of mucinous type of colonic and rectal carcinoma is still controversial. We used clinicopathological and follow-up data prospectively recorded for our series of colon and rectum cancer to compare 2 matched groups of mucinous and nonmucinous cancer patients. METHODS: Two-hundred-forty-eight patients operated for colon and rectum cancer between January 1986 and January 1997 were considered. Thirty-six patients showed mucinous pattern on histologic examination but only 29 (11.7%) had more than 50% of mucin-secreting acini and could be classified as mucinous type. The 29 mucinous cancer patients were compared with 212 nonmucinous cancer patients to evaluate differences in epidemiological and clinical features. A control group from the nonmucinous patients was sorted by matching for age, sex, location, and Dukes stage. RESULTS: In the case-control groups, survival was better for nonmucinous than for mucinous tumours. Many of the epidemiological findings already observed for mucinous carcinoma were also confirmed. CONCLUSIONS: The existence of prognostic, clinical, and epidemiological differences between mucinous and nonmucinous colorectal carcinoma, together with the preliminary reports about their difference as to genetic features, could support the hypothesis that mucinous type is a distinct biological entity.     

青年人与老年人直肠癌的临床病理与预后对比

目的探讨青年人与老年人直肠癌的临床病理特征及预后的差异。方法回顾1996年1月至2006年1月可手术的85例青年人（≤40岁）直肠癌与155例老年人（≥65岁）直肠癌患者的临床病理资料和随访资料,进行生存分析和预后多因素分析。结果青年人直肠癌发生在腹膜返折下占69.41％,高于老年组的52．90％（P=0．013）;低分化腺癌及黏液、印戒细胞癌比例分别为31．76％及22．35％,也分别高于老年组的18．71％及8．39％（P=0．023,P=0．007）;青年组有淋巴结转移者为63．53％,高于老年组的47．10％（P=0．015）;青年组与老年组的5生存率分别为48．2％、55．7％,两组差异无统计学意义（P=0．176）;多因素分析结果显示,手术性质、肿瘤侵犯深度、淋巴结转移、TNM分期是影响预后最重要的独立因素。结论与老年患者相比,青年患者直肠癌恶性度较高,发现较晚,但若能及早发现并通过根治手术为主联合放化疗,预后可与老年患者无差异。     

Intraperitoneal cancer dissemination: mechanisms of the patterns of spread

BACKGROUND: Well known patterns govern the distribution of hematogenous and lymphatic metastasis of cancer. In the past the distribution of cancer cells free within abdominal cavity received little attention and was thought to be a random event. However, surgical observation led the authors to generate and test hypotheses regarding patterns of spread that vary with tumor type, with the intraperitoneal environment, and with the physiology of the peritoneal surface tissues. METHODS: The distribution and volume of peritoneal surface malignancy was prospectively recorded in 129 patients with 5 different types of tumors at the time of cytoreductive surgery. The malignancies studied included pseudomyxoma peritonei (PMP) of appendiceal origin, colonic mucinous adenocarcinoma (MA), nonmucinous colonic adenocarcinoma (NMA), ovarian carcinoma (OV) and sarcoma (SA). The abdominal and pelvic cavity was divided into 3 horizontal sectors, 9 regions and 25 sites. The incidences of tumor implants in these designated areas were statistically analyzed for each tumor type and comparisons between tumor types studied. RESULTS: The magnitude of intraperitoneal cancer dissemination was similar for mucinous tumors, including PMP and MA and significantly higher than for non-mucinous tumors. Also the mucinous cancers were more likely to be present in the upper horizontal sector than were non-mucinous. When NMA was compared to PMP and MA the epigastric region was significantly less likely to contain tumor. For all cancer diagnoses the colon, greater omentum and cul-de-sac of Douglas were most often affected. The ileocecal valve region was more likely to have large tumor masses on its surface than small bowel surface or small bowel mesentery. CONCLUSIONS: Peritoneal carcinomatosis had a wider distribution when mucinous fluid was present; this cancer distribution by intraperitoneal fluid hydrodynamics occurred regardless of histologic aggressiveness. The organs that have peritoneal fluid resorption (omentum and omental appendages) have a high incidence of implants. Small bowel and its mesentery free to move by peristalsis had a reduced incidence of implants as compared to the ileocecal area, which is fixed to the retroperitoneum. These observations may facilitate efforts to treat peritoneal surface malignancy.     

Clinicopathologic study of early-stage mucinous gastric carcinoma

BACKGROUND: Mucinous gastric carcinoma (MGC) is rare, and whether MGC behaves more aggressively than nonmucinous gastric carcinoma (NGC) is controversial. To the authors' knowledge, there is no study of early-stage MGC, and the pathology and prognosis of patients who have early MGC is unknown. The aim of this study was to clarify the clinicopathologic characteristics of early MGC. METHODS: Pathologic and prognostic data of 30 patients who had early MGC were compared retrospectively against data of 165 patients who had early NGC and 58 patients who had advanced MGC. We defined MGC as a tumor in which more than half of the tumor area contained extracellular mucin pools. We defined early gastric carcinoma as a tumor restricted to the mucosa or to the mucosa and submucosa (T1, International Union Against Cancer [UICC], 1997) regardless of lymph node metastasis. RESULTS: Early MGC tumors, compared with early NGC tumors, were characterized by macroscopic elevation (57% vs. 23%, P < 0.01) and invasion to the submucosa (83% vs. 44%, P < 0.01). Tumor size, frequency of lymph node metastasis, and patient outcome did not differ between the two types, and no patient with early MGC died of recurrence during a median follow-up period of 67 months. When early MGC was compared with advanced MGC, tumor size (2.9 cm vs. 9.4 cm, P < 0.01), frequency of lymph node metastasis (10% vs. 88%,P < 0.01), total gastrectomy (0% vs. 52%, P < 0.01), noncurative surgery (0% vs. 38%, P < 0.01), and recurrent death (0% vs. 57%, P < 0.01) differed significantly. CONCLUSIONS: Our results indicated that although the macroscopic features of early MGC differed from those of early NGC, patient prognosis and the frequency of lymph node metastasis did not differ. Neither did mucinous histology seem to influence outcome adversely after gastrectomy.     

Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: A population‐based study

The aim of our study was to provide population‐based data on incidence and prognosis of synchronous peritoneal carcinomatosis and to evaluate predictors for its development. Diagnosed in 1995–2008, 18,738 cases of primary colorectal cancer were included. Predictors of peritoneal carcinomatosis were analysed by multivariable logistic regression analysis. Median survival in months was calculated by site of metastasis. In the study period, 904 patients were diagnosed with synchronous peritoneal carcinomatosis (4.8% of total, constituting 24% of patients presenting with M1 disease). The risk of peritoneal carcinomatosis was increased in case of advanced T stage [T4 vs. T1,2: odds ratio (OR) 4.7, confidence limits 4.0–5.6), advanced N stage [N0 vs. N1,2: OR 0.2 (0.1–0.2)], poor differentiation grade [OR 2.1 (1.8–2.5)], younger age [<60 years vs. 70–79 years: OR 1.4 (1.1–1.7)], mucinous adenocarcinoma [OR 2.0 (1.6–2.4)] and right‐sided localisation of primary tumour [left vs. right: OR 0.6 (0.5–0.7)]. Median survival of patients with peritoneum as single site of metastasis remained dismal [1995–2001: 7 (6–9) months; 2002–2008: 8 (6–11) months], contrasting the improvement among patients with liver metastases [1995–2001: 8 (7–9) months; 2002–2008: 12 (11–14) months]. To conclude, synchronous peritoneal metastases from colorectal cancer are more frequent among younger patients and among patients with advanced T stage, mucinous adenocarcinoma, right‐sided tumours and tumours that are poorly differentiated. The prognosis of synchronous peritoneal carcinomatosis remains poor with a median survival of 8 months and even worse if concomitant metastases in other organs are present.     

Clinicopathological characteristics of mucinous carcinoma of the colon and rectum

BACKGROUND AND OBJECTIVES: Clinicopathological significance of colorectal mucinous carcinoma (MC) remains controversial. The aim of the current study was to investigate the clinicopathological characteristics of colorectal MC. METHODS: Eighteen patients with MC and 265 with moderately or well differentiated adenocarcinoma of the colon and rectum, were clinicopathologically compared. RESULTS: MCs occurred in the right colon significantly more frequently than did non-mucinous carcinomas (NMCs). The maximal size of the tumors in MCs (7.0 +/- 2.9 cm) was significantly larger than that in NMCs (5.1 +/- 2.1 cm) (P < 0.001). Although the ratio of patients with peritoneal metastasis in MCs (22.2%; 4/18) was significantly higher than that in NMCs (6.0%; 16/265) (P < 0.05), there was no significant difference regarding liver metastasis. The proportion of lymph node metastasis in MCs (72.2%; 13/18) was significantly higher than that in NMCs (44.9%; 119/265) (P < 0.05). There was no significant difference regarding the lymphatic and venous invasion. The 1-, 3-, and 5-year survival rates of patients with MCs were 77. 8%, 45.4%, and 30.3%, respectively, and were significantly lower than those in patients with NMCs, that were 88.9 %, 65.6%, and 60.8%, respectively (P < 0.05). CONCLUSIONS: As colorectal MCs proliferate and metastasize more rapidly than do NMCs, surgeons should realize that more aggressive surgical treatment should be occasionally administered to improve the postoperative prognosis of the patients with colorectal MCs.     

VEGF-C、COX-2在细支气管肺泡癌中的表达及其意义

目的探讨细支气管肺泡癌（BAC）中VEGF．C、COX-2蛋白表达及意义。方法BAC60例为实验组,肺腺癌伴BAC20例和肺腺癌22例为对照组,采用免疫组化法分别检测VEGF—C、COX-2蛋白在3种组织中的表达并分析其临床意义。结果VEGF．C在BAC、肺腺癌伴BAC和肺腺癌中阳性率分别为66．7％、90．0％和95．5％,各组间表达差异有统计学意义（P〈0．05）;VEGF—C在BAC非黏液型表达阳性率显著高于黏液型（P〈0．05）,伴淋巴结转移组阳性率明显高于无转移组（P〈0．05）,VEGF—C表达与性别、年龄、肿块部位、大小及TNM分期均无关联（P〉0．05）。COX-2在BAC、肺腺癌伴BAC和肺腺癌中阳性率分别为63．3％、75．0％和77．3％,各组间表达差异无统计学意义（P〉0．05）;COX-2在BAC伴淋巴结转移组表达阳性率明显高于无转移组（P〈0．05）,肿块直径≥3cm组阳性率明显高于肿块直径〈3cm组（P〈0．05）,COX-2表达与性别、年龄、肿块部位、病理类型及TNM分期均无关（P〉0．05）。VEGF-C与COX-2表达呈正相关（r=0．269,P〈0．05）。结论VEGF—C联合COX-2检测可用于BAC侵袭、转移特性的评估及预测。     

83例胃癌卵巢转移临床病理特征及预后分析*

  目的  探讨胃癌卵巢转移患者临床病理特征及影响预后的因素。  方法  回顾性分析2006年1月至2017年12月83例于解放军总医院诊治胃癌卵巢转移患者的临床资料及治疗方法,对可能影响预后的因素行单因素或多因素分析。  结果  83例患者中卵巢转移的中位直径为7.1(1.0~24.0) cm,转移病灶位于单侧36例(43.4%),位于双侧47例(56.6%),同时伴有腹膜转移35例(42.2%)。全组患者均行化疗,联合转移病灶切除57例(68.7%),腹腔热灌注化疗22例(26.5%)。74例(89.1%)完成随访,中位生存期15(12.5~17.5)个月,1、3、5年生存率分别为71.1%、6.5%、0。单因素分析显示原发病灶淋巴结转移大于6个、转移病灶切除、同时性胃癌卵巢转移、合并腹膜转移、免疫组织化学法检测ER阳性、血清CEA及CA125升高是影响预后的因素(均P < 0.05),多因素分析显示转移病灶切除、同时性胃癌卵巢转移、合并腹膜转移、免疫组织化学法检测ER阳性是影响预后的独立因素(均P < 0.05)。  结论  同时性胃癌卵巢转移、合并腹膜转移患者预后较差,免疫组织化学法检测ER阳性患者预后好于阴性患者,转移病灶切除可延长患者的生存时间。