Dukes B期结直肠癌根治术后复发转移分析

目的探讨Dukes B期结直肠癌根治术后复发转移相关的临床病理因素。方法应用单因素分析法，回顾性分析1990—1999年265例Dukes B期结直肠癌根治术病例的临床病理因素。结果单因素分析显示，Dukes B期大肠癌的预后与肿瘤部位有关，直肠癌术后更易发生复发转移，特别是局部复发。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度、肠壁浸润深度与术后复发转移无关。结论Dukes B期的直肠癌患者术后局部复发的风险较大。     

结直肠癌术后复发和转移的防治对策

1　结直肠癌复发的概念及原因　　外科手术仍是治疗结直肠癌的主要手段 ,但对于进展期肿瘤而言 ,在所谓根治性手术后复发转移率一直在 5 0 %左右 ,其中 3 0 %的病例其最终结局是死于术后局部复发 ,因此如何预防、治疗结直肠癌术后复发既是困扰外科医师们的难题 ,又是外科医师们不懈努力的研究热点。结直肠癌术后复发实际上是肿瘤的转移特性 ,其概念可以这么认为 ,即在肿瘤得到相对根治性切除后 ,由残留的癌细胞继续生长而出现新的瘤灶 ,如第一次手术时已存在显性转移 ,不能称之为复发。如果做到了肿瘤的绝对根除 ,如早期肿瘤根除性切除以后 …     

复方斑蝥胶囊预防Ⅲ期结直肠癌患者术后复发转移的多中心临床研究

目的:研究复方斑蝥胶囊预防Ⅲ期结直肠癌患者术后复发转移的安全性与有效性。方法:采用多中心随机双盲安慰剂对照的临床研究方法,将141例Ⅲ期结直肠癌术后完成辅助化疗4个周期以上患者分为观察组68例,对照组73例,观察组予以复方斑蝥胶囊口服,对照组予以安慰剂口服。干预6个月后,评价两组复发转移情况,临床症状、生存质量及安全性。结果:中位随访36.5个月,观察组8例(11.8%)、对照组15例(20.6%)发生复发转移。观察组的2年无病生存率为95%,高于对照组的82%(HR=0.24,95%CI 0.07～0.85,P=0.02);与对照组相比,观察组总生活质量评分、疲乏、疼痛、气促明显改善。观察期间两组不良反应事件无明显差异,且均无严重不良反应发生。结论:复方斑蝥胶囊可延长Ⅲ期结直肠癌术后完成辅助化疗4个周期以上患者的两年无病生存率,改善症状,提高生存质量。     

Dukes B期结直肠癌根治术后复发转移分析

目的探讨Dukes B期结直肠癌根治术后复发转移相关的临床病理因素。方法应用单因素分析法,回顾性分析1990-1999年265例Dukes B期结直肠癌根治术病例的临床病理因素。结果单因素分析显示,Dukes B期大肠癌的预后与肿瘤部位有关,直肠癌术后更易发生复发转移,特别是局部复发。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度、肠壁浸润深度与术后复发转移无关。结论Dukes B期的直肠癌患者术后局部复发的风险较大。     

提高对结直肠癌术后复发和转移的诊治水平

全世界结直肠癌发病率仍处于上升趋势 ,平均每年递增 2 %。在欧美国家其死亡率仍居癌症死亡的第二位。我国情况亦相似 ,以上海为例 ,发病率年递增 4.2 %,比全球平均递增速度还要高一倍多。1 990～ 1 992年我国十分之一人口抽样调查 ,结直肠癌平均调整死亡率为 4.5 4 / 1 0万 ,居癌症死亡第五位 [1] 。　　在治疗上 ,结直肠癌治疗效果还不够理想 ,近三十多年来提高并不显著。美国癌症协会 Cutler统计分析 2 5 0 0 0例结直肠癌资料 ,外科治疗结肠癌 5年生存率从 1 940～ 1 96 0年由 48%提高到 5 6 %;直肠癌由 44%提高到 5 0 %。英国牛津大学…     

结直肠癌术后复发和转移的影响因素和对策

大肠癌是外科治疗效果良好的肿瘤之一，根据日本大肠癌研究会2000年的统计结、直肠癌根治术后5年累积生存率分别为82．2％和76．8％。但是结直肠癌术后复发仍是影响外科疗效主要因素，如何防止和早期发现及合理治疗复发性结直肠癌是提高远期疗效的关键。     

结直肠癌肝转移术后肝内复发的再治疗

外科手术切除结直肠癌肝转移灶后患者的5年存活率虽可达20%,但术后肝内再次复发转移并不少见[1]。我院1993年6月至2003年6月间71例结直肠癌肝转移患者接受外科治疗,其中22例(31.0%)肝癌复发,18例再次接受治疗。     

直肠癌术后局部复发的防治

直肠癌发病率在我国有逐渐增高趋势 ,直肠癌防治措施也在逐年提高 ,但局部复发率仍在 1 2 .7%～ 31 % [1] ,局部复发及远处转移仍是防治中难以解决的课题。 2 0年来我院普外肛肠专业组在吸取国内外经验的基础上 ,也尝试使用一些方法防治局部复发 ,收到一定效果 ,现将我们的体会介绍如下。1　临床资料　　 1 991年 1月至 1 998年 1 2月共收治直肠癌 640例 (失访 49例除外 ) ,其中保肛手术 (包括局部切除 ) 464例 ( 72 % ) ,Miles手术 1 76例 ( 2 8% ) ,复发 1 0 2例 ( Miles手术 62例 ,前切除 40例 ) ,总复发率为 1 6% ,局部复发 5 8例 (包…     

要重视结直肠癌根治术后复发及转移的防治

根治性手术切除是治疗结、直肠癌的最有效方法 ,但术后局部复发、远位转移仍是当前面临的难题。它不仅威胁着患者的生命 ,而且有些症状会使患者痛苦不堪 ,如 :盆腔持续性疼痛、直肠里急后重等 ,严重影响患者的生活质量。因此 ,必须重视根治术后防止复发及转移的研究。以下从临床方面就其发生的原因和对策谈几点认识。一、结直肠癌根治术后何时容易发生局部复发和转移结直肠癌根治术后 5年内复发和转移为 37% ,肝转移占 13%～ 32 % ;局部复发大多发生于术后 2年内。Ｈｉｎｄｏ[1] 报告的 115例患者 ,6 5%在术后 2年内复发。至于根治术后何时…     

IL-10和IL-12在结直肠癌肝转移中作用的临床研究

目的探讨IL-10、IL-12在结直肠癌肝转移中作用。方法分别收集自2008年1月到2010年6月健康成年人、结直肠癌术前、术后和术后肝转移患者外周血,采用ELISA法测定外周血清IL-10、IL-12水平,采用FACS Calibur3.0流式细胞仪测定T淋巴细胞及其亚群比例,进行各组结果统计学分析。结果结直肠癌术后肝转移患者外周血清IL-10水平显著高于健康成年人、结直肠癌术后患者(P<0.05),结直肠癌术后患者外周血清IL-10水平显著低于术前患者(P<0.05);结直肠癌术前、术后和术后肝转移患者外周血清IL-12水平显著低于健康成年人,结直肠癌术前、术后患者之间以及术后和术后肝转移患者之间外周血清IL-12水平存在统计学差异(P<0.05);结直肠癌术后肝转移患者外周血T淋巴细胞总数及Th细胞比例数显著低于健康成年人(P<0.05),Ts细胞比例数显著高于健康成年人(P<0.05)。NK细胞在结直肠癌术后肝转移患者显著低于健康成年人(P<0.05)。结论不同临床时期结直肠癌患者存在细胞免疫或体液免疫严重障碍,纠正机体细胞因子和免疫状态紊乱,不仅能够改善机体免疫功能,可能有助于控制结直肠癌的发生、发展。     

免疫功能水平与腹腔镜结直肠癌根治术后复发的相关性研究

目的:研究免疫功能水平与腹腔镜结直肠癌根治术后复发率的相关性.方法:回顾性选取2016年1月—2017年1月年于河北中石油中心医院治疗的120例结直肠癌患者作为研究对象,对患者进行为期3年的随访,根据是否复发分为复发组和对照组,每组60例.观察两组患者的临床资料及免疫指标水平,对比分析两组患者的相关指标是否存在差异.结...     

Randomized Trial Comparing Locoregional Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at the Presentation (Protocol MF07-01): A Study of Turkish Federation of the National Societies for Breast Diseases

Abstract:  The MF07-01 trial is a phase III randomized controlled trial which compares breast cancer patients with distant metastases at presentation who receive locoregional treatment for intact primary tumor with those who do not receive such treatment. The primary objective of the study is to assess whether locoregional treatment of the primary tumor provides a better overall survival. Secondary objectives include progression-free survival, quality-of-life, and morbidity related to locoregional treatment. Locoregional treatments consist of either mastectomy or breast conserving surgery with level I-II axillary clearance in clinically or sentinel lymph node positive patients. Radiation therapy to the whole breast follows breast conserving surgery. Standard systemic therapy is given to all patients either immediately after randomization in no-locoregional treatment arm or after surgical resection of the intact primary tumor in locoregional treatment arm. The study is conducted in Turkey as a multicenter trial with central randomization. Total accrual target is 271. The trial was activated in October 2007 and authorized centers started to recruit patients since then. ClinicalTrials.gov identifier number is NCT00557986.     

Radiofrequency Thermal Ablation of Breast Cancer Local Recurrence: A Phase II Clinical Trial

Background  The role of radiofrequency (RF) ablation to treat local recurrence of breast cancer is unknown. Methods  We conducted a two-stage phase II clinical trial. Eligible patients had a histologically confirmed noninflammatory and ≤3 cm ipsilateral breast tumor recurrence. The tumor site was identified by intraoperative sonography. A LeVeen needle electrode (RadioTherapeutics Corp, Mountain View, Calif) was inserted into a single site within the tumor and radiofrequency ablation was performed using a RF-2000 generator (RadioTherapeutics Corp). After completion of radiofrequency, a mastectomy was performed. Conventional staining and nicotinamide adenine dinucleotide-diaphorase (NADH-diaphorase) cell viability staining were performed. Results  During the first stage, procedures were uneventful. Conventional, cytokeratin, and NADH-diaphorase staining identified persistent viable tumor cells in the RF-ablated region in three patients. This phase II trial was stopped after completion of the first stage because of insufficient efficacy. Conclusion  We demonstrate in this study that RF ablation is a potential technique to destroy local recurrence of breast tumors but the technique we tested in this phase II clinical trial had insufficient efficacy to recommend its use in routine.     

腹腔镜结直肠癌根治术后血清趋化因子配体5、循环肿瘤细胞CK20表达与肿瘤复发、转移的关系研究

目的:探讨腹腔镜结直肠癌根治术后血清趋化因子配体5(CXCL5)、循环肿瘤细胞CK20的表达与肿瘤复发、转移的关系。方法:选取2015年5月—2017年7月在河北中石油中心医院接受腹腔镜结直肠癌根治手术治疗的120例结直肠癌患者,术后1 d检测两组血清CXCL5、外周血循环肿瘤细胞CK20的水平,并对患者进行为期36个月的随访观察,其中发生局部复发或转移的患者84例(复发组)、未发生局部复发或转移的患者36例(对照组);比较两组患者的一般资料、病理学资料及术后1 d的CXCL5、循环肿瘤细胞CK20表达情况;采用Logistic多因素分析CXCL5、循环肿瘤细胞CK20与肿瘤复发的关系。结果:复发组和对照组的年龄、性别、体质指数(BMI)、肿瘤位置差异无统计学意义(P0.05);复发组与对照组的肿瘤直径、病理学类型、肿瘤分化程度、是否伴有肠梗阻、TNM分期、淋巴结转移、肿瘤淋巴血管侵犯比较差异有统计学意义(P0.05);复发组的血清CXCL5水平、外周血循环肿瘤细胞CK20阳性检出率高于对照组,差异有统计学意义(P0.05);Logistic多因素分析结果显示,肿瘤低分化、肠梗阻、TNM分期为Ⅲ～Ⅳ期、发生淋巴结转移、发生肿瘤淋巴血管侵犯、血清CXCL5水平增高、外周血循环肿瘤细胞CK20阳性表达是结直肠癌患者腹腔镜根治手术后复发、转移的独立危险因素(P0.05)。结论:血清CXCL5水平增高、外周血循环肿瘤细胞CK20阳性表达可增大结直肠癌患者腹腔镜根治手术后复发、转移的风险。     

Prognostic Significance of Immunohistochemically Localized Biomarkers in Stage II and Stage III Breast Cancer: A Multivariate Analysis

Background: The aim was to investigate the expression of a panel of biomarkers such as prolactin (PRL), p53, Bcl-2, c-erb B2, Ki-67, CD44, and factor VIII-related antigen (FVIII-RA) in primary tumors of stage II and stage III breast cancer and its correlation with disease prognostication.Methods: The streptavidin-biotin peroxidase complex technique was used for the detection of these antigens. Cytoplasmic staining pattern was observed for PRL, Bcl-2, and Ki-67. Staining pattern for p53 was nuclear. Membranous and/or cytoplasmic staining was noted for c-erb B2 and CD44. Microvessel staining was noted for FVIII-RA.Results: Of the 93 primary breast tumors analyzed, positivity for PRL was noted in 82%, for p53 in 56%, for Bcl-2 in 73%, for c-erb B2 in 68%, and for Ki-67 and CD44 in 78% each. The microvessel count (MVC) for FVIII-RA ranged from 0.0 to 29.0, with a median of 6.0, which was used as a cutoff. MVC $ 6.0 was noted in 51% of breast tumors. With increasing tumor size, the higher frequency of positivity of MVC $ 6.0 (P 5 .0001), CD44 (P 5 .001), PRL (P 5 .002), and c-erb B2 (P 5 .008), and higher frequency of Bcl-2 negativity (P 5 .033), was noted. In stage III patients, a higher positivity of the following biomarkers was noted, compared with stage II patients: MVC $ 6.0 (P 5 .0004), PRL (P 5 .0002), c-erb B2 (P 5 .001), and CD44 (P 5 .005). Further, Bcl-2 positivity was significantly lower in patients with stage III disease compared with those with stage II disease (P 5 .024). In patients with nodal involvement, the frequency of c-erb B2 (P 5 .006), MVC $ 6.0 (P 5 .011), and PRL (P 5 .032) was higher than in those without nodal involvement. Moreover, in these patients, with the increase in the number of involved lymph nodes, there was a significant increase in frequency of CD441 (P 5 .0004) and PRL1 (P 5 .013) tumors. Abnormal expression of one biomarker was seen in 7% of tumors, of two biomarkers in 4%, of three in 15%, of four in 19%, of five in 28%, of six in 20%, and of all seven biomarkers in 7% of tumors. The frequency of an increasing number of biomarkers coexpressed was higher in stage III patients compared with stage II patients (P 5 .00003). In the total number of patients (n 5 93), tumors with Bcl-2 negativity (P 5 .00001), MVC $ 6.0 (P 5 .001), PRL positivity (P 5 .02), and CD44 positivity (P 5 .034) had a significantly poorer overall survival (OS) compared with their respective counterparts. In stage II patients (n 5 40), only p53 expression was significantly associated with reduced relapse-free survival (P 5 .009) and OS (P 5 .040). In multivariate analysis, p53 expression was an independent prognostic factor that influenced relapse-free survival (P 5 .034) of stage II breast cancer patients. However, it failed to attain statistical significance for OS. In stage III patients (n 5 53), tumors with Bcl-2 negativity (P 5 .0005) and MVC $ 6.0 (P 5 .039) had a significantly poorer OS compared with their respective counterparts. In multivariate analysis of stage III patients, Bcl-2 was the only independent prognostic factor (P 5 .001) for predicting OS. There was a significant association between coexpression of the biomarkers and OS (P 5 .001). The OS rates decreased with the increase in number of abnormally expressed biomarkers.Conclusions: p53 expression in primary tumors was an independent prognostic factor that influenced relapse-free survival in patients with stage II disease. In stage III patients, lack of Bcl-2 expression was independently associated with a poor prognosis and, thus, may be an indicator of aggressive phenotype.     

Lymph Node Retrieval and Assessment in Stage II Colorectal Cancer: A Population-Based Study

Background: Adjuvant chemotherapy for patients with stage III (node-positive) colorectal cancer (CRC) reduces mortality by one third. Retrieval of an inadequate number of lymph nodes in the surgical specimen may result in incorrectly designating some patients as stage II (node negative), and consequently, such patients may not be offered appropriate chemotherapy. Recent National Cancer Institute guidelines suggest that a minimum of 12 nodes should be examined to ensure accurate staging.Methods: This population-based study identified stage II (T3N0 and T4N0) CRC cases by using CRC pathology reports (1997–2000) from the Ontario Cancer Registry. Patients aged 19 to 75 years were identified, and demographic, surgical, pathologic, and hospital data were extracted. Factors relating to the number of lymph nodes assessed were examined.Results: A total of 8848 CRC cases were reviewed, and 1789 stage II cases were identified. Seventy-three percent of cases were designated as node negative on the basis of assessment of <12 lymph nodes. Multivariate analysis showed that age, tumor size, specimen length, use of a pathology template, and academic status of the hospital were significant predictors of the number of lymph nodes assessed.Conclusions: A subset of patients with CRC in Ontario were assigned stage II disease on the basis of examination of relatively few lymph nodes.