大肠癌淋巴结转移相关因素研究现况

大肠癌有无淋巴结转移是制定手术方案及术后辅助治疗方法的重要依据之一,也是影响患者预后的主要因素．我们概述了近年来大肠癌淋巴结转移相关因素的研究进展,试图找出大肠癌淋巴结转移的某些规律,以供临床参考．１　肿瘤生物学特性１．１　肿瘤浸润深度　Ｃａｗｔｈｏｒｎｅｔａｌ［１］对２７２例大肠癌进行了分析,认为肿瘤的浸润深度与淋巴结转移无关．Ｈｏｊｏｅｔａｌ［２］观察了３８９份直肠癌病例后认为肿瘤限于粘膜及粘膜下层者淋巴结转移率为５／２８（１７－９％）,侵犯肌层者为３１／８２（３７－８％）,侵犯浆膜下层者３…     

大肠癌组织MMP-7表达与淋巴结和肝转移相关性的探讨

应用免疫组化技术检测60例大肠癌(其中淋巴结转移33例,肝转移30例)组织中基质金属蛋白酶7(MMP-7)蛋白的表达,分析其在不同临床病理类型患者中表达水平的差异性.发现MMP-7的表达与TNM分期、淋巴结转移和肝转移有关.认为MMP-7的过度表达在大肠癌的发病过程中具有促进效应,MMP-7的检测对评估大肠癌淋巴结转移及肝转移有重要意义.     

胃癌淋巴结转移影响因素临床分析

背景:胃癌是常见的消化道恶性肿瘤,淋巴结转移是其最主要的转移方式,亦是影响根治性切除术后胃癌患者预后的重要因素。目的:探讨胃癌淋巴结转移与患者临床病理特点之间的相关性。方法:对2007年1月～2008年1月在浙江省诸暨市人民医院行胃癌根治术的72例病例行回顾性分析,总结其临床病理特点。结果:性别、年龄和肿瘤部位与胃癌淋巴结转移均不相关(P0.05);胃癌的TNM分期越晚,淋巴结转移率越高(P0.01);脉管内有癌栓者的淋巴结转移率显著高于脉管内无癌栓者(84.2%对52.8%,P0.05):肿瘤浸润浆膜和浆膜外者的淋巴结转移率显著高于肿瘤浸润浆膜以内者(86.4%对28.6%,P0.01);低分化胃癌的淋巴结转移率显著高于高中分化胃癌(75.0%对39.3%,P0.01)。多因素Logistic回归分析显示,TNM分期和肿瘤浸润深度是胃癌淋巴结转移的危险因素,RR分别为9.000和9.335。结论:肿瘤的TNM分期和浸润深度是影响胃癌淋巴结转移的主要因素。     

淋巴结微转移检测对大肠癌病理分期的影响

目的 研究淋巴结微转移对结肠癌患者病理分期的影响.方法 对1120枚结直肠癌患者淋巴结进行常规HE染色和CK20、CEA免疫组化微转移的检测,并对结果进行统计学分析.结果 CK20检测出有微转移淋巴结103枚,占9.2％(103/1120),CEA检测出有微转移淋巴结88枚,占7.9％ (88/1120).CK20联合CEA检测出130枚淋巴结检出有微转移,占11.6％ (130/1120).肿瘤浸润愈深,微转移愈易发生(P＜0.05),分化程度低者,微转移阳性率高(P＜0.05).130枚淋巴结检出有微转移,13例TNM分期提高,其中Ⅰ期→Ⅲ期2例,Ⅱ期→Ⅲ期11例,HE染色重新分期率为18.6％ (13/70).结论 结直肠癌淋巴结免疫组化检测有助于更准确地进行结直肠癌的临床病理分期.     

K19mRNA与大肠癌淋巴结微转移关系的实验研究

本文应用RT－PCR方法检测淋巴结中组织特异的K19mRNA表达，并与传统的病理学检测对照，探讨其在大肠癌淋巴结转移诊断中的应用．1材料和方法1．1材料10例大肠癌及其62枚周围淋巴结标本均取自本院普外科患者，并另取2份正常大肠组织、4枚正常林巴结、5枚肠良性肿瘤患者手术分离淋巴结作对照．标本获得后立即用DEPC处理的PBS洗二遍，分为二份，一份置－40℃贮存，以备抽提RNA；另一份浸泡于福尔马林溶液中送病理鉴定（检测按病理科常规）．1．2方法引物由中科院上海细胞所合成，序列如下：K19cDNA引物，K1AGGTGGATTCCGCTCCGG…     

贲门癌淋巴结转移50例

1 材料和方法 1.1 材料 1997/1998我院胸外科及腹部外科住院手术贲门癌患者50例,其中男39例,女11例,年龄29岁～75岁,平均57.8岁,均经病理确诊为贲门腺癌。 1.2 方法 本组手术经胸38例,经腹11例,胸腹联合切口1例,手术发现肿瘤<3.0cm 4例,3.0cm～7.0cm 34例,>7.0cm12例。手术常规距肿瘤3cm～5cm以上行肿瘤切除并行弓下吻合及淋巴结清扫,贲门旁淋巴结28例,食管下段旁淋巴结25例,胃左动脉旁淋巴结22例,胃小弯淋巴结5例,腹腔动脉旁淋巴结4例分别送病理检查。全部病理标本均行常规病理检查,包括肿瘤长度、浸犯深度、断端残留及淋巴结转移情况。 统计学处理 数据资料均用卡方检验进行统计处理。     

nm23-H1基因突变与大肠癌转移的相关性

0 引言侵袭和转移是恶性肿瘤的生物学特性之一,大肠癌致死的原因之一是癌细胞的转移,其转移的机制一直是分子生物学研究的热点.诸多证据表明,在恶性肿瘤转移的过程中有许多基因在不同层次上参与调控.这些基因就其作用的性质可分为正向作用的转移基因和反向作用的抑制肿瘤转移基因,例如移动因子、粘附因子或酶蛋白因子.目前已分离出的几个能抑制肿瘤转移的基因,如:nm23基因、多种肿瘤抑制基因-Ⅰ(multiple tumor suppressor gene I,MTSI),WDNM1,WDNM2,以 nm23基因研究较多.为了进一步探讨 nm23-H1基因突变在大肠肿瘤演进中的作用.我们应用 PCR-SSCP-银染法检测 nm23基因在大肠癌组织中的改变,结合肿瘤的临床、病理资料综合分析,探究 nm23基因突变与大肠癌转移相关性.     

I~III期结直肠癌淋巴结转移比率与预后关系

目的评价I~III期结直肠癌淋巴结转移比率与患者预后的关系。 方法回顾性分析中山大学附属第一医院胃肠胰腺外科2004年6月至2008年11月间446例行根治性切除的结直肠癌患者临床病理数据,探讨结直肠癌预后相关危险因素,评估结直肠癌淋巴结转移比率与患者预后的关系。 结果446例结直肠癌I、II、III期患者的5年总体生存率分别约为87.4%,83.1%和64.8%（Log-rank检验,P<0.001）。我们根据淋巴结转移比率（metastatic lymph node ratio, mLNR）将CRC患者分为三组：A组：mLNR为0;B组：mLNR为>0%~14%;C组：mLNR为>14%。A、B、C组三组患者的5年总体生存率分别约为84.3%、79.6%和49.1%（Log-rank检验,χ²=55.959,P<0.001）。就直肠癌患者而言,A、B、C三组5年生存率分别为79.0%、73.5%和43.2%（Log-rank检验,χ²=26.332,P<0.001）。而对于结肠癌患者来说三组的5年生存率分别为87.1%,80.8%和55.5%（Log-rank检验,χ²=21.214,P<0.001）。单因素和多因素Cox分析均显示,mLNR是结直肠癌独立的预后危险因素,随着mLNR的上升,结直肠癌患者的预后变差。 结论淋巴结转移比率（mLNR）是结直肠癌患者预后的独立危险因素,与N分期类似,但更有优势,可作为评估结直肠癌患者预后的指标之一。     

T2期直肠癌淋巴结转移特点及预后多因素分析

回顾性分析120例T2期直肠癌的淋巴结转移特点,并对预后相关因素进行分析.120例患者总淋巴结转移率为23.3% (28/120),不同肿瘤大小和分化程度的病例的淋巴结转移率有统计学差异(P<0.05).多因素分析显示,肿瘤大小、分化程度和淋巴结转移为T2期直肠癌患者预后的独立影响因素.     

结直肠癌淋巴结转移相关因素的研究进展

结直肠癌淋巴结转移受多种因素的影响,众多因素之间相互联系、相互作用,临床工作中需对各种因素综合分析才能正确地做出诊断和治疗,本文查阅近十年关于结直肠癌淋巴结转移的相关因素的文献,初步总结了目前被普遍认同的影响结直肠癌淋巴结转移的相关因素,为研究结直肠癌淋巴结转移的独立因素提供思路。目前认为肿瘤的浸润深度、原发部位、分化程度、病理类型以及患者的术前血清CEA水平等与结直肠癌的淋巴结转移具有相关性。而肿瘤的大小和大体形态等因素与结直肠癌淋巴结转移是否具有相关性,目前的认识还不一致。造成以上研究结果出现差异的原因可能有:不同学者对于患者选择的差异、样本数量的多少以及采用的标准不同等。     

Relationship between lymph node sinuses with blood and lymphatic metastasis of gastric cancer

AIM: To elucidate the relationship between lymph node sinuses with blood and lymphatic metastasis of gastric cancer. METHODS: Routine autopsy was carried out in the randomly selected 102 patients (among them 100 patients died of various diseases, and 2 patients died of non-diseased reasons), their superficial lymph nodes locating in bilateral necks (include supraclavicle), axilla, inguina, thorax, and abdomen were sampled. Haematoxylin-Eosin staining was performed on 10 % formalin-fixed and paraffin-embedded lymph node tissue sections (5 um). The histological patterns of the lymph sinuses containing blood were observed under light microscope. The expression of CD31, a marker for endothelial cell, was detected both in blood and non-blood containing lymph node sinuses with the method of immunohistochemistry. RESULTS: Among the 1 322 lymph nodes sampled from the autopsies of 100 diseased cases, lymph node sinuses containing blood were found in 809 lymph nodes sampled from 91 cases, but couldn't be seen in the lymph nodes sampled from the non-diseased cases. According to histology, we divided the blood containing lymph node sinuses into five categories: vascular-opening sinus, blood-deficient sinus, erythrophago-sinus, blood-abundant sinus, vascular-formative sinus. Immunohistochemical findings showed that the expression of CD31 was strongly positive in vascular-formative sinuses and some vascular-opening sinuses while it was faint in blood-deficient sinuses, erythrophago-sinuses and some vascular-opening sinuses. It was almost negative in blood-abundant sinus and non-blood containing sinus. CONCLUSION: In the state of disease, the phenomenon of blood present in the lymph sinus is not uncommon. Blood could possibly enter into the lymph sinuses through the lymphaticovenous communications between the veins and the sinuses in the node. Lymph circulation and the blood circulation could communicate with each other in the lymph node sinuses. The skipping and distal lymphatic metastasis of gastric cancer may have some connection with the blood containing lymph node sinuses.     

大肠癌P53蛋白PCNA和CEA的表达与淋巴结转移的关系

目的研究大肠癌Ｐ５３蛋白、增殖细胞核抗原（ＰＣＮＡ）和ＣＥＡ的表达与淋巴结转移的关系．方法应用链霉菌素生物素（ＳＰ）免疫组化法，观察４４例大肠癌Ｐ５３，ＰＣＮＡ的阳性率和ＣＥＡ的表达型式．结果大肠癌Ｐ５３阳性率为５２３％；大肠癌Ｐ５３阳性表达与性别、年龄及肿瘤的部位、分化程度和浸润深度无关（Ｐ＞００５）；大肠癌Ｐ５３阳性者其淋巴结转移率较阴性者高（１４／２３，６０９％ｖｓ６／２１，２８６％，Ｐ＜００５）；Ｐ５３阳性表达及有淋巴结转移者其细胞增殖活性分别较Ｐ５３阴性表达及无淋巴结转移者高（５５９±１７ｖｓ３７９±１４，Ｐ＜００５；５６２±１５ｖｓ３９６±１７，Ｐ＜００５）；Ｐ５３阳性表达及有淋巴结转移者其ＣＥＡ表型均以胞质型和间质型为主（２１／２３，９１３％ｖｓ１３／２１，６１９％，Ｐ＜００５；１９／２０，９５０％ｖｓ１５／２４，６２５％，Ｐ＜００５）．结论检测Ｐ５３和ＰＣＮＡ表达及ＣＥＡ表型对判断大肠癌的恶性程度，预测其淋巴结转移趋势和预后及指导临床治疗有重要价值．     

Correlation between mitochondrial TRAP-1 expression and lymph node metastasis in colorectal cancer

AIM: To evaluate the effect of mitochondrial tumor necrosis factor receptor-associated protein-1 (TRAP-1) on the lymph node metastasis (LNM) in Chinese colorectal cancer (CRC) patients, and develop potential LNM-associated biomarkers for CRC using quantitative real-time polymerase chain reaction (RT-PCR) analysis.METHODS: Differences in mitochondrial TRAP-1 gene expression between primary CRC with LNM (LNM CRC) and without LNM (non-LNM CRC) were assessed in 96 Chinese colorectal carcinoma samples using quantitative RT-PCR analysis, Western blotting, and confirmed with immunohistochemical assay. The relationship between clinicopathological parameters and potential diagnostic biomarkers was also examined.RESULTS: TRAP-1 was significantly upregulated in LNM CRC compared with non-LNM CRC, which was confirmed by RT-PCR, Western blotting and immunohistochemical assay. The expression of TRAP-1 in two different metastatic potential human colorectal cancer cell lines, LoVo and HT29, was analyzed with Western blotting. The expression level of TRAP-1 was dramatically higher in LoVo than in HT29. Overexpression of TRAP-1 was significantly associated with LNM (90.2% in LNM group vs 22% in non-LNM group, P < 0.001), the advanced tumor node metastasis stage (89.1% in LNM group vs 26.9% in non-LNM group, P < 0.001), the increased 5-year recurrence rate (82.7% in LNM group vs 22.6% in non-LNM group, P < 0.001) and the decreased 5-year overall survival rate (48.4% in LNM vs 83.2% in non-LNM group, P < 0.001). Univariate and multivariate analyses indicated that TRAP-1 expression was an independent prognostic factor for recurrence and survival of CRC patients (Hazard ratio of 2.445 in recurrence, P = 0.017; 2.867 in survival, P = 0.028).CONCLUSION: Mitochondria TRAP-1 affects the lymph node metastasis in CRC, and may be a potential biomarker for LNM and a prognostic factor in CRC. Over-expression of TRAP-1 is a predictive factor for the poor outcome of colorectal cancer patients.     

T2大肠癌淋巴结转移的相关临床病理因素

目的:探讨与T2期大肠癌淋巴结转移密切相关的临床病理因素,为其合理高效的个体化治疗提供指标.方法:收集1991-01/2006-08中国医科大学附属第一医院肿瘤外科行根治性手术的T2期大肠癌患者324例,回顾性分析其各临床病理因素与淋巴结转移的关系.结果: 肿瘤浸润深度(OR =3.841,95% CI: 1.581-9.329,P = 0.003)与组织分型(OR = 1.451,95% CI: 1.059-1.989,P = 0.023)是影响T2大肠癌淋巴结转移的主要因素.尤其是肿瘤浸及固有肌层上1/2即浅肌层(mp1)和下1/2即深肌层(mp2),淋巴结转移率差异显著.而性别、年龄、肿瘤部位、肿瘤大小、生长方式和淋巴管及血管浸润等因素与淋巴结转移的相关性不显著.结论:肿瘤的浸润深度及组织学类型是影响T2大肠癌淋巴结转移的主要因素.其中浸润深度尤为重要,可将mp1视为一道阻止癌细胞转移播散的屏障,一旦超过mp1水平,淋巴结转移风险将显著增加.     

Clinicopathologic factors and molecular markers related to lymph node metastasis in early gastric cancer

AIM: To analyze predictive factors for lymph node metastasis in early gastric cancer.METHODS: We analyzed 1104 patients with early gastric cancer(EGC) who underwent a gastrectomy with lymph-node dissection from May 2003 through July 2011. The clinicopathologic factors and molecular markers were assessed as predictors for lymph node metastasis. Molecular markers such as microsatellite instability, human mut L homolog 1, p53, epidermal growth factor receptor(EGFR) and human epidermal growth factor receptor 2(HER2) were included. The χ2 test and logistic regression analysis were used to determine clinicopathologic parameters.RESULTS: Lymph node metastasis was observed in 104(9.4%) of 1104 patients. Among 104 cases of lymph node positive patients, 24 patients(3.8%) were mucosal cancers and 80 patients(16.7%) were submucosal. According to histologic evaluation, the number of lymph node metastasis found was 4(1.7%) for well differentiated tubular adenocarcinoma, 45(11.3%) for moderately differentiated tubular adenocarcinoma, 36(14.8%) for poorly differentiated tubular adenocarcinoma, and 19(8.4%) for signet ring cell carcinoma. Of 690 EGC cases, 77 cases(11.2%) showed EGFR overexpression. HER2 overexpression was present in 110 cases(27.1%) of 406 EGC patients. With multivariate analysis, female gender(OR = 2.281, P = 0.009), presence of lymphovascular invasion(OR = 10.950, P 0.0001), diameter(≥ 20 mm, OR = 3.173, P = 0.01), and EGFR overexpression(OR = 2.185, P = 0.044) were independent risk factors for lymph node involvement.CONCLUSION: Female gender, tumor size, lymphovascular invasion and EGFR overexpression were predictive risk factors for lymph node metastasis in EGC.     

食管癌环氧化酶-2的高表达与淋巴转移的关系

目的　探讨环氧化酶 -2 (COX -2 )在食管癌中的表达情况及其与淋巴结转移的关系。方法　应用免疫组织化学方法(SP法 ) ,检测 1999～ 2 0 0 1年手术切除的 76例食管癌病人中COX -2的表达。其中有食管旁淋巴结转移者 18例 ,胃左动脉旁淋巴结转移者 11例。结果　COX -2在食管癌中的表达率为 81 6 %,主要为癌组织的表达 ,而在癌旁组织几乎不表达 ;食管癌旁和胃左动脉旁淋巴结转移组COX -2的表达水平均高于未转移组 (P <0 0 0 1)。结论　食管癌中COX -2的高度表达与食管癌的发生、发展及淋巴结转移有关 ,提示COX -2可能是防治食管癌的一个靶位。     

Sentinel lymph node concept in gastric cancer with solitary lymph node metastasis

AIM: To study the localization of the solitary metastases in relation to the primary gastric cancers and the feasibility of sentinel lymph node (SLN) concept in gastric cancer. METHODS: Eighty-six patients with gastric cancer, who had only one lymph node involved, were regarded retrospectively as patients with a possible sentinel node metastasis, and the distribution of these nodes were assessed. Thirteen cases with jumping metastases were further studied and followed up. RESULTS: The single nodal metastasis was found in the nearest perigastric nodal area in 65.1% (56/86) of the cases and in 19.8% (17/86) of the cases in a fairly remote perigastric area. Out of 19 middle-third gastric cancers,3 tumors at the lesser or greater curvatures had transverse metastases. There were also 15.1% (13/86) of patients with a jumping metastasis to N2-N3 nodes without N1 involved. Among them, the depth of invasion was mucosal (M) in 1 patient, submucosal (SM) in 2, proper-muscular (MP) in 4, subserosal (SS) in 5, and serosa-exposed (SE) in 1. Five of these patients died of gastric cancer recurrence at the time of this report within 3 years aftersurgery. CONCLUSION: These results suggest that nodal metastases occur in a random and multidirectional process in gastric cancer and that not every first metastatic node is located in the perigastric region near the primary tumor. The rate of “jumping metastasis” in gastric cancer is much higher than expected, which suggests that the blind examination of the nodal area close to the primary tumor can not be a reliable method to detect the SLN and that a extended lymph node dissection (ELND) should be performed if the preoperative examination indicates submucosal invasion.     

Predictive factors for lymph node metastasis in early gastric cancer

AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors ...