早期胃癌淋巴结转移对预后的影响

目的探讨早期胃癌的淋巴结转移对预后的影响。方法回顾性分析1990年6月至2000年6月收治早期胃癌的临床病理资料及术后随访资料,对有淋巴结转移的早期胃癌与无淋巴结转移的早期胃癌的病理特征及5年生存率进行比较。结果早期胃癌的淋巴结转移与肿瘤大小、浸润深度有关,有淋巴结转移的5年生存率明显低于无淋巴结转移者,分别是72.4%和92.5%。淋巴结转移≥4的5年生存率明显低于1~3淋巴结转移者,分别是50.0%和84.2%。结论淋巴结转移是影响预后的重要因素,对淋巴结转移广泛的早期胃癌应采取以根治性手术为主的综合治疗方案。     

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目的 探讨早期胃癌的淋巴结转移规律及其对预后的影响。方法 对161例有癌病人术后进行长期随访，对24例伴有淋巴结转移的早期胃癌与137例无淋巴结转移的早期胃癌的临床病理特征及3、5年生存率进行比较。结果 早期胃癌的淋巴结转移与肿瘤大小、浸润深度及淋巴、静脉侵犯有关，伴有淋巴结转移的早期胃癌3、5年生存率分别为82.8%和80.5%，明显低于无淋巴结转移者，后者分别为96.1%和92.4%。结论 术前或术中正确评估早期胃癌的淋巴结转移状态是选择合理的治疗方案和改善预后的重要条件。     

淋巴结转移数目是Vater壶腹癌术后显著的预后指标

目的探讨Vater壶腹癌根治术后的预后相关因素。方法回顾分析行胰十二指肠切除术及局部淋巴结清扫术的65例Vater壶腹癌患者的临床病理资料及生存状况。结果65例患者共切除淋巴结1380枚。有33例患者发现116枚淋巴结转移，随访83个月，发现20例有1～3枚淋巴结转移者，中位生存49个月，术后5年生存率为43％；13例有4枚或4枚以上淋巴结转移者，术后23个月内全部死亡。单因素分析发现，阳性淋巴结数目（P〈0．01）和位置（P〈0．01）是显著的预后指标。多因素分析发现，阳性淋巴结数目是独立的预后指标（P=0．007）。结论淋巴结转移数目是Vater壶腹癌患者根治手术后长期生存的独立相关因素。     

老年人早期胃癌的外科治疗

目的探讨老年人早期胃癌的临床病理特征、适宜的外科治疗方式及其预后。方法回顾性分析1989年8月至2004年8月间我院收治的83例老年早期胃癌患者临床病理及术后随访资料。结果本组手术切除率为100％，手术死亡率为0，腹腔及切口感染率为0，无吻合口漏。5年生存率为98％、10年生存率为95％、15年生存率为92％。83例中黏膜癌61例，占74％，无淋巴结转移；黏膜下癌22例，占26％，淋巴结转移4例，多原发癌7例。结论对老年人早期胃癌多癌灶而言，即使病变较小也应作3／4胃切除；癌灶相距远者则应行全胃切除。淋巴结转移、多原发癌及肿瘤侵及黏膜下层是影响预后的重要因素。     

直肠癌尖淋巴结转移的危险因素分析

为探讨直肠癌尖淋巴结（APN）转移与其预后及与转移淋巴结总数的关系,回顾性研究510例行直肠癌切除术病理诊断淋巴结阳性患者的临床资料,并对APN与患者预后和N分期之间的关系进行单因素及多因素分析。全组患者术后平均随访47个月,术后5年局部复发率18．3％,无瘤生存率55．5％,总生存率58．8％。     

N1期食管鳞癌淋巴结转移规律及预后分析

目的：探讨N1期食管鳞癌淋巴结转移规律及其与预后的关系。方法回顾性分析2005年1月至2008年12月间天津医科大学肿瘤医院行食管癌根治术且术后病理诊断为N1期（1～2枚淋巴结转移）的126例患者的临床及随访资料,分析各组淋巴结转移情况及其对预后的影响。结果126例患者中仅1枚淋巴结转移者70例,2枚淋巴结转移者56例。上纵隔淋巴结、中下食管旁淋巴结、贲门周围淋巴结和胃左动脉旁淋巴结的早期转移率较高,分别为53．8％（14/26）、38．3％（41/107）、34．5％（30/87）和36．8％（39/106）。隆突下淋巴结转移（P＝0．031）和中下食管旁淋巴结转移（P＝0．042）是影响食管鳞癌早期淋巴结转移患者的独立预后因素。隆突下淋巴结转移者5年生存率明显低于其他部位淋巴结转移者（8％比26％,P＝0．004）;而仅中下食管旁淋巴结转移者5年生存率则明显高于其他部位淋巴结转移者（33％比12％,P＝0．029）。结论 N1期食管鳞癌淋巴结易转移至上纵隔、中下食管旁、贲门周围和胃左动脉旁淋巴结等部位,而隆突下及中下食管旁淋巴结转移是N1期患者的独立预后因素。     

外科治疗ⅢA期N2非小细胞肺癌的预后分析及临床意义

目的 探讨影响ⅢA期N2非小细胞肺癌（NSCLC）预后的因素，并分析经手术治疗不同亚组病人的生存率差异。方法 分析1997年1月至2000年1月146例手术治疗的ⅢA期N2 NSCLC病人的可能影响预后因素：病理类型、肿瘤位置、肿瘤大小、手术方式、临床N2情况，N2转移组数及个数、术后辅助治疗等，并用Kaplan-Meier曲线及Logr ank检验生存率差异，Cox单因素、多因素分析各因素对生存率的影响。结果 ⅢA期N2 NSCLC病人的3年和5年生存率分别为19．86％和14．56％。单因素分析示肿瘤位置、临床N2情况、N2转移组数及个数是影响生存率的因素；多因素分析示肿瘤大小、临床N2情况，N2转移组数和肿瘤位置影响预后。右肺下叶肿瘤单组或单个N2转移，预后最好。结论 纵隔N2转移淋巴结的大小、个数和组数是影响术后生存率主要因素。手术前未发现N2转移（mN2），有1组N2转移（N2h），N2转移数少于4个者手术治疗效果好。右肺下叶肿瘤发生单组N2淋巴结转移预后好。     

胸上段食管癌临床病理与预后分析

目的探讨胸上段食管癌的临床病理特征及其与预后的关系。方法回顾性分析1996年1月至2001年12月65例胸上段食管癌患者的临床病理特征及其预后影响因素。结果患者1、3、5年生存率分别为72.3％、36．9％、21．5％。单因素分析显示患者预后与肿瘤浸润深度、肿瘤大小、临床分期、淋巴结转移、肿瘤根治程度等因素有关（P〈0．05）；多因素分析显示，肿瘤根治程度、淋巴结转移、肿瘤浸润深度为影响食管癌切除术后预后的重要因素（P〈0．05）。结论肿瘤根治程度、淋巴结转移、肿瘤浸润深度是影响预后的独立因素。     

淋巴结转移对胰腺癌患者预后的影响北大核心CSCD

目的分析有无淋巴结转移胰腺癌的临床病理特点,探讨淋巴结转移与患者预后的关系。方法回顾性收集2001至2015年经病理证实且有完整临床及随访资料的胰腺癌216例,运用Kaplan-Meier法计算患者的生存率．描绘有无淋巴结转移患者的生存曲线;采用Log-rank法比较胰腺癌患者有无淋巴结转移与预后的关系。结果患者术后生存时间4～86个月,中位生存时间19个月,术后1、3、5年生存率分别为65．1％、33．8％、20．5％。有淋巴结转移胰腺癌患者术后1、3、5年生存率分别为36．5％、12．2％、0％,无淋巴结转移胰腺癌患者术后1、3、5年生存率分别为70．3％、38．0％、21．4％,无淋巴结转移组患者的生存时问长于有淋巴结转移组转患者（X^2=15．803,P〈0．001）。结论有淋巴结转移胰腺癌患者预后较无淋巴结转移患者差,淋巴结转移是胰腺癌根治切除术患者预后的主要影响因素之一。     

复发性结直肠癌的临床病理特征和预后

目的探讨复发性结直肠癌的临床病理特征和预后。方法对进行根治性切除的993例结直肠癌患者中235例复发患者的临床资料进行总结，并分析术后复发的影响因素。结果根治术后全组总体5、10年生存率分别为67．7％和55．8％；术后复发组则分别为43．9％和28．1％；差异有统计学意义（P〈0．001）。复发组患者中，再次行根治性切除者的5、10年生存率分别为50．2％和32．7％；而予以姑息手术或保守治疗者则分别为25．8％和0；差异亦有统计学意义（P〈0．001）。单因素分析显示，复发的结直肠癌患者年龄、癌性肠梗阻和腹水、淋巴结转移及肿瘤大体分型、侵袭程度及病理分期与术后复发密切相关；而多因素分析则显示，癌性肠梗阻和腹水、肿瘤大体分型及病理分期与术后复发和转移密切相关。结论根治术后结直肠癌患者的复发和转移与癌性肠梗阻和腹水及肿瘤病理分期密切相关；再次手术切除可以提高复发转移患者的生存率。     

早期胃癌患者临床病理因素与预后的关系

目的 探讨早期胃癌患者临床病理因素与预后之间的关系,为制定合理的治疗方案提供帮助.方法 回顾性分析2002年1月至2007年10月复旦大学附属中山医院收治的459例接受D2手术的早期胃癌患者的临床资料.Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析,Cox回归模型分析年龄、性别、肿瘤直径、大体类型、分化程度、浸润深度、淋巴管浸润、淋巴结转移数目对预后的影响.结果 肿瘤直径、分化程度、浸润深度、淋巴管浸润和淋巴结转移数目影响早期胃癌患者预后(χ~2=8.476,6.210,4.014,14.197,55.027,P<0.05).是否有淋巴结转移是影响早期胃癌预后的独立危险因素,且淋巴结转移数目越多,对预后的影响越大.结论 淋巴结转移是影响早期胃癌预后最为重要的因素,适度地施行淋巴结清扫有重要的意义,对于存在淋巴结转移高危因素的患者更应谨慎地施行微创手术.     

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目的探讨胃癌的临床病理特征与预后的关系。方法应用单因素和多因素的分析方法,回顾性分析1996年1月至2001年7月有完整临床病理资料和随访资料的256例胃癌病人的临床特点、病理特征及其预后影响因素。结果胃癌病人总的1、3年存活率分别为82.6%和63.1%。单因素分析显示,其预后与贫血、血小板增多、分化等级、浸润深度及转移情况均有相关性。应用Cox比例危险回归模型分析显示,血小板增多、浸润深度和转移情况是影响胃癌病人术后生存的独立因素。结论血小板增多是继肿瘤转移、肿瘤浸润深度后,影响胃癌预后的重要指标。     

Significant prognostic factors in patients with early gastric cancer

BACKGROUND: Early gastric cancer is defined as a gastric carcinoma confined to the mucosa or submucosa regardless of lymph node status, and it has an excellent prognosis with a 5-year survival rate of more than 90%. From 1985 to 1995, we encountered 266 cases of early gastric cancer in our hospital. METHODS: A retrospective analysis of the 266 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathological features (age, gender, tumor size, tumor location, depth of invasion, lymph node metastasis, histological type, lymphatic invasion, vascular invasion, histological growth pattern, cancer-stromal relationship and type of operation). RESULTS: The overall survival rate of all the patients with early gastric cancer was 95.7%. In univariate analysis, the statistical significant prognostic factors were regional lymph node metastasis (P = 0.0004), lymphatic invasion (P = 0.0053) and cancer-stromal relationship (P = 0.0016). Absence of lymph node metastasis and lymphatic invasion, and a medullary-type histopathology were associated with improved survival. In multivariate analysis, the statistically significant prognostic factors were lymph node metastasis and cancer-stromal relationship. CONCLUSIONS: Presence of lymph node involvement and a scirrhous type of gastric cancer are associated with poor prognosis. Lymph node dissection with gastric resection is necessary for patients with early gastric cancer who have a high risk of lymph node metastasis. Postoperative chemotherapy is recommended for a scirrhous type of early gastric cancer.     

Lymph node metastasis as a significant prognostic factor in early gastric cancer: Analysis of 1,136 early gastric cancers

Background: Gastric cancer is the most frquent cancer and the leading cause of death from cancer in Korea. Early gastric cancer has been defined as a gastric carcinoma confined to mucosa or submucosa, regardless of lymph node status, and has an excellent prognosis with a >90% 5-year survival rate. From 1974 to 1992, we encountered 7,606 cases of gastric cancer and performed 6,928 gastric resections. Among them, 1,136 cases were early gastric cancer (14.9% of all gastric cancer cases and 16.4% of resected gastric cancer cases). Methods: A retrospective analysis of 1,136 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathologic features (sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, resection type). Lymph node metastasis was classified into three groups: N(n=0) for no lymph node metastasis; N(n=1–3) for one to three lymph node metastases; and N(n>3) for more than three lymph node metastases. All patients received radical total or subtotal gastrectomy with lymph node dissection. Results: In univariate and multivariate analysis of these nine factors, the only statistically significant prognostic factor was regional lymph node metastasis (p<0.001). The others had no statistically significant association with prognosis. Lymph node metastasis was present in 178 cases (15.7%). The factors associated with the lymph node metastasis were depth of invasion and gross type [protruding type (e.g., types I, IIa)]. One hundred twenty-five of these patients had one to three lymph node metastases, and 53 cases had more than three lymph node metastases. The difference in 5-year survival rates among these groups was statistically significant: 94.5% for N(n=0), 88.3% for N(n=1–3), and 77.3% for N(n>3). Conclusion: We propose that for early gastric cancer, lymph node dissection is necessary in addition to gastric resection, at least in patients with a high risk of lymph node metastasis.     

结直肠癌根治术后复发转移危险因素分析

目的探讨结直肠癌根治术后复发转移的相关因素。方法应用单因素和多因素Cox分析方法,回顾性分析1990—1999年692例结直肠癌根治术后病例的临床病理因素。结果复发转移率23.4%(162/692),复发转移在术后2年内出现者占74.1%(120/162),3年内出现者占92.0%(149/162)。3、5年生存率:复发转移组分别为33.1%和19.7%,非复发转移组分别为92.8%和86.1%。单因素分析显示,结直肠癌患者的Dukes分期、淋巴结转移、肠壁浸润深度、分化程度、肿瘤部位、大体类型与复发转移有关。多因素分析显示,结直肠癌的淋巴结转移、肿瘤部位、分化程度是复发转移的危险因素,其中淋巴结转移是影响术后复发转移最重要的因素。分别进行局部复发和远处转移多因素分析显示,淋巴结转移、肿瘤部位、分化程度与局部复发有关,而淋巴结转移、肠壁浸润深度与远处转移有关。直肠癌多因素分析显示分化程度是术后复发的预后因素。结论淋巴结转移是影响结直肠癌术后复发转移最重要的危险因素。浸润深度是术后远处转移的重要预后因素,肿瘤位于直肠且分化程度低的患者术后局部复发的风险较大。     

胃癌转移淋巴结被膜外扩散和患者预后的关系

目的 探讨胃癌转移淋巴结被膜外扩散的相关因素及其对患者预后的影响.方法 通过对131例行胃癌根治术患者的临床病理和随访资料进行分析,评价胃癌转移淋巴结被膜外扩散与患者预后的关系.结果 78例(59.5%)患者有胃周区域性淋巴结转移,其中有46例转移淋巴结出现被膜外扩散,其5年累计生存率为13.5%;而32例无被膜外扩散的患者5年生存率为39.3%,生存率随胃周转移淋巴结出现被膜外扩散而明显下降(P=0.001).胃周转移淋巴结被膜外扩散与淋巴结转移数目、淋巴结转移距离、肿瘤浸润深度以及远处转移具有显著的相关性,是胃癌患者预后的独立影响因素(P=0.003).结论 胃周转移淋巴结被膜外扩散是一个简单有效判断预后的指标,是影响预后的一个独立因素.进行胃癌病理分期应当检查转移淋巴结被膜外扩散状况,并予以报道.

Abstract：

Objective The aim of the current study was to investigate the prognostic value of extracapsular lymph node spread in gastric cancer patients and to find correlations with clinicopathological parameters.Methods Clinicopathological data of 131 gastric cancer patients who underwent gastrectomy with lymphadenectomy were analyzed retrospectively. The number of metastatic lymph nodes with extracapsular spread were determined. Multivariate analysis was performed to find the clinical prognosis affecting extracapsular lymph node involvement. Results Seventy-eight patients (59.5%)had perigastric lymph node metastasis. Fortysix cases were detected extracapsular lymph node involvement. The 5-year cumulative survival rate for patients with extracapsular lymph node spread was 13. 5% , while 32 patients with lymph node metastasis but without extracapsular involvement had a 5-year survival rate of 39.3%. The survival rate decreased significantly with the increase of extracapsular lymph node involvement(P =0.001). Extracapsular lymph node involvement was significantly associated with the higher number of metastatic lymph nodes, the location of lymph node metastasis, tumor invasion depth and distant lymph node metastasis. In the multivariate analysis, extracapsular lymph node spread also remained as an independent prognostic factor(P =0.003). Conclusions Extracapsular lymph node involvement is a convenient and reliable prognostic index, and is an independent prognostic factor in gastric cancer patients. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered, be pathologically checked and reported in order to determine extracapsular spread status.     

乳腺神经内分泌癌的临床病理特征及预后分析

目的：分析乳腺神经内分泌癌的临床病理学特征及预后因素。方法收集43例乳腺神经内分泌癌的临床资料和生存情况,分析其临床病理特点和预后因素。结果所有患者中位随访时间48个月（8～90个月）,患者5年总生存率为67％。单因素分析显示腋窝淋巴结转移（P＝0．037）、较晚的TNM分期（P＝0．005）、较高的组织学分级（P＝0．005）和Ki-67高表达（P＝0．040）与患者生存差相关,多因素分析显示仅组织学分级（P ＝0．022）是患者预后的独立因素。结论乳腺神经内分泌癌是一类具有特殊临床病理特征的乳腺癌,常用的临床病理学指标中仅组织学分级是其独立预后因素。     

早期远端胃印戒细胞癌淋巴结转移的危险因素分析及外科手术指征探讨

目的研究早期远端胃印戒细胞癌淋巴结转移的危险因素,进一步分析其外科手术指征。方法回顾性分析2013年3月至2018年11月期间在苏州大学附属第一医院普外科接受外科根治手术且术后病理学检查证实为远端胃印戒细胞癌的91例早期胃癌患者的临床资料,收集患者的性别、年龄、肿瘤最大径、病灶数量、浸润深度、肿瘤大体外观、脉管癌栓、合并溃疡等数据,探索发生淋巴结转移的危险因素,进一步分析外科手术指征。结果91例早期远端胃印戒细胞癌均接受了外科根治性手术,其中淋巴结转移10例。单因素分析结果显示,肿瘤最大径(χ^2=5.631,P=0.025)、浸润深度(χ^2=4.389,P=0.016)、病灶数量(χ^2=5.615,P=0.023)及脉管癌栓(χ^2=22.500,P=0.001)均与早期远端胃印戒细胞癌的淋巴结转移有关。多因素分析结果显示,肿瘤最大径(OR=3.675,P=0.012)、浸润深度(OR=3.886,P=0.015)及脉管癌栓(OR=8.711,P<0.001)是早期远端胃印戒细胞癌发生淋巴结转移的影响因素,肿瘤最大径≥2 cm、浸润至黏膜下层及有脉管癌栓的患者有更高的淋巴结转移率。结论肿瘤最大径≥2 cm、浸润至黏膜下层及存在脉管癌栓的早期远端胃印戒细胞癌患者有更高的淋巴结转移风险;满足肿瘤最大径≥2 cm和存在脉管癌栓中任何1项条件者均可能需接受外科根治性手术。     

Long-term Results after Dissection of Positive Thoracic Lymph Nodes in Patients with Esophageal Squamous Cell Carcinoma

Background Although thoracic lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma (SCC) has been reported to be a negative risk factor for long-term survival, only a few studies have evaluated the clinicopathologic difference between the impact of metastasis to the paraesophageal lymph nodes and to the nonparaesophageal lymph nodes. The purpose of this study was to evaluate surgical outcome after the clearance of metastatic thoracic lymph nodes. Methods Retrospectively reviewed were 164 consecutive patients with thoracic esophageal SCC who had not had preoperative treatment and underwent surgery from 1980 to 2005 and were found to have thoracic lymph node metastases. Of these patients, 83 underwent surgery from 1980 to 1994 and 81 from 1995 to 2005. Univariate and multivariate analyses were performed to evaluate the impact of nonparaesophageal lymph node metastasis on survival. Results Univariate analysis revealed that T3/T4 tumors and the presence of nonparaesophageal node metastases were associated with only a 20% overall five-year survival rate. The overall five-year survival for the most recent period was significantly better than for the former period (42% vs. 13%, p < 0.01). Based on a multivariate analysis of prognostic impact of each nonparaesophageal node, the presence of metastatic subcarinal and/or posterior mediastinal nodes was an independent risk factor for reduced survival. Conclusion Surgical outcome for patients with thoracic esophageal cancer and metastatic thoracic lymph nodes has improved during the last 25 years. Although postoperative chemotherapy might improve survival, the presence of T3/T4 tumors and/or metastatic nonparaesophageal nodes were unfavorable factors for survival.     

Significance of Long-Term Follow-Up of Early Gastric Cancer

Background Therapeutic outcomes for most patients with early gastric cancer are favorable. However, mortality among these patients remains a concern. Improvements in therapeutic outcomes are being sought by studying the timing and causes of death. Here, the results of surgery were evaluated to assess the appropriate treatment and follow-up schedule for early gastric cancer. Methods A total of 1169 patients with early gastric cancer underwent curative gastrectomy between 1992 and 1999. Survival time, prognostic factors, cause of death, and time of death were evaluated retrospectively. Results Multivariate analysis of disease-specific survival identified lymph node metastasis as an independent prognostic factor. The anatomical extent of lymph node metastasis and the number of metastatic lymph nodes influenced the rate of recurrence. Multivariate analysis of overall survival identified age as a prognostic factor. A total of 91 patients (7.8%) from the study group died: 56 from comorbid diseases, 21 from gastric cancer, and 14 from other second primary cancers. Death from gastric cancer was frequently observed within 5 years of surgical resection, whereas death from other diseases usually occurred after 5 years. Patients who died as a result of diseases other than gastric cancer tended to be older. Conclusions Appropriate lymph node dissection is necessary for patients with early gastric cancer, particularly those with risk factors associated with lymph node metastasis. Meticulous follow-up protocols that can detect second primary cancers, together with the development of treatments for comorbid diseases, are required to improve survival.