Analysis of Clinicopathologic Features of Esophageal Carcinoma Patients Undergoing Surgery-a Report of 4,329 Cases

OBJECTIVE To investigate the clinicopathological features of esophageal carcinoma (EC) patients, and to analyze epidemiologic characteristics and the current situation of esophageal cancioma in the southern area of Hebei Province.METHODS A total of 4329 patients with esophageal cancinoma,undergoing surgery in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2005,were selected. Collection and statistical analysis of the pathologic data were performed using a SAS 6.0 software package.RESULTS Over the past ten years, there has been a tendency for an increase in the mean age of EC onset (P ＜ 0.05), a downtrend in the percentage of squamous cancer (SqCa) (P ＜ 0.05) and an uptrend in the frequency of small cell carcinoma (P ＜ 0.05). In clinical stages, there was a drop in the percentage of Stage-Ⅱsquamous EC patients (P ＜ 0.05), and an increase in that of Stage-Ⅳ patients (P ＜ 0.05). There were statistical differences in sex, age,pathologic types, depth of infiltration, ratio of stages and lymph node metastasis, etc. Among the superior, middle and inferior segments of the EC diseased region (P ＜ 0.05).CONCLUSION It was relatively late for the EC patients from this area to see a doctor, resulting in a drop in the ratio of SqCa and an ascensus in that of small cell cancer. However, due to a low incidence of adenocarcinoma, no obvious ascending tendency was found in the frequency of this carcinoma over the past ten years.     

4329例手术后食管癌临床病理资料分析

目的: 了解食管癌在河北省南部地区的发病情况,探究其发生发展现状。 方法: 选取1996年1月1日～2005年12月31日在河北医科大学第四医院行手术的食管癌患者共4329例,收集其病理资料并进行统计分析。 结果: 十年来平均发病年龄有上升的趋势(P<0.05)。鳞癌构成比有下降趋势(P<0.05),小细胞癌构成比有增多趋势(P<0.05)。临床分期Ⅱ期患者构成比下降(P<0.05),而Ⅳ期患者构成比增加(P<0.05)。上、中、下段各发病部位在性别、年龄、病理类型、浸润深度、分期构成比及淋巴结转移率方面均有统计学差异(P<0.05)。 结论: 本地区食管癌患者就诊偏晚,鳞癌构成比下降,小细胞癌构成比上升,而腺癌由于发病率较低,10年来构成比未见明显上升趋势。     

食管鳞癌DNA定量分析的临床意义

目的通过原发性食管鳞癌的DNA定量分析，探讨肿瘤细胞DNA含量与食管鳞癌的关系。方法采用CMIAS真彩色医学图像分析系统，对食管鳞癌术后标本以Feulgen法染色制成的石蜡切片进行检测，并计算出肿瘤细胞DNA相对倍体均值（简称11值）。结果u值随食管肿瘤增大而升高（P＜0．01）。u值随食管癌分期增高而升高（P＜0．01）。区域淋巴结有转移比无转移的u值大（p＜0．01）。u值随食管癌组织学分级增加而升高（p＜0．01）。结论食管鳞癌患者行DNA定量分析，可以帮助判断食管鳞癌的分期、恶性程度、预后和指导治疗。     

电视胸腔镜下食管癌切除术36例

目的 探讨电视胸腔镜(VATS)下微创手术治疗食管癌的适应证及操作特点.方法 对36例食管癌胸腔镜下经右胸游离食管、肿瘤,清扫淋巴结,经上腹切口游离胃,并经胸骨后上提,行左颈食管胃吻合.结果 成功完成30例VATS下食管癌切除手术,6例VATS辅助小切口完成手术.手术时间160～270 min,胸部操作时间60～90 min,术中出血300～400 mL,无手术死亡.术后吻合口瘘2例,吻合口狭窄1例,喉返神经损伤1例;平均住院时间12(10～14)d.结论 VATS下微创手术治疗食管癌,手术创伤明显减轻,为高龄、肺功能差的患者增加了手术机会,也为早期食管癌患者缩短了术后恢复时间.     

Surgical Treatment of Perforation Esophageal Carcinoma

OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3～72months.Of these cases 15 wree alive at 7～12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.     

10例食管基底细胞样鳞癌的临床病理及免疫组化研究

目的：研究食管基底细胞样鳞癌病理特征,探讨其病变性质、诊断及鉴别诊断。方法：应用形态学、组织化学（ＡＢ／ＰＡＳ）和免疫组织化学方法（Ｓ－Ｐ法）,对１０例男性食管ＢＳＣ患者进行病理形态学观察和多种抗体免疫组织化学检测。结果：癌瘤显示基底细胞和鳞状细胞双相型癌肿成分。基底细胞样癌多呈实体分叶状（１００．０％）、巢索状（８０．０％）、指突状（５０．０％）、巢周栅状（９０．０％）排列,巢中央有特征性粉刺型     

中国部分市县1998～2002年食管癌发病与死亡

[目的]探讨中国居民食管癌的发病和死亡特征。[方法]分析中国30个肿瘤登记处1998～2002年食管癌登记资料。[结果]食管癌新病例38339例，死亡30116例。食管癌粗发病率在0.3/10万～115.1/10万之间，世界人口调整发病率在0.3/10万～132.7/10万之间。食管癌粗死亡率在1.3/10万～90.9/10万之间，世界人口调整死亡率在2.7/10万～110.6/10万之间。[结论]各地的食管癌发病率差异较大。在不少地区尤其是农村，食管癌是严重威胁居民健康的主要恶性肿瘤，应积极开展防治工作。     

19例男性乳腺癌临床病理分析

目的分析男性乳腺癌（MBC）的临床病理特征和影响预后的因素。方法对19例MBC患者临床病理资料进行回顾性分析。结果MBC发病率低,发病年龄大,病程长,病理类型多为浸润性导管癌,易见淋巴结转移。19例MBC患者中PR阳性率为63．16％（12／19）,ER阳性率为73．68％（14／19）,Her-2阳性率为21．05％（4／19）,Ki-67阳性率≥25％者为63．16％（12／19）。结论MBC较少见,多见于老年人,多为浸润性导管癌,且易经淋巴系统转移,且具有一定的性激素表达水平,应采取内分泌治疗。     

超长食管癌215例临床分析

目的回顾性分析超长食管癌不同方法治疗后的疗效，探讨超长食管癌的治疗对策。方法对１９８７年３月至１９９２年８月间２１５例超长食管癌单纯外放射治疗、外放射＋腔内放疗、单纯手术治疗、术后放疗和术前放疗患者的生存率采用ｋａｐｌａｎ－Ｍｅｉｅｒ分析、ｌｏｇ－ｒａｎｋ检验，其它结果采用卡方检验，探讨不同治疗方法的疗效及失败的原因。结果超长食管癌术后放疗和术前放疗疗效较好，术前放疗不增加手术并发症，能明显降低“Ｔ”分期（Ｐ＜０．０５）；姑息术后放疗能明显提高５年生存率（Ｐ＜０．０５），根治术后放疗组５年生存率比单纯手术组提高１５．１％，术后放疗能明显降低淋巴结转移率（Ｐ＜０．０５）；超长食管癌失败的主要原因为局部未控或复发和远处转移，外放射＋腔内放疗有降低局部未控或复发率的趋势。结论对超长食管癌应采用手术＋放疗进行综合治疗，不能手术治疗者应采用非常规分割外放射配合腔内放疗和全身化疗。     

Expresston of the EphA2 Gene in Esophageal Carcinoma Tissues

OBJECTIVE To investigate the relationship of the EphA2 gene with the occurrence, invasion and metastasis of esophageal carcinoma. METHODS The expression of EphA2 mRNA was detected by RT-PCR and the EphA2 protein was estimated by immunohistochemistry （SP method） in both esophageal, cancerous tissues and normal epithelial tissues. RESULTS The expression of EphA2 mRNA showed no difference between esophageal cancerous tissues and normal epithelium, and there appeared to be no correlation with differentiation of the cancerous tissues, the depth of infiltration or lymph node metastasis （P〉0.05）. However, the expression of the EphA2 protein was significantly higher in cancerous tissues compared to normal epithelial tissues （P〈0.05）. The expression of the EphA2 protein in a deeper invasive group and in a group with lymph node metastasis was significantly higher compared to a superficial： ly invasive group and a group without lymph node metastasis （P〈0.05）. Its expression did not appear to be correlated with differentiation of cancerous tissues （P〉0.05）. CONCLUSION The occurrence of esophagus carcinoma and the formation of invasion and metastasis may be related to overexpression of the EphA2 protein but not to the level of mRNA, a finding which may due to up-regulation at the translation level or by increased protein stability.     

208例食管癌淋巴结转移的临床病理分析

目的探讨食管癌淋巴结转移的规律,相关因素及临床意义。方法对208例食管癌根治术后的临床病理资料进行分析。结果208例中124例发现淋巴结转移,转移率为59．62％（131／208）清扫淋巴结2651个,其中430个淋巴结转移,淋巴结的转移率为16．22％（430／2651）,并讨论了影响淋巴结转移的相关因素。结论对中上段食管癌应行全胸段食管切除,食管胃颈部吻合,彻底清扫各组淋巴结,才能达到根治目的。     

老年人肝癌的临床病理特点(附161例分析)

本文报告了老年人肝癌161例.结果:(1)血清AFP≤3lμg/L者占43.1％,显示老年肝癌患者中AFP阴性者较多.(2)血清HBsAg阳性占46.4％,肝硬变合并率占67.7％,提示老年人肝癌的发生仍与HBV感染有关.(3)体检发现的肝癌仅占13％,瘤体平均直径达7.5cm,提示老年人肝癌具有隐匿快速发展的特点.(4)术后1、3、5年生存率分别为82.6％,59.6％和26.1％,11例复发性肝癌再切除后3年生存率为72.7％,认为手术切除仍是老年人肝癌的有效治疗手段.     

Expression of the EphA2 Gene in Esophageal Carcinoma Tissues

OBJECTIVE To investigate the relationship of the EphA2 gene with the occurrence, invasion and metastasis of esophageal carcinoma. METHODS The expression of EphA2 mRNA was detected by RT-PCR and the EphA2 protein was estimated by immunohistochemistry (SP method) in both esophageal cancerous tissues and normal epithelial tissues. RESULTS The expression of EphA2 mRNA showed no difference between esophageal cancerous tissues and normal epithelium, and there appeared to be no correlation with differentiation of the cancerous tissues, the depth of infiltration or lymph node metastasis (P>0.05). However, the expression of the EphA2 protein was significantly higher in cancerous tissues compared to normal epithelial tissues (P<0.05). The expression of the EphA2 protein in a deeper invasive group and in a group with lymph node metastasis was significantly higher compared to a superficially invasive group and a group without lymph node metastasis (P<0.05). Its expression did not appear to be correlated with differentiation of cancerous tissues (P>0.05). CONCLUSION The occurrence of esophagus carcinoma and the formation of invasion and metastasis may be related to overexpression of the EphA2 protein but not to the level of mRNA, a finding which may due to up-regulation at the translation level or by increased protein stability.     

泰兴市1999~2011年食管癌发病趋势分析

[目的]分析1999～2011年泰兴市食管癌的发病趋势,为制定防治措施提供依据。[方法]利泰兴市疾病预防控制中心肿瘤登记处登记的1999～2011年新发食管癌病例资料,计算粗发病率、中标率和构成比等指标。[结果]11999．2011年泰兴市食管癌新发病例共9635例,占全部肿瘤发病的24．51％。1999～2011年食管癌粗发病率为51．03／10万,其中男性71．97／10万,女性42．95／10万,食管癌粗发病率从1999年的52．5l,10万上升至2011年的60．37／10万。食管癌发病率随着年龄上升而上升,60岁组达到发病最高峰,中标率为110．42／10万．[结沦]食管癌发病呈逐年上升趋势,中老年人群是食管癌发病的重点人群。     

185例70岁以上老年人食管癌的外科治疗

[目的]分析70岁以上老年人食管癌的手术适应证、围手术期并发症、死亡以及围手术期处理,探讨降低围手术期死亡的方法。[方法]回顾性分析2000年1月～2005年1月间,在我科行食管癌根治术的年龄大于70岁的185例老年食管癌患者的临床资料,采用单因素和多因素分析围手术期死亡的危险因素。[结果]全组无手术死亡,手术切除率100%。26例（14.1%）手术时间大于5h。术后并发症发生率为28.6%,围手术期死亡率为8.1%。围手术期死亡主要原因为肺部并发症、吻合口瘘和心脑血管并发症。Logistic回归分析显示术前伴发病、肺功能差、手术时间长及喉返神经损伤与围手术期死亡明显相关。[结论]70岁以上老年人食管癌术后围手术期死亡率相对较高,严格选择手术适应证和合理周密的围手术期处理对降低围手术期死亡有重要意义。     

放射治疗食管癌配合DF方案化疗

目的　探讨放射治疗配合DF方案化疗对食管癌治疗的价值。方法　将 14 4例食管癌患者随机分为 2组进行研究。综合组72例行放射治疗配合DF方案化疗 ,单放组 72例行单纯放射治疗。 2组随访均 3年。结果　综合组与单放组 1、2、3年生存率分别为 62 .5 %、45 .8%、3 4.7%和 44 .4%、3 1.9%、16.6% ,综合组 1、2、3年生存率明显高于单放组 (P <0 .0 5 ) ,且无严重毒副反应发生。 2组局控率差异无显著意义 (P >0 .0 5 ) ,远地转移率综合组低于单放组 (P <0 .0 5 )。结论　放射治疗食管癌配合DF方案化疗是疗效好、值得进一步研究的方法。     

Clinicopathologic Characteristics of Male Breast Cancer: A Report of 21 Cases in Radiotherapy Center of Hamedan,Iran

Background: Male breast cancer accounts for less than 1% of all cancer in men and only around 1% of alldiagnosed breast cancer. Despite a significant raise in the last 25 years, it still remains a rare disease. Materialsand Methods: We conducted a retrospective study from 2004-2011 with 21 male breast cancer patients. We aimedto analyze the epidemiologic data (age, personal and family history), tumor characteristics (size, histological type,location, TNM stage, receptors), surgery, adjuvant chemotherapy and radiation therapy, hormonal therapy andsurvival (relapse, follow up, death) who reffered to our center with breast cancer. Results: The median age was49.2±14.2 years (range 30-83 years). A family history of breast cancer was noted in four cases. The main clinicalcomplaint was a retroareolar mass in 85.7%of patients (n=18). Histologically, 85.7% (n=18)were invasive ductalcarcinoma and 4.7% (n=1) had ductal carcinoma in situ and 9.4% (n=2) had mixed histology including invasivemedullary and ductal carcinoma. Hormonal therapy was delivered to 16 cases (76.1%) due to ER or PR positivity.During median follow up of 30 months (3-84 month), distant metastases were evident in 4 cases (19%). Duringthe follow-up period, only one patient died due to metastatic disease. The mean time to recurrence detection was30 months. Conclusions: The percentage of cases of male breast cancer is very low compared to breast cancer infemales, explaining why very few investigations have been conducted in Iran. Limited coverage in the literaturemake gender-specific findings difficult so future research of this entity involving multi-institutional cooperationand longer follow up is essential to provide new insights about the biological and clinical factors of this rarecancer.     

50例原发性食管小细胞癌的临床特点和综合治疗

目的:探讨原发性食管小细胞癌(PESC)的临床特点和综合治疗方法。方法:分析50例PESC的临床资料,其中放、化疗16例,单纯手术11例,术后联合放、化疗17例,术前化疗6例,分析其中位生存时间。结果:全组手术根治切除率为85.2%,手术死亡2例。放、化疗的中位生存时间7.2个月,单纯手术的中位生存时间为11个月,术后联合放、化疗的中位生存时间为16个月,术前化疗的中位生存时间为22个月。结论:PESC是一种全身性疾病,恶性程度较高,应采用综合治疗以达到延长生存的目的,特别是采用术前化疗的方法值得重视。     

6 207例乳腺肿瘤临床病理资料分析

 目的 探讨1981～2007年27年来乳腺肿瘤发病趋势特点和变化规律,为临床和病理医师提供有价值的参考。 方法 选自天津医科大学总医院病理科1981～2007年外科手术活检病理档案中的乳腺原发肿瘤6 207例,应用SAS6.0统计软件包对该资料进行统计分析。 结果 27年来乳腺肿瘤占肿瘤总数百分比呈上升趋势（P=0.005）,乳腺恶性肿瘤占恶性肿瘤百分比虽然有所波动,但总体呈上升趋势（P=0.027）。三个年代乳腺良、恶性肿瘤发病平均年龄有增高趋势。三个年代乳腺肿瘤组织学类型也有所变化,乳腺良性肿瘤中,纤维腺瘤和导管内乳头状瘤构成比增加,腺瘤和间叶性肿瘤构成比下降。乳腺恶性肿瘤中,浸润性导管癌仍是主要类型,但导管内癌构成比增加,腺癌和髓样癌有所下降。青年组、中年组和老年组乳腺良、恶性肿瘤组织学类型差异均有统计学意义 （P<0.001）,良性肿瘤中青年组纤维腺瘤构成比高于中老年组,而导管内乳头状瘤和间叶性肿瘤构成比低于中老年组。恶性肿瘤中青年组恶性叶状肿瘤及浸润性小叶癌高于老年组。 结论 乳腺肿瘤检出率增加,尤其是乳腺恶性肿瘤检出率增加明显,组织学类型也有所变化,应引起临床和病理医师的注意。     

食管癌组织中Skp2的表达及其与临床病理特征的关系

目的研究Skp2（S相激酶相关蛋白2）在食管癌组织和正常组织中的表达差异,并探讨Skp2的表达和食管癌临床病理特征的关系。方法选取64例食管癌组织和22例食管良性疾病组织,应用免疫组化S-P法检测Skp2在上述组织中的表达差异,然后用SPSS10．0软件对上述数据进行分析。结果64例食管癌组织中,Skp2的表达阳性率为32．8％,22例食管良性疾病组织中,Skp2的阳性表达率为9．1％,经χ^2检验,该差异具有统计学意义（P〈0．05）。Skp2的表达和食管癌的分化程度存在相关性（P〈0．05）,但和患者的年龄、性别、病灶位置、淋巴结转移和临床分期等无显著相关性（P〉0．05）。结论Skp2在食管癌的发生过程中具有重要作用,并有望作为治疗的新靶点。