癌结节对胃癌患者预后的影响

目的探索癌结节与胃癌临床病理特征之间的关系,分析其对胃癌患者预后的影响。方法2012年1月1日至2015年1月1日在河北医科大学第四医院外三科行根治性手术治疗的胃癌患者2386例,分析癌结节与临床病理特征的关系及其对胃癌患者总生存和无病生存的影响。结果2386例胃癌患者中,459例(19.24%)有癌结节,1927例无癌结节。Logistic多因素分析结果显示,pT分期(P=0.036)、pN分期(P=0.024)、pTNM分期(P=0.032)、Borrmann分型(P=0.008)、有无脉管瘤栓(P=0.001)是形成癌结节的独立危险因素。共有2273例患者获得随访,随访期内1259例患者发生复发转移,1152例死亡,5年总生存率和5年无病生存率分别为49.32%和44.61%。有癌结节组患者(441例)的5年总生存率和5年无病生存率分别为26.76%和24.94%,无癌结节组患者(1832例)的5年总生存率和5年无病生存率分别为54.75%和49.34%,两组差异均有统计学意义(均P<0.001)。1个癌结节组(115例)、2~3个癌结节组(202例)和≥4个癌结节组(124例)患者的5年总生存率分别为41.74%、30.69%和10.48%,差异有统计学意义(P<0.001);5年无病生存率分别为40.00%、28.22%和9.68%,差异也有统计学意义(P<0.001)。Cox多因素分析显示,组织学类型(P=0.004)、pT分期(P=0.007)、pN分期(P=0.004)、pTNM分期(P=0.002)、有无脉管瘤栓(P=0.034)、有无癌结节(P=0.005)和癌结节数量(P=0.001)是胃癌患者预后的独立危险因素,术后辅助化疗(P=0.043)是胃癌患者预后的保护性因素。结论癌结节的发生与多种临床病理因素密切相关,有无癌结节及癌结节数量是影响胃癌患者预后的独立危险因素。     

神经浸润与胃癌预后关系的Meta分析

目的 神经浸润与胃癌预后之间的关系仍未达成一致,通过Meta分析,系统回顾分析神经浸润与胃癌预后的关系.方法 通过中国知网、万方数据、PubMed、Embase数据库中进行截止2016年的相关文献检索,合并HR及95％CI用于评估神经浸润对胃癌预后的价值.结果 14篇相关文献共17162例行胃癌根治术患者,神经浸润阳性率为23.1％.神经浸润与胃癌不良预后显著相关(HR=1.33,95％CI:1.08～1.57,P＜0.05),亚组分析显示神经浸润与胃癌预后不受地区、神经浸润阳性率、论文质量得分影响.结论 胃癌术后神经浸润阳性的患者预后差,神经浸润是影响胃癌预后的独立危险因素,也是术后辅助治疗的参考指标.     

癌结节对胃癌患者生存预后的影响

  目的  探讨癌结节对胃癌患者生存预后的影响。  方法  回顾性分析2007年1月至2012年12月海南医学院第一附属医院收治的312例胃癌患者的临床病理资料,根据术后病理标本中有无癌结节将所有患者分为癌结节阴性组和阳性组。分析癌结节与临床病理因素的关系及其对胃癌患者生存预后的影响。  结果  本组患者中84例存在癌结节,阳性率为26.9%。单因素分析显示,Borrmann分型、肿瘤大小、浸润深度、N分期、TNM分期、脉管癌栓与癌结节阳性相关;多因素分析证实仅Borrmann分型、N分期和脉管癌栓是癌结节阳性的独立相关因素。单因素生存分析显示,年龄、肿瘤部位、Borrmann分型、肿瘤大小、TNM分期、术式、脉管癌栓和癌结节与胃癌患者预后相关。癌结节阴性组和阳性组5年生存率分别为67.5%和34.5%,差异有统计学意义（P < 0.001）。多因素生存分析显示年龄、Borrmann Ⅲ/Ⅳ型、TNM分期、脉管癌栓和癌结节是患者的独立预后因素。进一步分层分析显示,癌结节仅对N0~3a期胃癌患者预后影响有统计学意义,N3b期癌结节阴性组和阳性组患者预后无显著差异。癌结节阳性患者预后与N分期、有无脉管癌栓及术后辅助化疗独立相关。  结论  癌结节是胃癌患者独立预后因素,可作为N0~3a期患者预后评价指标,无论分期如何,癌结节阳性者需行术后辅助化疗并密切随访。      

探索淋巴结外侵犯对胃癌患者生存预后的影响（附2 386例报告）

背景与目的：在第8版胃癌TNM分期中,淋巴结外侵犯被列为独立疾病登记变量之一,其阳性患者具有更高的疾病相关病死率和复发率,与不良预后密切相关。探讨淋巴结外侵犯（extracapsular lymph node involvement,EC-LNI）与胃癌临床病理学特征之间的关系,分析其对胃癌患者生存预后的影响。方法：回顾性分析河北医科大学第四医院外三科自2012年1月1日—2015年1月1日行根治性手术治疗的2 386例胃癌患者,分析EC-LNI与临床病理学特征的关系及其对胃癌患者生存预后的影响。结果：2 386例胃癌患者中EC-LNI（+）333例（13.96%）,EC-LNI（-）2 053例（86.04%）。单因素分析结果显示,肿瘤直径、组织学类型、Borrmann分型、浸润深度pT分期、肿瘤pTNM分期、Lauren分型、脉管瘤栓、神经受侵、Ki-67增殖指数、血清肿瘤标志物癌胚抗原（carcinoembryonic antigen,CEA）、糖类抗原（carbohydrate,CA）19-9及CA72-4表达情况均与EC-LNI状态有关（均P<0.05）;多因素分析结果显示,肿瘤直径大小（P=0.010）、组织学类型（P=0.016）、肿瘤浸润深度pT分期（P=0.011）、肿瘤pTNM分期（P=0.003）、Borrmann分型（P=0.032）、脉管瘤栓浸润（P=0.022）均是发生EC-LNI的独立危险因素。2 386例胃癌患者中共有2 273例（95.26%）获得完整随访资料,全组患者5年总生存率（overall survival,OS）为49.32%,5年无病生存率（disease-free survival,DFS）为44.61%。其中EC-LNI（+）者5年OS为27.86%,5年DFS为25.39%,而EC-LNI（-）者5年OS、DFS分别为52.87%、47.79%,两组患者的5年OS、DFS差异均有统计学意义（P均<0.001）。单因素分析显示,EC-LNI数目（P=0.001）与胃癌患者预后有关,同时年龄、病灶部位、肿瘤直径、组织学类型、Borrmann分型、肿瘤浸润深度pT分期、淋巴结转移pN分期、肿瘤pTNM分期、Lauren分型、脉管瘤栓有无、Ki-67阳性比例、术后是否化疗也均与预后相关（均P<0.05）。多因素分析显示,肿瘤组织学类型（P=0.013）、浸润深度pT分期（P=0.020）、淋巴结转移pN分期（P=0.019）、肿瘤pTNM分期（P=0.001）、脉管瘤栓有无（P=0.031）和EC-LNI数目（P=0.001）是影响患者预后的独立危险因素,而术后辅助化疗（P=0.003）是患者预后的保护性因素。结论：EC-LNI与胃癌患者的肿瘤分期及预后密切相关,有无EC-LNI和EC-LNI数目均是影响胃癌患者预后的危险因素。     

增殖细胞核抗原与胃癌浸润、转移和预后的关系

增殖细胞核抗原与胃癌浸润、转移和预后的关系上海医科大学附属肿瘤医院外科（上海市２０００３２）周烨综述朱慰祺审校增殖细胞核抗原（Ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ），又称为周期蛋白（Ｃｙｃｌｉｎ），是１９７８年Ｍｉｙ...     

肝外胆管癌神经及脉管浸润转移的危险因素

目的:探讨肝外胆管癌神经及脉管浸润转移的危险因素.方法:回顾性分析2001年1月-2011年1月收治的128例肝外胆管癌患者的临床病理资料.分析肝外胆管癌神经及脉管浸润转移与临床病理因素之间的关系.结果:128例患者中,神经及脉管浸润转移50例(39.1％).单因素分析显示,肿瘤大小(P=0.010)和肿瘤浸润深度(P=0.000)与肝外胆管癌神经及脉管浸润转移有关,患者的性别、年龄、乙型肝炎病毒感染、肿瘤部位、肿瘤病理类型、肿瘤分化程度、淋巴结转移和术前血清CA19-9水平均与肝外胆管癌神经及脉管浸润转移无关(P＞0.05).多因素logistic回归分析显示,肿瘤大小和肿瘤浸润深度与神经及脉管浸润转移相关(P＜0.05).结论:肿瘤大小和肿瘤浸润深度是影响肝外胆管癌神经及脉管浸润转移的独立危险因素.     

胃癌肝转移患者预后影响因素分析

摘 要：［目的］ 探讨影响胃癌肝转移患者的预后因素。［方法］ 回顾性分析收治的82例胃癌肝转移患者的临床病理资料,对患者的生存时间进行随访,计算患者的1、2年生存率,及中位生存时间（median survival time,MST）。采用Log-rank检验及Cox比例风险模型对可能影响胃癌肝转移患者生存的影响因素进行单因素及多因素分析。［结果］ 82例胃癌肝转移患者1、2年生存率分别为46.3%、13.4%,MST为10.9个月。单因素分析结果显示,病理类型、分化程度、肝转移灶数目、化疗、介入治疗、甲胎蛋白（α-fetoprotein,AFP）与胃癌肝转移患者的预后相关;多因素分析结果显示,病理类型（HR=0.470,95%CI：0.256～0.861,P=0.015）、肝转移灶数目（HR=0.413,95%CI：0.233～0.732,P=0.002）是影响胃癌肝转移患者预后的独立危险因素,化疗（HR=2.193,95%CI：1.354～3.551,P=0.001）是胃癌肝转移患者的独立保护因素。［结论］胃癌肝转移患者预后较差,尤其是病理恶性程度较高及肝转移数目较多的患者,化疗可改善患者的预后。     

神经周围浸润与早期舌鳞状细胞癌患者临床病理特征的相关性及对预后的影响

目的:探讨神经周围浸润（perineural invasion,PNI）与早期舌鳞状细胞癌（tongue squamous cell carcinoma,TSCC）患者临床病理特征的相关性及对预后的影响。方法:收集75例早期TSCC患者的完整病例资料,观察PNI情况并分析其与TSCC临床病理特征的关系及对患者5年生存率和生存期的影响。结果:PNI阳性与性别、年龄、临床分期差异均无统计学意义（P＞0.05）;PNI阳性与分化程度、淋巴结转移、浸润深度、淋巴脉管浸润、手术切缘阳性差异均有统计学意义（P＜0.05）。PNI阳性患者5年生存率及生存期均明显低于PNI阴性者（P＜0.05）。COX多因素回归分析表明PNI阳性是早期TSCC患者术后预后的独立危险因素（P＜0.05）。结论:PNI阳性对早期TSCC患者的预后有影响,对早期TSCC患者预后辅助治疗的方案设计具有一定的参考价值,并且可以作为早期TSCC患者预后判断的独立危险因素。     

胃肠胰神经内分泌肿瘤患者预后的多因素分析

目的:分析胃肠胰神经内分泌肿瘤患者预后的危险因素,并探讨对应的干预对策,以期为临床提供借鉴。方法:回顾自2002年6月至2013年12月入院治疗的胃肠胰神经内分泌肿瘤患者的资料,对患者的一般情况如性别、年龄、肿瘤大小、肿瘤部位、肿瘤侵犯程度、淋巴结转移、血管侵犯、手术切缘、远处转移、总生存期等数据进行分析,总结胃肠胰神经内分泌肿瘤患者预后的危险因素。结果:123患者平均发病年龄56.9岁,男性平均发病年龄59.5岁,女性平均发病年龄52岁。＜60岁患者68例,≥60岁55例,从发病到明确诊断时平均时间为9.8月,中位生存时间为46.1个月,1年生存率为69%,3年生存率为37.4%, 5年生存率为29.6%。通过单因素分析,年龄、肿瘤大小、肿瘤侵犯程度、淋巴结转移、血管侵犯、手术切缘、远处转移与胃肠胰神经内分泌肿瘤患者预后显著相关,P＜0.05;性别、肿瘤部位与胃肠胰神经内分泌肿瘤患者预后无明显相关,P分别为0.784、0.988。通过多因素COX回归分析,年龄(HR=1.93,95%CI:1.06~3.50)及远处转移(HR=1.83,95%CI:1.24~2.72)为胃肠胰神经内分泌肿瘤患者预后的独立危险因素。结论:年龄、肿瘤大小、肿瘤侵犯程度、淋巴结转移、血管侵犯、手术切缘、远处转移等是胃肠胰神经内分泌肿瘤患者生存预后的危险因素,年龄大、远处转移患者生存预后最差。     

Impact of perineural invasion on survival in node negative colon cancer

Perineural invasion (PNI) has been implicated as a poor prognostic indicator in many cancers. The National Comprehensive Cancer Network recommends consideration of observation or adjuvant therapy in the presence of PNI in early colon cancer. These recommendations are based on single institutional studies that fail to evaluate PNI within the context of adjuvant chemotherapy. The US National Cancer Database (2004–2012) was reviewed for patients with node negative colon cancer, and stratified by PNI and receipt of chemotherapy.

Of 21,488 patients evaluated, 55.2% had T3 disease (n = 11,852), 23.1% had T2 (n = 4,971), 14.4% had T1 (n = 3,088), and 7.3% had T4 disease (n = 1,577); 4.6% (n = 987) had PNI. Most patients (86.8%, n = 18,641) did not have PNI and did not receive chemotherapy; 8.7% (n = 1,860) did not have PNI but received chemotherapy; 3.7% (n = 785) had PNI and did not receive chemotherapy, and 0.9% (n = 202) had PNI and received chemotherapy. Among those with PNI, patients who received chemotherapy tended to be younger (P<0.001), covered by private insurance (P<0.001), with fewer comorbidities (P<0.001), and greater T stage disease (P<0.001). Those with PNI who received chemotherapy had significantly improved survival over those who did not in T3–4 disease (P<0.001), but not in T1–2 disease. On multivariate analysis, those with PNI had a 38% greater hazard of mortality (HR 1.38, P<0.001). Additionally, chemotherapy decreased the hazard of mortality by 43% (HR 0.57, P<0.001). PNI appears to be an independent poor prognostic indicator in stage T3–4 node negative colon cancer. Chemotherapy administered to this patient population is associated with improved survival.     

Impact of a previous cancer history on the overall survival of patients with primary gastric cancer: A SEER population-based study

BackgroundThe impact of previous cancers on the survival of gastric cancer (GC) patients is still uncertain. To evaluate the impact of a prior cancer history on the overall survival of patients with primary GC.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database provided data on patients diagnosed with GC as the first or second primary malignancy between 2010 and 2015 in this retrospective cohort study. Cox proportional hazards models, Kaplan-Meier curves and forest plots were utilized to analyze overall survival. Subgroup analysis was performed based on age, gender, race and prior cancer type.ResultsTotally 39,379 were eligible for this study, including 7403 (18.8%) with a previous cancer history. A previous cancer was an independent risk factor for overall survival [hazard ratio (HR) = 1.103, 95% confidence interval (CI): 1.070–1.138]. For GC patients aged 40–60 years (HR = 1.191, 95% CI: 1.084–1.308) and ≥60 years (HR = 1.093, 95% CI: 1.058–1.13) at diagnosis, a previous cancer was significantly associated with worse overall survival. GC patients with previous oral cavity and pharynx cancer (HR = 1.249, 95% CI: 1.038–1.501), respiratory system cancer (HR = 1.177, 95% CI: 1.076–1.286), female genital system cancer (HR = 1.169, 95% CI: 1.011–1.351), or lymphoma cancer (HR = 1.192, 95% CI: 1.023–1.389) had shorter overall survival than GC patients without a previous cancer.ConclusionA previous cancer adversely affected the overall survival of GC patients. Specifically, GC patients aged ≥40 years, or with oral cavity and pharynx cancer, respiratory system cancer, female genital system cancer, or lymphoma cancer had inferior overall survival. These patients should obtain more attention and get individualized treatment to improve prognosis, and clinical trial eligibility criteria could be reconsidered for particular age and cancer types.     

胃癌外周神经侵犯与ＥＧＦＲ及预后的相关性研究

目的　检测外周神经侵犯（ＰＮＩ）在人胃癌中的发生情况,探讨其与表皮生长因子受体（ＥＧＦＲ）的相关性以及对胃癌预后的影响。方法　检测６６９例胃癌组织石蜡切片中神经侵犯的发生情况及ＥＧＦＲ的表达情况,分析神经侵犯与胃癌临床病理参数的关系及其在胃癌患者预后中的价值。结果　ＰＮＩ的发生与浸润深度、癌栓、淋巴结转移、ＴＮＭ分期及ＥＧＦＲ表达均相关。单因素生存分析显示,ＰＮＩ阳性组的５年生存率为２６.４％,低于阴性组的４３.３％（Ｐ＜０.０５）。结论　胃癌患者发生ＰＮＩ与预后有关,并提示预后不良,ＥＧＦＲ可能是参与胃癌发生ＰＮＩ的因素之一。     

Impact of prior cancer history on survival of patients with gastric cancer

BackgroundPatients with prior cancer history are commonly excluded from clinical trial. However, the impact of prior cancer on survival of patients with gastric cancer remains largely unknown. The aim of this study was to evaluate the prevalence of prior cancer and assess its impact on survival of patients diagnosed with gastric cancer.MethodsPatients with gastric cancer as the primary or second primary malignancies diagnosed from 2004 to 2010 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. Kaplan-Meier method, multivariate Cox proportional hazard model, and multivariate competing risk model were performed for survival analysis.ResultsA total of 28,795 eligible patients with gastric cancer were included, of whom 2695 (9.35%) had a history of prior cancer. Prostate (35%), breast (12%), colon (8%), and urinary bladder (7%) malignancies were the most common prior cancer types. Patients with prior cancer history had slightly inferior overall survival (AHR = 1.06; 95% CI [1.00–1.12]; P = 0.043) but superior gastric cancer-specific survival (AHR = 0.82; 95% CI [0.76–0.88]; P < 0.001) compared with those without prior cancer. The subgroup analysis determined that a prior cancer history did not adversely affect gastric patients’ clinical outcomes, except in those with prior cancer diagnosed within one year, at distant stage, or originating from lung and bronchus.ConclusionA substantial proportion of gastric cancer patients with a history of prior cancer had non-inferior clinical outcome to those without prior cancer. These patients should be considered in clinical trials.     

Matrix metalloproteinase-9 is associated with disease-free survival and overall survival in patients with gastric cancer

Matrix metalloproteinase-9 is a member of the Matrix metalloproteinases (MMP) family, which is overexpressed in some solid tumor and thought to enhance the tumor invasion and metastasis ability. Our study is to investigate the association of MMP-9 expression with disease-free survival and overall survival of patients with gastric cancer. Clinical gastric cancer specimens and adjacent normal tissues from 286 patients who had not received neoadjuvant chemotherapy were investigated by immunohistochemistry assay. Staining evaluation results were analyzed statistically in relation to various clinicopathological characters, disease-free survival and overall survival. High level of MMP-9 expression was detected in gastric cancer, significantly more than in adjacent normal epithelial cells. In gastric cancer, MMP-9 was significantly positively correlated with depth of invasion, lymph node metastasis and distant metastasis. However, no correlations between MMP-9 expression and patients' age, sex, tumor location or differentiation status were detected. The disease-free survival and overall survival were significantly shorter for patients with MMP-9 positive than those with MMP-9 negative tumors. Multivariate analysis identified MMP-9 was an independent prognostic factor for both disease-free survival and overall survival. Our findings provided convincing evidence for MMP-9 as an important role in human gastric cancer recurrence and prognosis. It might also serve as a novel target for both prognostic prediction and therapeutics.     

Overexpression of NUAK1 is associated with disease-free survival and overall survival in patients with gastric cancer

Transient receptor potential vanilloid 2 (TRPV2) was proved to play a crucial role in the tumor progression of various cancers. The association between the expression of TRPV2 and clinical outcome in cancer patients has not been studied yet. We aim to elucidate the role of TRPV2 in predicting prognosis of patients with esophageal squamous cell carcinoma (ESCC). Fresh frozen samples were collected immediately from 170 patients with ESCC after surgical resection from 2003 to 2008, including 45 pairs of tumor tissues and non-tumor tissues. TRPV2 expression was measured by quantitative real-time PCR. TRPV2 mRNA was over-expressed in ESCC tissues and cell lines. High expression of TRPV2 was observed more frequently in patients with advanced pT stage (P < 0.001), lymph node metastasis (P = 0.010) and advanced pathological stage (P = 0.001). Patients with high expression of TRPV2 (>44.40, n = 83) had worse 5-year disease-specific survival (40.0 vs 62.6 %, P < 0.001) and disease-free survival (38.4 vs 61.5 %, P < 0.001) than that with low expression (≤44.40, n = 87). Multivariate analysis found that the expression of TRPV2 mRNA (HR 2.19, 95 % CI 1.39–3.46, P = 0.031) and pN category (HR 2.13, 95 % CI 1.36–3.33, P = 0.001) were independent prognostic factors. Overexpression of TRPV2 mRNA was associated with poor prognosis and might serve as a novel prognostic biomarker for resected ESCC patients in early stage.     

Lymphatic, blood vessel and perineural invasion identifies early-stage high-risk radically resected gastric cancer patients

The availability of different treatment options for radically resectable gastric cancer reopened the question of treatment selection and correct definition of high-risk categories. Lymphatic, blood vessel and perineural invasion (LBVI/PNI) seem to possess the necessary potential to provide useful information for the clinical management of this disease. Seven hundred and thirty-four patients with advanced gastric cancer who underwent curative gastrectomy were analysed according to the presence of LBVI/PNI. Patients were divided into two groups: group A for patients with LBVI/PNI (189 patients 26%) and group B for patients without LBVI/PNI (545 patients, 74%). The disease-free survival (DFS) for patients in group A was 32.1 months, whereas it was not reached for patients in group B (P=0.0001); the median overall survival was 45.5 months for patients in group A, whereas it was not reached for patients in group B (P=0.0001). At multivariate analysis, the presence of LBVI/PNI appeared an independent prognostic factor for DFS and OS. Our results were confirmed in subgroup analysis, separately considering stage I and early gastric cancer patients with and without LBVI/PNI. Taken together, our findings suggest the importance of LBVI/PNI in gastric cancer as it may provide additional information for identifying patients at high risk, who may be candidates for further medical treatment after or before surgery.     

Impact of nonspecific death on overall survival in early-stage epithelial ovarian cancer patients

Objective: To estimate the impacts of nonovarian cancer-specific death (non-OCSD) and ovarian cancer-specific death (OCSD) on early-stage patients, and to determine which statistical method yielded survival results most similar to real-world situations. Methods: Data of patients with early-stage epithelial ovarian cancer from 1988 to 2015 registered in the Surveillance, Epidemiology, and End Results database were analyzed. The primary outcome events of epithelial ovarian cancer were OCSD, non-OCSD, or alive. Incidences of non-OCSD and OCSD with different clinicopathological factors, cumulative incidences of non-OCSD and OCSD, and overall survival impact of non-OCSD were analyzed. Results: A total of 1606 non-OCSD (8.9%) and 3022 OCSDs (16.8%) were analyzed. Several independent features were associated with non-OCSD, including age (>60 years), radiotherapy, and marital status. In patients with histology (eg, endometrioid or mucinous), well-differentiated cells, stage I disease, or widowed marital status, as well as age older than 60, non-OCSD rates of all causes of death notably distorted overall survival, resulting in inaccurate and biased interpretations. Conclusions: Overall survival was greatly influenced by non-OCSD in early epithelial ovarian cancer. Future clinical trials should consider non-OCSD as a competing risk event, especially among patients older than 60 years and those with well-differentiated cells, no chemotherapy, and widowed marital status.