不同淋巴清扫术式对食管癌手术切除患者的疗效及并发症的影响

目的 探讨不同淋巴结清扫术式对食管癌手术切除患者近期、远期临床效果的影响.方法 回顾性分析接受食管癌根治术的268例患者临床资料.按淋巴结清扫方式不同分为标准二野组(n=121),全二野组(n=147),观察两组患者的淋巴结清扫情况、术后并发症、生存率及淋巴结复发情况.结果 标准二野组淋巴结转移率71.1％.全二野组淋巴结转移率63.3％,差异无统计学意义(P＞0.05);全二野组术后并发症发生率为17.0％ (25/147),明显高于标准二野组的5.8％(7/121),差异有统计学意义(x2=7.948,P＜0.01).标准二野组的5年生存率为29.8％,全二野组的5年生存率为28.6％,差异无统计学意义(x2=0.005,P＞0.05).标准二野组术后淋巴结复发率为41.3％ (50/121),远远高于全二野组的19.0％ (28/147),差异有统计学意义(x2=15.959,P＜0.01) .结论 与标准二野淋巴清扫术相比,全二野淋巴清扫并未提高食管癌患者术后生存,相反还带来了更高的并发症风险.     

淋巴结清扫术对早期卵巢癌患者预后影响的回顾性队列研究

目的 评估淋巴结清扫对临床早期上皮性卵巢癌（epithelial ovarian cancer,EOC）患者预后的影响。方法 回顾性招募2008年1月至2018年12月在本院接受首次手术Ⅰ～Ⅱ期EOC患者。根据是否进行淋巴结清扫将患者分为未切除淋巴结的手术组（No-LND组）和淋巴结清扫术组（LND组）,收集两组患者的人口学特征、临床病理资料以及围手术期不良事件发生情况,采用Cox比例风险回归进行生存分析。结果 共纳入279例EOC患者,其中No-LND组56例,LND组223例。LND组患者切除淋巴结中位数为25枚,包括21枚盆腔淋巴结和4枚主动脉旁淋巴结。LND组和No-LND组的5年无进展生存率分别为85.9%和81.6%,10年无进展生存率分别为81.3%和72.9%,差异有统计学意义（P=0.013）。LND组和No-LND组的5年总生存率分别为93.8%和88.7%,10年总生存率分别为86.7%和82.6%,差异有统计学意义（P=0.042）。多因素Cox回归分析显示,淋巴结清扫是预后的保护因素（HR=0.89,95%CI:0.79～0.97,P=0.041）,但LND组...     

胸腔镜肺叶切除术及淋巴清扫术对不同病理类型肺癌患者肺功能、生存率的影响

目的 探讨胸腔镜肺叶切除术及淋巴清扫术对不同病理类型肺癌患者肺功能、生存率的影响。方法 选取2009年6月—2011年9月在我院接受胸腔镜肺叶切除术及纵隔淋巴清扫术的125例肺癌患者作为研究对象,根据病理类型分为腺癌组(AG)、鳞癌组(SG)、大细胞癌组(LG),观察手术前后临床效果、肺功能指标及生存率等。结果 LG组在手术时间、术中出血量、术后胸管引流量方面均高于SG组、AG组(P＜0.05);AG组在术中出血量、术后胸管引流量及术后恢复时间方面均高于SG组(P＜0.05);LG组在FVC%方面高于AG组(P＜0.05);LG组、AG组在FVC%、FEF50%、FEF75%方面与SG组有统计学差异(P＜0.05);18个月后各组患者生存率均低于第12个月的随访结果(P＜0.05),SG组在12、18个月的生存率均高于AG组、LG组(P＜0.05)。结论 胸腔镜肺叶切除术联合淋巴结清扫术治疗不同病理类型肺癌患者时,大细胞癌手术治疗时手术时间、术中出血量、术后胸管引流量方面均高于腺癌、鳞癌患者;鳞癌患者生存率及身体评价均高于其他各组。     

卵巢癌二次探查手术中淋巴结清扫的意义

背景与目的：盆腹腔淋巴结清扫是国际妇产联盟（FIGO）卵巢癌手术病理分期的主要内容之一,但在卵巢癌的二次探查手术中,盆腔和腹主动脉旁淋巴结清扫的价值还存在争议。本文拟分析有关资料,以对卵巢癌二次探查手术中淋巴结清扫的价值进行探讨。方法;收集中国医学科学院肿瘤医院1994年7月1日至1996年10月1日收治的15例Ⅲ期和Ⅳ期卵巢癌患者的临床资料并进行回顾性分析。结果：15例患者的组织病理类型均为卵巢浆液性乳头状囊腺癌;组织分化程度分别为：高分化2例、中分化7例、低分化6例。15例患者在初次细胞减灭术时均没有进行淋巴结清扫,“二探术”时患者的盆腔和腹主动脉旁淋巴结均为阴性。“二探术”阴性的10例患者中有4例（40％）发生肿瘤复发,复发部位为盆腔腹膜、腹腔和肝脏,盆腔和腹主动脉淋巴结均没有复发。结论：初次减灭术时淋巴结阴性的卵巢癌患者,在进行“二探术”时可不必进行淋巴结清扫。     

早期宫颈癌的生存率分析

对我院1987~1994年收治的124例早期宫颈癌患者行根治术后的生存率进行回顾性分析,报告如下:临床资料与方法1 资料124例宫颈癌患者中,年龄最小25岁,最大68岁,平均年龄46岁,40~55岁占67.8%。病期Ia占5%,Ib占14.5%,Ia占66.9%和Ⅱb占13.6%。临床分型:糜烂型占19.4%,菜花型占54.8%,结节型占17.8%和溃疡型占8%。病理以鳞癌占95.2%,腺癌占4.8%。     

卵巢癌合并胸腹水83例分析

回顾性分析83例卵巢癌合并胸腹水的临床资料,结果认为胸腹水脱落细胞检查有一定的假阴性率,术前胸腹腔化疗组能达到较高的理想细胞减灭术的手术率,并能延长术后生存时间。     

胸段食管癌清扫淋巴结数对生存率的影响

长期以来,胸段食管癌以清扫全胸段食管淋巴结、隆突下、左右支气管旁淋巴结和胃贲门旁和胃左淋巴结的二野清扫为标准式而普遍应用.在不同医院或外科医师之间存在技术水平上的差别,清扫纵隔淋巴结的彻底程度上也存在差异.如何界定清扫的彻底程度是一个相当困难的问题,因其影响对术后辅助治疗的选择,尤其是淋巴结数少的情况下导致临床分期降期,放弃了恰恰需要进行术后放射的病例,对于预后的影响是不言而喻的.我们回顾分析101例食管癌手术病例,就纵隔淋巴结及胃周淋巴结清扫彻底程度的差异对生存率影响进行探讨,现报告如下.     

喉癌三种不同颈淋巴结转移状态者生存率分析

目的比较喉癌三种不同颈淋巴结转移状态者的生存率以及它们在诸多影响喉癌预后的因素中的地位,提高对喉癌迟发性颈淋巴结转移的重视.方法回顾性分析336例喉癌的临床资料,分三组即初发性淋巴结转移、迟发性淋巴结转移和阴性淋巴结组,采用Kaplan-Meier法、COX模型分析结果 1.初发性、迟发性淋巴结转移和阴性淋巴结发生率分别是10.1%(34/336)、10.0%(33/336),76.5%(257/336).2.声门上型喉癌中初发、迟发和阴性淋巴结者的生存率的差异有统计学意义(Log Rank统计值=14.14,P=0.0009),其中初发组生存率低于阴性组(Wald=11.405,P=0.001),迟发组界于两者之间(初发组与迟发组比:Wald=3.338,P=0.068;迟发组与阴性组比:Wald=2.160,P=0.142);声门型喉癌中三组生存率的差异也有统计学意义(Log Rank统计值=32.70,P=0.0000),其中初发组生存率与迟发组无统计学差异(Wald=0.916,P=0.339),迟发组和初发组生存率都低于阴性组(Wald分别是25.832和4.030,P分别是0.000和0.045).3.在诸多影响喉癌预后的因素中,初发性和迟发性淋巴结转移是最重要的.结论喉癌颈淋巴结转移者生存率低,迟发性颈淋巴结转移对生存率有负面影响,并且在众多影响因素中,淋巴结转移状态包括初发和迟发性淋巴结转移最重要.     

早期肺癌特异性淋巴清扫的临床回顾研究

背景与目的 本研究旨在探讨不同淋巴结清扫方式对Ⅰ期肺癌患者生存率的影响,考察影响预后的相关因素,探讨肺叶特异性淋巴结清扫的临床应用指征.方法 回顾性分析1998年-2005年上海市胸科医院病理Ⅰ期且符合完全性切除的379例肺癌患者,其中系统性淋巴结清扫组148例,肺叶特异性淋巴结清扫组150例,术后病理均为T1a-2aN0M0,比对研究两组手术相关因素并进行预后分析.结果 两组临床病理特征无统计学差异(P＞0.05);两组总体3年及5年生存率无统计学差异(P＞0.05),但不同病理分期、病理类型和肿瘤直径之间的生存率存在明显差异(P＜0.01);在手术时间、术中失血、胸管引流量、拔管时间及住院天数等方面,两组存在明显差异(P＜0.01);两组术后并发症亦有统计学差异(P＜0.05).结论 系统性淋巴结清扫并未增加Ⅰ期肺癌患者5年生存率;病理分期、病理类型和肿瘤直径是影响患者预后的重要因素;肺叶特异性淋巴结清扫可明显减少手术并发症并降低围手术期风险.     

卵巢癌二探术中广泛切除腹膜后淋巴结的疗效

回顾性分析卵巢癌二探术中施行腹膜后淋巴结广泛切除的疗效。方法在二探术过程中均行系统的腹膜后淋巴结切除术,包括左肾静脉下缘水平的腹主动脉旁淋巴结和盆腔各组淋巴结,回顾性分析行二探术阳性发现结果一患者的预后。结论在二探术中行淋巴结切除术扩大了探量范围,可减低卵巢癌患者阴性二探术后的复发率。     

Adjuvant intraperitoneal chromic phosphate therapy for women with apparent early ovarian carcinoma who have not undergone comprehensive surgical staging

Forty-nine women with apparent Stage I and II ovarian carcinoma received intraperitoneal phosphate 32 as the only adjuvant therapy after primary surgery. In addition to bilateral salpingo-oophorectomy, 40 (82%) had analysis of peritoneal cytology, and 35 (71%) underwent omentectomy. Random peritoneal biopsies and retroperitoneal lymph node sampling were not done in any of these patients. The overall and disease-free survival rates were 86% and 75%, respectively, with no significant differences by stage, histologic grade, histologic type, or low-risk versus high-risk subsets recognized in patients who received comprehensive surgical staging. Seven (58%) of 12 patients had lymph node metastasis as the first site of recurrence, including two of three with late recurrences. Significant morbidity related to intraperitoneal chromic phosphate (32P) occurred in one (2%) woman. These results emphasize the need for comprehensive surgical staging of women with apparent early ovarian carcinoma to aid in the selection of appropriate initial adjuvant therapy.     

Prognosis of patients with primary epithelial ovarian carcinoma who were not successfully cytoreduced

The aim of this study was to determine prognostic factors of patients with advanced ovarian carcinoma who were not successfully cytoreduced at first surgery. Twenty patients with incomplete initial cytoreduction surgery (12 patients with stage IIIc and 8 patients with stage IV), were analyzed for prognostic factors. The survival time of 13 patients with second reduction surgery (SRS) was significantly (P<0.005) longer than that of 7 patients in whom SRS was not applicable. According to the histologic types, the survival time of patients with serous cystadenocarcinoma or endometrioid adenocarcinoma was significantly (P<0.0001) longer than that of patients with clear cell carcinoma, mucinous cystadenocarcinoma or undifferentiated carcinoma. Size of residual tumor after SRS was correlated with response to combination chemotherapy consisting of cyclophosphamide, epirubicine and cis-diamminedichloroplatinum (II) (CAP therapy). The survival time of patients with less than 2 cm residual tumor after SRS was significantly (P<0.05) longer than that of patients with 2 cm or more residual tumor after SRS. Patients in whom CA125 normalized in response to CAP therapy after first surgery had less than 2 cm residual tumor after SRS and survived longer, compared to patients in whom CA125 did not normalize. These results suggest that even if initial cytoreduction surgery failed, patients with good response to CAP therapy and less than 2 cm residual tumor after SRS can be expected to have relatively good prognosis.     

Improved survival in women with BRCA-associated ovarian carcinoma

BACKGROUND: The objective of this study was to determine the clinical characteristics, treatment response, and frequency of p53 overexpression in Ashkenazi Jewish women with hereditary ovarian carcinoma. METHODS: Seventy-one Jewish women with epithelial ovarian carcinoma (EOC) were tested for the three BRCA founder mutations using single-strand conformation polymorphism analysis, heteroduplex analysis, and protein truncation testing. Clinical and histopathologic data were reviewed retrospectively. In vitro chemoresistance was analyzed in 32 patients. Mutations of p53 were studied using immunohistochemical detection of p53 overexpression. RESULTS: Thirty-four of 71 Jewish patients with EOC (48%) had germline BRCA mutations (BRCA heterozygotes), including 22 BRCA1 mutations and 12 BRCA2 mutations. BRCA heterozygotes were younger compared with Jewish patients who had EOC without mutations (sporadic carcinoma; 50 years vs. 59 years, respectively; P = 0.01). BRCA1 heterozygotes were younger compared with BRCA2 heterozygotes (48 years vs. 57 years, respectively; P = 0.01). Histopathologic tumor features were similar; however, tumors with low malignant potential were seen only in women with sporadic carcinoma. Both groups had equivalent rates of surgical cytoreduction and similar median follow-up (72 months). BRCA heterozygotes had higher response rates to primary therapy compared with patients who had sporadic disease (P = 0.01). In vitro chemoresistance predicted tumor response to platinum chemotherapy correctly in BRCA heterozygotes (P = 0.0096). BRCA heterozygotes with advance-stage disease had improved survival compared with patients who had advanced stage sporadic carcinoma (91 months vs. 54 months, respectively; P = 0.046) and had a longer disease free interval (49 months vs. 19 months, respectively; P = 0.16). p53 overexpression was common in BRCA heterozygotes (80%). CONCLUSIONS: BRCA1 heterozygotes developed EOC at a younger age compared with BRCA2 heterozygotes and women who had sporadic ovarian carcinoma. BRCA heterozygotes had a better response to platinum chemotherapy compared with women who had sporadic disease, which may have contributed to their improved prognosis.     

Uterine metastases in ovarian carcinoma: frequency and survival in women who underwent hysterectomy

Objective

Possible reasons for hysterectomy in the initial surgical management of advanced invasive epithelial ovarian carcinoma (EOC) might be a high frequency of uterine involvement and its impact on survival. The aim of the present study was to describe the frequency of uterine involvement and its association with survival in an unselected population of EOC patients who underwent hysterectomy.

Methods

All incident cases of EOC diagnosed in Israeli Jewish women between March 1994 to June 1999, were identified within the framework of a nationwide case-control epidemiological study. The target population of the present report includes all stage II-IV EOC patients who had a uterus at the time of diagnosis. Of the 822 such patients, 695 fulfilled the inclusion criterion. Excluded were 141 patients for various reasons. The present analysis is based on the remaining 554 patients.

Results

Uterine involvement was present in 291 (52.5%) of the patients and it was macroscopic in only 78 (14.1%). The serosa was the most common site of isolated metastases. Multivariate analysis showed that advanced stage significantly increased the risk for uterine involvement. The overall median survival with any uterine involvement was significantly lower compared to those with no involvement (38.9 months vs. 58.0 months; p<0.001).

Conclusion

There is an association between uterine involvement, whether macro- or microscopic, and lower survival even after hysterectomy although residual tumor could not be included in the analysis. Further studies are required to establish whether uterine involvement itself is an unfavorable risk factor or merely a marker of other unfavorable prognostic factors.     

Ethnic differences in survival among women with ovarian carcinoma

BACKGROUND: Ovarian carcinoma is the leading cause of death among all female reproductive malignancies. There are substantial differences in age-adjusted incidence rates and survival rates between Caucasian women and African-American women. The objective of this study was to examine ethnic differences in survival after ovarian carcinoma in a population-based sample of women. METHODS: Thirteen thousand eighty-three patients (12285 Caucasian women and 798 African-American women) who were diagnosed with primary ovarian carcinoma from the population-based Surveillance, Epidemiology, and End Results (SEER) Program were used for analysis. Odds ratios were used to estimate the association between prognostic variables and ethnicity. Chi-square tests were used to determine the statistical significance of these associations (using two-sided P values). Univariable and multivariable Cox proportional hazards models were used to assess survival differences. RESULTS: African-American women were significantly younger at the time of diagnosis, were more likely to be single, and were less likely to undergo site specific surgery compared with Caucasian women. In addition, the crude median survival for African-American women was nearly 1 year less than for Caucasian women (22 months vs. 32 months, respectively; P < 0.0001). African-American women were at a 30% increased risk of death from any cause when adjusting for all other prognostic variables that differed between the two ethnic groups. CONCLUSIONS: African-American women who are diagnosed with ovarian carcinoma are at a significant increased risk of death from any cause compared with Caucasian women who are diagnosed with ovarian carcinoma.     

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

No randomised trials have addressed the value of systematic aortic and pelvic lymphadenectomy (SL) in ovarian cancer macroscopically confined to the pelvis. This study was conducted to investigate the role of SL compared with lymph nodes sampling (CONTROL) in the management of early stage ovarian cancer. A total of 268 eligible patients with macroscopically intrapelvic ovarian carcinoma were randomised to SL (N=138) or CONTROL (N=130). The primary objective was to compare the proportion of patients with retroperitoneal nodal involvement between the two groups. Median operating time was longer and more patients required blood transfusions in the SL arm than the CONTROL arm (240 vs 150 min, P<0.001, and 36 vs 22%, P=0.012, respectively). More patients in the SL group had positive nodes at histologic examination than patients on CONTROL (9 vs 22%, P=0.007). Postoperative chemotherapy was delivered in 66% and 51% of patients with negative nodes on CONTROL and SL, respectively (P=0.03). At a median follow-up of 87.8 months, the adjusted risks for progression (hazard ratio [HR]=0.72, 95%CI=0.46-1.21, P=0.16) and death (HR=0.85, 95%CI=0.49-1.47, P=0.56) were lower, but not statistically significant, in the SL than the CONTROL arm. Five-year progression-free survival was 71.3 and 78.3% (difference=7.0%, 95% CI=-3.4-14.3%) and 5-year overall survival was 81.3 and 84.2% (difference=2.9%, 95% CI=-7.0-9.2%) respectively for CONTROL and SL. SL detects a higher proportion of patients with metastatic lymph nodes. This trial may have lacked power to exclude clinically important effects of SL on progression free and overall survival.