小淋巴结转移与结直肠癌分期和预后的关系

淋巴结转移是影响结直肠癌预后的重要因素。目前临床上对结直肠癌标本淋巴结检查没有统一的规范，对直径〈5mm的小淋巴结的检出和转移状况不重视。而传统的淋巴结检查方法，对小淋巴结漏检的可能性极大。多个研究表明：小淋巴结中不仅存在转移，且其占阳性淋巴结总数的50％以上。小淋巴结的检出精确了结直肠癌患者的病理分期，有利于术后正确辅助治疗方案的选择。临床上应改进结直肠癌标本淋巴结检查方法，提高小淋巴结的检出率。     

淋巴结切除数目对无淋巴结转移的结直肠癌患者预后的影响

目的 探讨淋巴结阴性的结直肠癌患淋巴结切除数目与预后的关系。方法 分析42例无显微镜下淋巴结转移的结直肠癌手术患的临床病理资料，将他们按淋巴结切除数目分为A组(50枚或以下)和B组(50枚以上)，用Kaplan-Meier方法计算5年生存率，用χ^2检验两组间的差异。结果 B组5年生存率为100％，较A组(78．4％)明显增加，P=O．027；A组患肿瘤复发5例，其中5年内死亡3例；而B组患无肿瘤复发和死亡。结论 对无显微镜下淋巴结转移的结直肠癌患。尽量切除全数淋巴结可明显延长患的存活时间。     

结直肠癌术前D-二聚体水平与淋巴结转移的关系

目的 研究结直肠癌患者术前D-二聚体水平与淋巴结转移之间的关系.方法 全组106例患者均行标准结直肠癌根治性切除术,记录患者术前D-二聚体水平,及肿瘤大小、浸润深度、切除淋巴结数目、转移数目等病理学资料.结果 N分期晚的患者血浆D-二聚体水平明显升高;结直肠癌患者术前D-二聚体水平与淋巴结转移数之间的相关性有统计学意义;D-二聚体临界水平为0.4μg/mL时,可预测淋巴结转移与否.结论 术前D-二聚体水平的测定,对判断结直肠癌淋巴结转移状况有一定的意义.     

结直肠癌的前哨淋巴结示踪技术与淋巴结微转移

结直肠癌（colorectal cancer，CRC）是世界上胃肠道恶性肿瘤的重要死因，在美国位居第一位。由于临床Ⅰ、Ⅱ期（American Joint Committeeon Cancer，MCC）病例尚缺乏全身辅助化疗对延长生存期有利的证据，故通常未进行化疗。然而却有约20％～30％的局限于肠壁、“无转移”的早期病例（约55％），虽然施行了标准的结直肠癌根治术，仍然于5年内不可避免的死于复发和远处转移。最有可能的解释是，因为隐蔽微转移（micrometastasis，MM）的漏诊，将临床Ⅲ期病例误诊、降低分期为Ⅰ、Ⅱ期，而未行化疗。     

Ⅲ期结直肠癌淋巴结转移比率与预后的关系

目的 探索Ⅲ期结直肠癌的淋巴结转移比率与其临床病理特征及预后的关系.方法 将247例Ⅲ期结直肠癌患者根据淋巴结转移比率(MLR)的中位数分为3个组:低比率组(≤0.21),中比率组(＞0.21 ～0.42),高比率组(＞0.42).分析比较各组的临床病理因素和5年生存率的差别,并采用Cox比例风险模型分析Ⅲ期结直肠癌预后的相关因素.结果 247例Ⅲ期结直肠癌的淋巴结转移比率为0.02～1.00,中位数为0.21,在低比率组中,高中分化的结直肠癌的所占比例(57.9％,113/195)明显高于低分化癌的比例(23.1％,12/52)(P＜0.01);≥12枚病检淋巴结的结直肠癌所占比例(56.5％,95/168)明显高于＜12枚淋巴结的比例(38.0％,30/79)(P＜0.05).低比率组、中比率组、高比率组的5年生存率分别为67.4％,28.8％,6.3％,3组生存率存在明显差异(P＜0.05).多因素Cox回归模型分析表明,淋巴结转移比率是Ⅲ期结直肠癌预后的重要因素.结论 MLR是判断Ⅲ期结直肠癌预后的一个重要指标.     

淋巴结检出数和淋巴结转移度对Ⅱ～Ⅲ期结直肠癌患者预后的影响

目的 探讨淋巴结检出数和淋巴结转移度（LNR）对Ⅱ～Ⅲ期结直肠癌患者预后的影响.方法 回顾性分析507例Ⅱ～Ⅲ期结直肠癌患者的临床病理资料和随访资料.结果 507例患者共计检出淋巴结5801枚;转移淋巴结1122枚;淋巴结转移数与检出数呈正相关（r=0.171,P＜0.01）.淋巴结检出数大于或等于12枚与小于12枚的Ⅱ期患者,5年生存率分别为80.5%和62.7%,差异有统计学意义（P＜0.01）;而Ⅲ期患者则差异无统计学意义（P＞0.05）.不同LNR的Ⅱ～Ⅲ期结直肠癌患者5年生存率差异有统计学意义（P＜0.01）.不同淋巴结转移区域的同一LNR组患者的5年生存率差异也有统计学意义（P＜0.05,P＜0.01）.结论 淋巴结检出数对Ⅱ期结直肠癌患者预后的影响更为明显.为了获得更准确的分期及更好的预后,术中应尽量检出12枚/例以上淋巴结.LNR是Ⅱ～Ⅲ期结直肠癌的预后因素,用其评估患者预后时应兼顾淋巴结转移区域.     

结直肠癌淋巴结转移的多因素分析

目的探讨结直肠癌淋巴结转移的相关临床病理因素。方法回顾分析广西医科大学第一附属医院结直肠肛门外科2008年4月至2009年12月手术治疗的291例结直肠癌病例资料,采用单因素和Logistic多因素回归分析方法,研究结直肠癌淋巴结转移与临床病理因素之间的关系。结果单因素分析显示,性别、年龄、肿瘤部位、肿瘤占肠腔周径、肿瘤大小、大体类型、组织类型与结直肠癌淋巴结转移无关,而肿瘤分化程度、肠壁浸润深度、术前血癌胚抗原（CEA）水平与淋巴结转移有关。Logistic多因素回归分析显示,肿瘤分化程度和肠壁浸润深度与淋巴结转移有关。结论肿瘤分化程度和肠壁浸润深度是影响结直肠癌淋巴结转移的重要危险因素。     

结直肠癌的淋巴结隐匿性转移

局部淋巴结转移是结直肠癌复发的重要预测因素,有局部淋巴结转移者的复发率高达50％。然而,即使是不存在局部淋巴结转移的pN。结直肠癌患者,复发率也高达25％。美国Tomas Jefferson大学Waldman等的新研究揭开了其中的奥秘：pN0并不代表淋巴结没有肿瘤细胞浸润。     

结直肠癌淋巴结转移规律及其相关因素的分析

目的 :探讨结直肠癌淋巴结转移规律及其影响的相关因素。方法 :91例完整切除的结直肠癌患者的手术标本 ,将逐一清除的淋巴结分别送检 ,同时采用免疫组化的方法检测 E- cad和 TIMP- 3在肿瘤组织中的表达情况 ,结合临床病理资料分析结直肠癌淋巴结转移与诸因素的关系。结果 :91例结直肠癌患者中 33例发生淋巴结转移 ,共清除淋巴结 974枚 ,其中 1 1 3枚发生转移。影响淋巴结转移的因素有 1年龄 :小于 4 0岁的结直肠癌患者的淋巴结转移高于其他两组 (P =0 .0 36 ) ;2肿瘤的侵袭程度 :随着侵袭程度的加深 ,淋巴结转移的机会越大 (P <0 .0 0 5 ) :3E- cad和 TIMP- 3在肿瘤组织中的表达与否淋巴结的转移呈副相关 ,且差异具有显著性 (P值均 <0 .0 5 )。结论 :结直肠癌淋巴结的转移与年龄、肿瘤侵袭的程度以及 E- cad和TIMP- 3在肿瘤组织中的表达情况有关 ,根据这些因素可以初步估计结直肠癌患者淋巴结转移情况 ,从而指导手术和术后辅助治疗 ,以及判断患者的预后     

前哨淋巴结活检在结直肠癌根治术中的应用研究

目的探讨前哨淋巴结活检（SLNB）在结直肠癌根治术中临床应用的可行性及其价值。方法应用美蓝对67例结直肠癌患者行前哨淋巴结（SLN）定位活检,分体内、体外组,采用HE染色病理检查法、CK-20免疫组化染色（SP法）检测SLN中转移癌。结果共检出淋巴结660枚,其中SLN130枚,检出率19．7％。腹腔镜结直肠癌根治术和开腹结直肠癌根治术对SLN的检出差异无统计学意义（P=0．742）;体内、体外两种SLN的标记方法差异无统计学意义（P=0．564）;SP法检测SLN癌转移的敏感性明显高于HE染色,而假阴性率明显低于后者;肿瘤细胞在SLN的转移率明显高于区域淋巴结的转移率（P〈0．01）。结论结直肠癌根治术中体内、体外SLN定位方法均可以获得成功,均具有切实的可行性,与手术方式无关,并能够预测区域淋巴结的转移状况;通过SP法检查有助于明确结直肠癌的病理分期,有利于判断预后和个体化治疗方案的制定。     

Positive sentinel lymph node biopsy predicts the number of metastatic axillary nodes of breast cancer

It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.     

Impact of metastatic lymph node ratio in node-positive colorectal cancer

Colorectal cancer (CRC) is one of the most common malignant diseases in the world. Presently, the most widely used staging system for CRC is the tumor nodes metastasis classification system, which classifies patients into prognostic groups according to the depth of the primary tumor, presence of regional lymph node (LN) metastases, and evidence of distant metastatic spread. The number of LNs with confirmed metastasis is related to the severity of the disease, but this number depends on the number of LNs retrieved, which varies depending on patient age, tumor grade, surgical extent, and tumor site. Numerous studies and a recent structured review have demonstrated associated improvements in the survival of CRC patients with increasing numbers of LNs retrieved for examination. Hence, the impact of lymph node ratio (LNR), defined as the number of metastatic LNs divided by the number of LNs retrieved, has been investigated in various malignancies, including CRC. In this editorial, we review the literature demonstrating the clinicopathological significance of LNR in CRC patients. Some reports have indicated the advantage of considering the LNR compared to the number of LNs retrieved and/or LN status. When the LNR is taken into consideration for survival analysis, the number of LNs retrieved and/or the LN status is not always found to be a prognostic factor. The cut-off points for LNRs were proposed in numerous studies. However, optimal thresholds for LNRs have not yet received consensus. It is still unclear whether the LNR has more prognostic validity than N stage. For all these reasons, the potential advantages of LNRs in the staging system should be investigated in large prospective data sets.     

Immunomorphologic study of regional lymph nodes in cancer: Response of regional lymph node cells from gastric and colorectal cancer to PHA stimulation

To obtain information regarding the immunologic capacity of uninvolved regional lymph nodes (RLNs) draining tumor, the in vitro response of regional lymph node cells (RLNCs) to PHA was investigated in lymph nodes from 55 patients with gastric or colorectal cancer, and gastric ulcer. Evaluation of data relative to cancer progress demonstrated that, in gastric cancer patients, the response of stimulated RLNCs from patients with middle stage carcinoma was significantly higher compared with those of cells from patients with early or late stage carcinoma, such being similar to the response of RLNCs from control patients with gastric ulcer. The results from colorectal cancer patients were also similar to those from patients with gastric cancer. Our results suggest that RLNs without metastasis contain cells capable of responding to PHA despite the presence of growing tumors in these cancer patients. In the results of PHA stimulation in relation to the lymph node morphology, we observed in both groups of patients with gastric or colorectal cancer that, regardless of the extent of the cancer lymph nodes with lymphocyte predominance there was a high PHA response while lymph nodes with lymphocyte depletion and unstimulated nodes exhibited a low PHA response. These results show a close relationship between this lymph node morphology and immunologic status of nodes.     

Prognostic significance of lymph node metastases and ratio in esophageal cancer

BACKGROUND: The incidence of carcinoma of the distal esophagus and GE junction is rapidly increasing. A large single-center experience was reviewed to determine the impact of lymph node positivity and ratio on survival. METHODS: All patients undergoing esophagogastrectomy at Thomas Jefferson University Hospital between January 1994 and December 2004 were reviewed. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazard models, and survival curves were estimated using the Kaplan-Meier method. RESULTS: Of 173 patients with invasive cancer, 123 (71%) underwent preoperative chemoradiation therapy. The largest number of patients (45%) had adenocarcinoma of the GE junction; 29% of patients had esophageal adenocarcinoma while 14% had squamous cell cancer of the esophagus. Perioperative mortality was 5.7%. Median overall survival of the entire group was 22 months and 5-year overall survival was 27%. The most significant prognostic factor for overall survival was the presence of positive LN (P = 0.01). Additionally, patients with zero involved LN had a 5-year survival of 34%, while patients with 1 to 3 positive LN and >3 positive LN had 5-year survival of 27% and 9%, respectively (P = 0.01). Finally, an increasing ratio of positive to examined LN was linearly associated with a worsening 5-year survival, (P = 0.153). CONCLUSIONS: Increasing number of positive LN in patients with esophageal cancer and increasing ratio of metastatic to examined LN portend a poor prognosis. These factors should play an important role in determining which patients receive adjuvant therapy.     

结直肠癌前哨淋巴结转移相关蛋白的蛋白组学研究

目的 筛选前哨淋巴结(SLN)中与结直肠癌早期转移相关的蛋白质.方法 术中取43名结直肠癌早期患者的SLN及对应的正常淋巴结(NLN).提取SLN和NLN两组总蛋白后行双向凝胶电泳和质谱法对差异蛋白进行筛选和鉴定.用蛋白质印迹法和免疫组织化学法对其中的转移相关蛋白行进一步研究.结果 两组间检测出40种差异表达的蛋白质,SLN中表达升高且与转移相关的蛋白分别为核不均一核糖核蛋白A1( hnRNP A1)、埃兹蛋白(Fzrin)、微管蛋白β-2C (tubulin β-2C)和膜联蛋白A1(Annexin A1).蛋白定量结果显示两组间4种蛋白表达差异有统计学意义(P＜0.05).结论 结直肠癌SLN与NLN蛋白表达存在差异.筛选出的4种转移相关蛋白可能成为结直肠癌早期淋巴转移的标志物.     

South Australian clinical registry for metastatic colorectal cancer

Introduction: The aims of the South Australian Clinical Registry for Metastatic Colorectal Cancer are to record case outcomes according to site of recurrence and mode of clinical practice and to utilize the accumulated information for quality assurance activities. Methods: All patients who had a diagnosis of synchronous or metachronous metastatic colorectal cancer (CRC) after 1 February 2006 were eligible to be included in the registry. Data on patient details, disease characteristics, investigations, histopathology and treatment were collected. Disease‐specific survival data were assessed using Kaplan–Meier product moment estimates and the log‐rank test of equality was used for comparisons. Results: 1544 patients have been entered as of 22 March 2010. In addition, 54.7% of primary CRCs were in the rectosigmoid area, 92.9% of them adenocarcinomas. Also, 52.6% of patients received chemotherapy and 15% had radiotherapy. Two hundred five patients underwent liver resection, nine had radiofrequency ablation and seven had selective internal radiotherapy. The overall 3‐year survival from time of diagnosis of metastatic CRC was 29.5%. There was no significant survival difference between patients with synchronous and metachronous metastatic CRC. Patients with lung‐ or liver‐only metastases have significantly improved survival if they underwent surgical resection. Discussion: The treatment of patients with metastatic CRC continues to progress with modern medical and surgical developments. Important insights into the current patterns of care and clinical outcomes for metastatic CRC are provided by these data. In addition, this registry provides a feasible and useful database for the evaluation of current treatments established as best evidence in this population.     

Cancer biology and necrotic changes in metastatic lymph nodes and survival of colon cancer patients

BACKGROUND: Identifying factors that can contribute to a better understanding of tumor progression in stage III colon cancer patients continues to be an important task. Necrotic changes in metastatic lymph nodes have not been previously analyzed in English literature. METHODS: The study included 48 consecutive colon and rectosigmoid cancer patients with stage III disease who underwent radical surgery. After reviewing the diagnostic slides, a pathologist developed a scale describing the extent of necrotic changes. Results were evaluated using Kaplan-Meier method and log-rank test. RESULTS: Thirty-four (70%) patients had necrotic changes in metastatic lymph nodes. Patients with necrotic changes in metastatic lymph nodes had more risk factors than patients without necrosis. The 5-year survival rate for patients with necrotic changes in metastatic lymph nodes was 85% and for patients without necrosis was 50% (P = 0.02). CONCLUSIONS: The survival of patients with necrotic changes in metastatic lymph nodes was higher (P = 0.02). These necrotic changes can help us to understand body-tumor relations.     

Quantitative lymph node evaluation as an independent marker of long-term prognosis in stage III rectal cancer

Background: The prognostic significance of lymph node evaluation is not well described for rectal cancer due to a lack of reproducibility in nodal counts and variable use of adjuvant and neoadjuvant therapy. The aim of this study was to examine the role of quantitative lymph node evaluation as an independent marker of prognosis in stage III rectal cancer. Methods: New Zealand Cancer Registry data were retrieved for consecutive patients with rectal cancer from January 1995 to July 2003. Cases with node‐negative tumours, distant metastases, death within 30 days of surgery and incomplete data fields were excluded. Three nodal stratification systems were investigated – Total Number of Nodes examined (TNN), Absolute number of Positive Nodes (APN) and Lymph Node Ratio (LNR). Univariate and Cox regression analyses were performed with 5‐year all‐cause mortality as the primary end point. Results: The study identified 895 stage III rectal cancer cases. The mean APN and LNR were significantly higher in patients who died within 5 years. An increasing APN or LNR was associated with a significant increase in 5‐year mortality. The APN and LNR were also powerful predictors of 5‐year mortality after correcting for other factors using Cox regression. The TNN was of no prognostic significance. Conclusions: Both the APN and LNR are highly effective at independently predicting and stratifying 5‐year mortality in stage III rectal cancer. The significant predictive value of the LNR is likely to be a reflection of the APN rather than one functioning in autonomy, given that the TNN was of no prognostic significance.