Ovarian metastasis in patient with endometrial carcinoma

Objective： To study the clinical pathological characteristics of ovarian metastasis of endometrial carcinoma and the factors affecting prognosis. Methods： Retrospective analysis was made to the clinical pathological outcome of endometrial carcinoma patients receiving surgical treatment in our hospital from January 1990 to December 2002. Results： Among the 191 cases of endometrial carcinoma patients, 17 cases （8.9%） had ovarian metastasis and young patients were more likely to have ovarian metastasis. The multiple factor analysis showed that the independent risk factors of ovarian metastasis in endometrial carcinoma included the depth of myometrial invasion, lymph node metastasis and pathological types. Conclusion： Ovarian metastasis in patients with endometrial carcinoma is associated with poor prognosis, the depth of myometrial invasion, lymph node metastasis and histologic types are independent risk factors affecting the prognosis. For young patients at early stage of the disease, it should be prudent as to whether to retain the ovary.     

Predictive Factors Relating to Tumor-Free Survival Rates and the Clinical Management of Small Cancer of the Liver after Hepatectomy

OBJECTIVE To investigate factors associated with tumor-free survival rates and methods of treatment for small cancer of the liver. METHODS A total 105 cases of small cancer of the liver (maximum diameter ≤5 cm in a solitary nodule or the sum of maximum diameters in double nodules ≤5 cm) were studied between 1983 and 2000. Patients were divided into an invasive group (primary tumor accompanied by any one or more of the following features: satellite nodules, venous invasion, adjacent organ involvement and double nodules) and a non-invasive group. RESULTS Three patients died from liver failure within 30 days after operation and 100 of the other patients were followed-up. The 1, 3, 5, 7 and 10-year survival rates after the first resection were 95.8%, 64.8%, 48.8%, 39.4% and 34.3% respectively. The main factors influencing tumor-free survival after radical resection were tumor size, presence or absence of satellite nodules or vascular invasion, the incisal edge, the UICC TNM stage, and the number of tumor nodules. The survival rate of the invasive group was significantly lower than that of the non-invasive group. Tumors of fifty-one cases recurred after radical resection. For the recurrent patients, treatments included a repeated resection for 17 cases, transcatheter artery chemotherapy and embolization (TACE) for 18 cases and no treatment or chemotherapy for 18 cases. The 1,3 and 5-year survival rates after repeated hepatectomy for recurrent patients were 82.4% , 51.3% and 34.2% respectively, which were higher than those in the non-resected group.CONCLUSIONS Factors that influence postoperative tumor-free survival rate were concluded to be early stage detection, tumor invasive or noninvasive traits and the incisal edge. For the recurrent patients, active treatment especially a second hepatectomy, is safe and feasible, and can improve the 5-year survival rate by 10 percent. The categorization of invasive and non-invasive groups for small cancer of the liver is useful in clinical work. For patients with invasive small cancer of the liver, postoperative close surveillance and follow-up is the key to improve the prognosis.     

Synchronous primary cancers of the endometrium and ovary： review of 43 cases

Objective:To investigate the clinicsl and pathological characteristics.treatment methods,and prognosis of synchronous primary cancer of the endometrium and ovary.Methods:The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed.The survival was calculated by Kaplan-Meier method and compared using the log-rank test.Results:The median age of the patients at diagnosis was 49 years(range.28-73 years).The most common symptoms were abnormal vaginal bleeding(69.8%)and abdominal or pelvic pain(44.2%).Pelvic masses were found in 39.5%of the patients and enlarged corpus in 27.9%at physic examination.while pelvic masses were found in 67.4%of the 43 patients(29 cases)and thickening or abnormal endometrium in 23.3%(10 cases)during ultrasound exami-nation.Of 25 patients examined by CT/MRI.pelvic masses were found in 13 cases and enlarged uterus in 11 cases.All 15 patients who underwent endometriaI biopsies were proven to have endometrioid carcinomas.Serum CA125 level was found to be elevated in 22 of the 34 examined cases(64.7%)with median value 500 U/mL(range,39-3439 U/mL).FIGO stages of endometrial carcinomas:ⅠA 18 cases,ⅠB 20 cases.ⅠC 2 cases,and ⅡA 3 cases;Stages of ovarian cardnomas:ⅠA 19 case,ⅠB 4 cases,ⅠC 7 cases.Ⅱ 4 cases,and ⅢC 9cases.Twenty-four patients(55.8%)were in stage Ⅰ both endometrial and ovar-ian carcinomas.Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy,meanwhile,12 patients had pelvic lymph nedes dissection.Thirty-eight of the 43 patients(88.4%)had a pathologically proven endometrial adenocarcinomas.The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components(30/43,69.8%).Postoperatively,26 patients(60.5%)received adjuvant chemotherapy alone.12 had chemotherapy plus radiotherapy,only one patients had radiation alone and the remaining 4 cases received no adiuvant treatment.The 3-year and 5-year survival rates of the group were 87.4%and 71.1%respectively.The 3-year and 5-year survival rates of patients with endometriold carcinoma at both endometrial and ovarian were higher than that of those with non-endometriold or mixed histologic subtypes(93.8%,82% vs 79.7%.69%).The 3-year and 5-year survival rates of patients with earty stages disease were better than those of other patients(93.3%,93.3% vs 69.7%,36.7%).Recurrence developed in 15 patients(34.9%).It was showed by univariate analysis that lower CA125 level,early FIGO stage,and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate.while only eady FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.Conclusion:Syn- chronous primary cancers of the endometrium and ovary were different from either the primary endometrial or ovarian cancer,while usually it can be detected in early stage with a good prognosis.The impact of the CA125 level on prognosis needs to be further studied.Surgery treatment alone may be enough for early stage patients.Chemotherapy plus radiotherapy may benecessary for advanced patients.     

Ⅰ、Ⅱ期子宫内膜癌MRI表现与病理对照研究

Objective： To analyze MRI features of FIGO stage Ⅰ and Ⅱ endometrial carcinoma and to study the value of MRI in assessing myometrial and cervical invasion of endometrial carcinoma. Methods： Thirty patients with surgicopathologically proven endometrial carcinoma were included in this retrospective study. All patients underwent Tl-weighted spin-echo, T2-weighted fast spin-echo and dynamic contrastenhanced fast multiplanar spoiled gradient echo sequences before surgery. The type, signal intensity and enhancement features of the tumors and the appearance of junctional zone or subendometrial enhancement were analyzed. The MRI diagnosis of myometrial and cervical invasion was correlated with pathologic findings.Results： Endometrial carcinoma demonstrated diffuse widening of endometrial stripe （n=14） or polypoid or large mass in the endometrial cavity （n=16）. The tumors were usually isointense relative to the myometrium on TlWI and hyperintensity on T2WI. In the first phase of dynamic contrast-enhanced sequences, diffuse endometrial carcinoma usually showed mild （n=8） or moderate （n=5） enhancement, while focal endometrial carcinoma tended to enhance markedly （n=6） or moderately （n=9）. On T2WI junctional zone was seen in 18 cases. On dynamic contrast-enhanced images subendometrial enhancement was seen in 17 cases. The sensitivity, specificity and diagnostic accuracy of dynamic contrast-enhanced images in combination with T2WI were 87.5%, 95.5% and 93.3% for assessing deep myometrial invasion, and 75%, 95.5% and 90% for assessing cervical invasion. Conclusion： MRI is accurate and reliable in the evaluation of myometrial and cervical invasion of endometrial carcinoma, and should be performed as preoperative routine examination.     

13例胃和结直肠同时性癌的临床分析

Objective： To investigate the clinical characteristics and prognosis of patients with synchronous gastric and colorectal cancer. Methods： Clinical and pathological data of 3416 cases with gastric cancer and 3109 with colorectal cancer, from March 1985 to May 2005, were analyzed retrospectively. Results： Thirteen cases were confirmed as synchronous gastric and colorectal cancer and the incidences of the disease were 0.38% in gastric cancer cases and 0.42% in colorectal cancer. Of patients suffering from synchronous gastric and colorectal cancer, 15.4% were diagnosed before the first operation and 33.3% were not diagnosed with the second cancer until it was radically dissected. The 3-year survival rate of the patients was 30.8%. Conclusion： The preoperative diagnosis rate of the synchronous gastric and colorectal cancer, the radical dissection rate of the second cancer and the 3-year survival rate after surgical removal of the second cancer were rather low. The key for enhancing the radical dissection rate of the second cancer and the survival rate after surgery for the second cancer lies in the improvement of diagnosis rate before the first operation.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

Prognostic factors in endometrial carcinoma

From Apr. 1964 to Dec. 1985, the prognostic factors of 325 patients suffering from endometrial cancer treated by total hysterosalpingo-oophorectomy and bilateral pelvic lymph node dissection are analyzed. The results indicated that pelvic lymph node metastasis was related to the prognosis of this cancer, the 5-year survival rate was 86.56% in the negative group and 44.74% in the positive group (P less than 0.01). The factors leading to lymph node metastasis were: (1) The more advanced stage, the higher the pelvic lymph node metastatic rate (stage I 12.50%, II 27.16%, III 55.56%) (P less than 0.01); (2) The deeper the myometrial invasion, the higher the metastatic rate (no myometrial invasion 0%, superficial 8.25%, medium 36.96%, deep 40.74%) (P less than 0.01); (3) The higher the histological grade, the higher the metastatic rate (G1 12.50%, G2 21.57%, G3 30.00%) (P less than 0.05), implying that the histological grade is in direct proportion to the myometrial invasion and (4) The metastatic rate to pelvic lymph node is higher in the cervical invaded group than that without it (29.41% in the positive group and 15.42% in the negative group) (P less than 0.05). In this paper, the method of operation for endometrial cancer is discussed, suggesting that hysterosalpingo-oophorectomy be performed before opening the cavity of uterus. Should the cancer invades to a medium or deep degree in the myometrium, histological grade was high or the cervix was infiltrated pelvic lymph node dissection can be performed. After the operation, radiotherapy should be supplemented in those with positive lymph nodes.     

子宫内膜癌147例临床分析

目的：探讨子宫内膜癌的治疗及预后相关因素。方法：回顾性分析我科1991～1997年收冶的147例子宫内膜癌患者的临床病理资料，并全部随访。结果：147例患者、平均年龄56．1岁；5年生存率72．8％；临床表现不规则阴道出血135例、盆腔包块81例、白带增多38例及腹痛23例；绝经前病例为39．5％，已占相当比例，有年轻化趋势；临床病理分期愈晚，预后愈差；肌层侵犯的深度与淋巴结转移及病理组织学分级密切相关，深肌层浸润者，易淋巴结转移、病理组织学分级也差；手术为主、放疗、化疗为辅助治疗的综合治疗预后好、并发症少；孕激素对改善预后有一定的价值。结论：以手术为主的综合治疗是目前治疗子宫内膜癌的首选治疗措施；绝经前后的妇女出现不规则阴道出血等非特异性的妇科症状时，必须警惕子宫内膜癌的发生；临床病理分期、肌层浸润深度、病理组织学分级、淋巴结转移情况及孕激素的应用都是影响预后的相关因素。     

139例子宫内膜癌的临床分析

目的：探讨影响子宫内膜癌患者预后的因素。方法：1995年1月-2003年12月广西肿瘤医院妇瘤科收治的手术治疗的子宫内膜癌患者154例。对其中139例有完整病史资料和随访资料患者的预后因素进行回顾性分析。结果：1,3,5,8年生存率为90％,78％,69％,57％。单因素分析表明：是否绝经、手术病理期别、病理分级、组织类型、肌层浸润、ER、PR、手术方式是影响子宫内膜癌预后的相关因素;多因素回归分析表明：手术病理期别、病理分级、组织类型、肌层浸润、ER、PR是影响子宫内膜癌预后的独立因素。结论：子宫内膜癌的预后与高危因素有关。早期诊断和合理治疗能进一步改善其预后。     

HER2和BRCA1在子宫内膜癌中的表达及其与预后的关系

目的探讨人表皮生长因子受体-2(human epidermal growth factor receptor 2,HER2)和乳腺癌易感基因1(breast cancer susceptibility gene 1,BRCA1)在子宫内膜癌中的表达及其与预后的关系。方法采用免疫组织化学方法检测79例子宫内膜癌、40例非典型增生子宫内膜、30例正常子宫内膜组织中HER2与BRCA1的表达,并结合随访资料分析这2个指标与患者生存时间的关系。结果在正常子宫内膜、非典型增生子宫内膜、子宫内膜癌中HER2阳性表达率分别为6.7%、17.5%、67.1%(P=0.000),BRCA1阳性表达率分别为93.3%、62.5%、31.7%(P=0.000)。子宫内膜癌中,HER2阳性表达与组织分化、手术病理分期、肌层浸润及淋巴结转移有关(均P<0.05),BRCA1阳性表达与组织分化、手术病理分期及淋巴结转移有关(均P<0.05);HER2阳性表达患者的5年生存率低于HER2阴性表达患者(69.8%vs 92.3%,P<0.05),BRCA1阳性表达患者与阴性表达患者的5年生存率差异无统计学意义(84.6%vs 72.2%,P>0.05);BRCA1与HER2蛋白在子宫内膜癌中表达无相关性(r=-0.103,P>0.05)。结论 BRCA1的表达缺失可能与子宫内膜癌的发生、发展有关,HER2蛋白的高表达与子宫内膜癌侵袭性及不良预后有关。     

Ⅰ-Ⅱ期子宫内膜癌术后辅助治疗疗效评价及预后因素分析北大核心

目的:探讨Ⅰ-Ⅱ期子宫内膜癌术后不同辅助治疗方式对患者生存和预后的价值,并综合分析其中影响预后因素。方法:对符合纳入标准并在我院妇科中心治疗的Ⅰ-Ⅱ期子宫内膜癌患者随访资料、病理结果以及临床数据进行回顾性分析,对影响患者术后生存结局和预后因素分别进行Kaplan-Meier生存分析和多因素Logistic回归模型分析;卡方检验分析复发率及生存率。有统计学差异用P<0.05表示。结果:本研究共纳入143例患者,其中术后化疗者58例、放疗者19例、联合放化疗者66例,中位随访时间59个月,生存时间为24~144个月,3年及5年生存率化疗组为92.90%、82.40%,放疗组为93.10%、87.50%,联合放化疗组为98.10%、88.30%,三组数据差异有统计学意义(χ^(2)=6.029,P=0.04)。未复发率化疗组为36%,放疗组为14%,放化疗组为50%,差异有统计学意义(χ^(2)=9.385,P=0.01)。χ^(2)检验结果表明:患者年龄、是否复发、组织学分级及类型与术后辅助治疗疗效差异有统计学意义(P<0.05)。术后放化疗可能是保护性因素[P<0.05,OR=0.563,95%CI(0.048~6.563)];而术后复发是一项强有力的独立危险因素[P<0.01,OR=42.047,95%CI(21.708~61.121)]。结论:组织学类型、分级,术后辅助治疗方式,复发情况可影响Ⅰ-Ⅱ期子宫内膜癌患者的生存情况,术后联合放化疗能够有效避免疾病再发,改善生存率以及总生存时间。     

Bcl-2相关转录因子-1在肝细胞癌组织中的表达及其临床意义

目的:探讨Bcl-2相关转录因子-1（BCLAF1）在肝细胞癌（HCC）组织中的表达及临床意义。方法:免疫组织化学染色法检测104例HCC癌组织及配对的癌旁组织中BCLAF1的表达水平。根据染色结果,将患者分为高表达组和低表达组。生存分析用Kaplan-Meier法,多因素分析用COX比例风险回归模型。结果:癌组织中BCLAF1高表达率为65.38%（68/104）,明显高于癌旁组织的14.42%（15/104）,差异有统计学意义（P＜0.05）。高表达组AFP＞400 ng/mL、TNM分期为Ⅲ-Ⅳ、组织学分级为G3-G4的占比均高于低表达组（P均＜0.05）。多因素分析结果显示,肿瘤直径＞5 cm、血管侵犯、TNM分期为Ⅲ-Ⅳ、组织学分级为G3-G4和BCLAF1高表达是HCC患者OS和PFS较短的影响因素（P均＜0.05）。高表达组5年总体生存率和无进展生存率分别为41.17%和36.76%,明显低于低表达组的80.56%和58.33%,差异有统计学意义（P均＜0.05）。结论:BCLAF1与HCC的发生和发展有关,对评价患者的生存预后有一定价值。     

CIP2A在子宫内膜样腺癌中的表达及临床意义

目的:探究蛋白磷酸酶2A(CIP2A)在子宫内膜样腺癌中的表达情况及临床意义。方法:选取2011年1月至2014年3月行手术切除并经病理证实的50例子宫内膜样腺癌(EAC)及同期行门诊刮宫术获取的40例正常增生期子宫内膜(NE)组织标本。应用RT-PCR、Western blot法检测EAC和NE组织中CIP2A mRNA及蛋白水平,免疫组化法检测CIP2A阳性表达情况。分析CIP2A在EAC和NE组织中的表达差异及与子宫内膜样腺癌临床病理特征的关系。采用Kaplan-Meier法分析CIP2A不同表达水平对患者预后生存的影响,通过COX分析预后独立危险因素。结果:免疫组化染色显示:CIP2A在子宫内膜样腺癌中呈高表达,阳性着色定位于细胞浆和细胞核中,EAC组织中CIP2A阳性表达率显著高于NE组织(P＜0.01)。RT-PCR和Western blot检测显示EAC组织中CIP2A mRNA及蛋白表达水平高于NE组织(P＜0.01)。CIP2A表达与EAC的组织学分级、FIGO分期、宫颈管受累情况、p53表达及Ki-67增殖指数有关（P＜0.05）。Kaplan-Meier法生存分析显示EAC患者5年无病生存率为92.0%、总生存率为88.0%;CIP2A表达、组织学分级、FIGO分期、肌层浸润深度、附件转移、脉管内癌栓及Ki-67增殖指数与患者预后不良相关（P＜0.05）。多因素分析显示,组织学分级、FIGO分期及脉管内癌栓是影响子宫内膜样腺癌患者预后生存的独立危险因素（P＜0.05）。结论:CIP2A在子宫内膜样腺癌中呈高表达,与患者总生存率下降相关,并非影响患者预后的独立危险因素。     

lncRNA HOXC13-AS在宫颈癌组织中的表达及临床意义

目的:探究反义长链非编码RNA HOXC13-AS（lncRNA HOXC13-AS）在宫颈癌组织中的表达及其临床意义。方法:选取2012年9月至2014年5月本院进行手术切除的73例宫颈癌患者作为研究对象,将切除的癌组织作为试验组,同时取同一患者的癌旁（距肿瘤边缘＞2 cm）组织作为对照组。用实时荧光定量PCR（qRT-PCR）检测lncRNA HOXC13-AS表达情况;分析lncRNA HOXC13-AS与宫颈癌病理特征的关系;分析lncRNA HOXC13-AS表达情况对宫颈癌患者5年生存情况的影响;Cox回归分析影响宫颈癌的预后因素。结果:试验组HOXC13蛋白阳性率明显高于对照组（P＜0.05）;试验组lncRNA HOXC13-AS表达明显高于对照组（P＜0.05）;宫颈癌患者癌组织中lncRNA HOXC13-AS表达与患者年龄、肿瘤直径、病理类型及分化程度无关（P＞0.05）,与淋巴结是否转移、肌层浸润深度和FIGO分期有关（P＜0.05）;绘制宫颈癌患者术后1~60个月生存曲线,lncRNA HOXC13-AS高表达者的5年生存率明显低于低表达者（P＜0.05）;Cox回归分析显示,lncRNA HOXC13-AS表达、淋巴结是否转移、肌层浸润深度和FIGO分期均是影响宫颈癌患者预后的危险因素（P＜0.05）,其中lncRNA HOXC13-AS表达是影响宫颈癌患者预后的独立危险因素（P＜0.05）。结论:宫颈癌患者癌组织中lncRNA HOXC13-AS呈高表达,其表达水平与淋巴结是否转移、肌层浸润深度和FIGO分期有关,是影响患者预后的独立危险因素,与宫颈癌患者预后密切相关,有望成为宫颈癌的潜在治疗靶点。     

子宫内膜癌的预后影响因素分析

背景与目的:子宫内膜癌的预后影响因素较多,但其中仅有少数因素对预后构成独立影响。本研究的目的在于探讨子宫内膜癌的独立预后影响因素。方法:对我院1990年1月至2000年12月间初治时行手术治疗的265例子宫内膜癌患者的临床资料进行回顾性研究,预后相关因素采用单因素分析及多因素相关回归分析,并进行逐步筛查。结果:本组病例的5年无瘤生存率及总生存率分别为83.3%和84.3%。单因素分析显示:临床分期、手术-病理分期、病理分级、组织学类型、肌层浸润深度、宫颈受累、淋巴结转移、腹腔液性质、脉管瘤栓及附件转移与5年无瘤生存率及总生存率有显著性相关(P<0.05),年龄、合并症因素与预后无显著性相关(P>0.05)。经多因素分析后得出,手术-病理分期、病理分级、肌层浸润深度及宫颈受累4个因素对子宫内膜癌患者的5年无瘤生存率及总生存率均产生显著性影响(P<0.05),临床分期仅对5年无瘤生存率有显著性影响(P<0.001),而对总生存率无显著性影响(P=0.074)。肌层浸润>50%者远处转移率(12.9%)明显高于≤50%者(0.6%)(P<0.001)。宫颈受累者的淋巴结转移率(21.1%)明显高于宫颈未受累者(3.6%)(P<0.001)。结论:FIGO分期、病理分级、肌层浸润深度及宫颈受累是子宫内膜癌独立的预后影响因素。在估计预后方面,手术-病理分期     

Survival and prognostic factors of endometrial cancer patients in Iceland 1964–1985: Can attendance at population-based pap-smear screening affect survival?

After histological review of all cases registered during the period 1964–1985 at the Cancer Registry, 260 cases with endometrial carcinoma were eligible for analyses of survival rates and prognostic factors, as well as the association of Pap-smear screening attendance with these factors and survival. The total age-adjusted 5- and 10-year relative survival rates were 76% and 75%, respectively. The prognostic factors were tested by univariate analysis and simultaneously by a multivariate analysis using the Cox proportional hazards model. Factors that independently gave a less favorable prognosis were non-attendance at screening, older age at diagnosis, deep myometrial invasion, advancing stages and tumor grading, radiotherapy only, extra-genital symptoms and histology types of serous, clear cell and undifferentiated tumors (histologic type 3). Tested simultaneously with the Cox proportional hazards model, parameters that maintained a less favourable prognosis were grade 3, stage III-IV, deep myometrial invasion, older age, radiotherapy only and extra-genital symptoms. In addition, screening attendance showed significant interaction with age. In stages III and IV only grade 3 maintained a significantly less favorable prognosis. We conclude that our results indicate that attendance at Pap-smear screening (taking Pap smears and screening for genital symptoms) has a favorable prognostic value, especially among women under the age of 62. Int. J. Cancer (Pred. Oncol) 79:166–174, 1998.© 1998 Wiley-Liss, Inc.