电子鼻咽镜和MRI对鼻咽癌颈淋巴结转移的诊断价值

目的探讨鼻咽镜和MRJ检查诊断鼻咽癌颈部淋巴结转移的价值。方法对185例鼻咽癌患者的临床资料进行回顾性分析。结果185例鼻咽癌患者中有131例出现颈部肿块,占70．81％。颈部肿块位于单侧102例,占55．13％,双侧20例,占15．68％,电子鼻咽镜及MRI检查鼻咽灶分布和咽旁间隙受累与颈淋巴结转移有关,双侧咽旁间隙受累比单侧咽旁间隙受累其双侧颈淋巴结转移率高P〈0．005。以颈部淋巴结的影像学分区为标准：Ⅰ-Ⅵ区和咽后区的转移率分别为2．4％、95．42％、51．15％、11．45％、19．84％、0％和75．57％。结论鼻咽癌患者大多数会出现颈淋巴结转移,鼻咽灶分布与颈淋巴结转移率、大小及在颈部分区之间存在着密切相关性,鼻咽镜检查及MRI在鼻咽癌的诊断中起重要作用。     

110例鼻咽癌原发灶部位、体征和鼻咽、颅底CT关系探讨

目的：探讨鼻咽癌原发灶部位、体征与鼻咽、颅底CT关系。材料与方法：分析1993年12月至1995年10月我院收治的110例鼻咽癌之临床表现及鼻咽、颅底CT扫描。结果：茎突内侧软组织受侵率为87．3％（96／110），颈淋巴结转移率为77．3％。原发灶位于侧壁单侧颈淋巴结转移为52．9％（18／34），双侧颈淋巴结转移为35．4％（12／34）；原发灶位于顶侧壁单侧颈淋巴结转移为48．4％（17／35），双侧颈淋巴结转移为40．0％（14／35）。鼻咽癌除了直接向各壁和周围邻近组织发展蔓延外，咽旁间隙受侵和颈淋巴结转移有直接关系。鼻咽癌原发灶部位与颈淋巴结转移亦有关。本组资料还说明茎突内侧软组织受侵的侧别对颈深上淋巴结转移和前后组颅神经损害有一定关系。     

110例鼻咽癌原发灶部位,体征和鼻咽,颅底CT关系探讨

探讨鼻咽癌原发灶部位，体征与鼻咽、颅底ＣＴ关系。材料与方法：分析１９９３年１２月１９９５年１０月院收的１１０例例鼻咽癌之临床表现及鼻咽，颅底ＣＴ扫描。结果：茎突内侧软组织受侵率为８７．３％，颈淋巴转移率为７７．３％。原发灶位于侧壁单侧颈淋巴结转变为５２．９％，双侧颈淋巴结转移为３５．４％；原发灶位于顶侧壁单侧颈淋巴结转移为４８．４％，双侧颈淋     

鼻咽癌颈 部淋巴结转移与咽旁间隙受侵的关系

作者对本院1985年12月至1988年8月首次治疗前的196例鼻咽癌临床及CT扫描发现的资料进行了分析。单侧或双侧颈部淋巴结转移灶≥3cm者,咽旁间隙及颈动脉鞘受侵率分别为65.42％(70/017)及62.62％(67/017),但颈部淋巴结转移灶<3cm者,咽旁间隙及颈动脉鞘受侵率仅为15.63％(5/32)及12.5％(4/32),二者具有显著性差异(P<0.005);咽旁间隙及颈动脉鞘受侵者,颈部淋巴结转移率分别为84.27％(75/89)及84.52％(71/84)。4例后组颅神经受累者全部有咽旁间隙受累,其它颅神经受累者咽旁间隙受侵者仅为35.71％(10/28)。我们的资料表明,颈部淋巴结转移灶与颈动脉鞘关系密切,颈部淋巴结转移可能是原发灶直接侵犯颈动脉鞘后产生的。在缺少CT扫描的情况下,根据颈部淋巴结大小,我们提出鼻咽癌放疗设野的建议。     

333例鼻咽癌咽后淋巴结转移特点的MRI分析

目的了解鼻咽癌咽后淋巴结的发生率及特征,探讨其与受累部位、颈部淋巴结转移的关系。方法回顾性分析333例经病理证实、无远处转移的初诊鼻咽癌患者MRI资料。根据2008临床分期标准进行分期。采用率的比较分析咽后淋巴结转移与临床分期、肿瘤侵犯部位及颈部淋巴结转移的关系。结果（1）咽后淋巴结阳性率为66.3%,其中单侧41.4%,双侧24.9%;不同T、N分期（T1、T2、T3、T4;N1b、N2、N3）的咽后淋巴结转移率均不同,其中T1期均低于T2、T3以及T4期（P＜0.05）,N1b期均较N2、N3期低（P＜0.05）;（2）茎突前间隙、颈动脉鞘区、口咽、椎前肌、翼内肌等结构侵犯者的咽后淋巴结转移发生率均明显高于其未侵犯者（P＜0.05）;（3）全组病例颈淋巴结转移率为82.0%,其中咽后淋巴结阳性者高于阴性者（87.8% vs.70.5%,P＜0.05）;双侧咽后淋巴结转移者高于单侧转移者（94.0% vs. 84.1%,P＜0.05）;（4）咽后淋巴结最大直径≤20 mm与最大直径＞20 mm患者的颈淋巴结各区转移率差异无统计学意义（P＞0.05）。结论（1）鼻咽癌咽后淋巴结转移率高与茎突前间隙、颈动脉鞘区、椎前肌、翼内肌及口咽侵犯相关;（2）鼻咽癌咽后淋巴结转移影响颈淋巴结的转移;（3）咽后淋巴结的直径大小与颈淋巴结各区转移无相关性。     

鼻咽癌淋巴结转移的磁共振成像研究

目的探讨鼻咽癌淋巴结转移的影像学规律。方法搜集初治鼻咽鳞癌315例，全部行常规鼻咽部MRI平扫及增强检查，采用2003年RTOG推荐的头颈部肿瘤淋巴结转移的分区标准。结果315例中254例淋巴结转移，跳跃性淋巴结转移4例。254例转移淋巴结中，81例仅左侧转移，72例仅右侧转移，101例为双侧转移；73例仅咽后淋巴结转移，21例仅有颈淋巴结转移，160例为咽后及颈淋巴结均有转移。原发肿瘤单纯累及顶后壁的89例中，78％累及咽后淋巴结；单纯累及侧壁的43例中，49％累及咽后淋巴结（x^2=11．00，P〈0．01）。原发肿瘤T1、T2、T3、T4期的淋巴结转移率分别为73．5％、91．2％、71．9％、73．5％（x^2=1．81，P〉0．05）。局部早期（T1～T2期）和局部晚期（T3～T4期）病变淋巴结转移分布间差异无统计学意义。结论鼻咽癌淋巴结转移率高，以咽后淋巴结最多见，跳跃性转移率低。不同T分期淋巴结转移率无差别，鼻咽癌淋巴结转移的分布与T分期无关。     

38例鼻咽癌腔外侵犯的CT扫描分析

（目的）分析鼻咽癌腔外侵犯的情况及其与颈部淋巴结转移的关系。（方法）总结38例经活检病理证实为鼻咽癌患者的CT图像。平扫11例，平扫加增强27例，横断加冠状位扫描4例。层厚、层距各5mm。（结果）38例均有鼻咽腔变形、局部隆起、粘膜下增厚肿块、咽隐窝挤压、消失等变化。参照黎福祥的咽旁间隙划区方法，94．7％有不同程度咽旁间隙侵犯。咽旁间隙后区受侵者，颈淋巴结转移63．3％（19／30）。口咽受侵者，颈淋巴结转移率为100％（10／10）。受侵部位大于3个者，颈淋巴结转移率为86．6％（13／15）。（结论）CT扫描对鼻咽癌诊断及明确侵及部位具有重要价值。合理扫描可增加肿瘤侵及范围的检出率。咽旁后间隙受侵、口咽受侵及部位多者其颈淋巴结转移率高，这对放疗设野具有重要参考价值。     

512例鼻咽癌颈淋巴结转移规律的研究

背景与目的:合理定义鼻咽癌颈部靶区在临床上显得越来越重要,本研究旨在探讨鼻咽癌颈淋巴结转移的规律,以指导三维适形放射治疗颈部靶区的勾画.方法:收集2003年1月～2004年6月在中山大学肿瘤防治中心初治的鼻咽癌病例512例,所有病例均经病理证实、并行增强CT模拟扫描.淋巴结分区标准采用2003年RTOG推荐的颈部淋巴结分区标准.结果:512例病例中,328例(64.1%)诊断为有淋巴结转移.淋巴结阳性的病例中61.3%为单侧淋巴结转移,38.7%为双侧淋巴结转移.咽后淋巴结的发生率为64.1%,其中单侧占50.9%,双侧占49.1%.淋巴结阳性的病例中Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ和咽后区的转移率分别为3.0%、97.9%、46.0%、9.5%、13.7%、0%和74.4%.跳跃性转移率仅为4.6%～6.5%.25.3%的N1-3病例出现了推荐标准以外区域的侵犯.结论:鼻咽癌的颈部淋巴结转移是由上而下循序性的;跳跃性转移发生率低;咽后淋巴结为鼻咽癌转移的首站淋巴结.咽后、Ⅱ区和Ⅲ区最容易受累及;Ⅰa和Ⅵ区从未受累.有部分阳性淋巴结超出了RTOG推荐用于N0的颈部CTV范围.以上结果有助于鼻咽癌的三维适形放疗和调强放疗颈部靶区的勾画.     

鼻咽癌调强放疗靶区描绘和设定及剂量分配的现状

调强放疗提高了局部和区域控制率，降低了并发症，是鼻咽癌放疗发展的方向。CT和MRI融合能更充分展示鼻咽癌原发病变范围，被认为是目前较理想的影像模式；目前困扰颈淋巴结范围描绘的关键因素是怎样将颈淋巴结分区转换为CT层面可描绘的影像边界，欧美共同描绘规范缩小了各肿瘤中心在勾画颈淋巴结区域时的差异而值得推荐；世界各主要肿瘤中心鼻咽癌调强计划规范中，大体肿瘤区的定义基本一致，且处方剂量接近甚至高于80Gy．主要差异是对鼻咽CTV范围的定义及鼻咽CTV和上颈部的处方剂量方案。根据随访结果分析，建议鼻咽CTV的范围除在鼻咽原发肿瘤外扩一定边径外，还应包括整个鼻咽腔、咽后淋巴结区、斜坡、颅底骨质结构、翼腭窝、咽旁间隙、部分蝶窦、鼻腔和上颌窦后1／3，且处方剂量宜≥60Gy；双侧上颈部应列为高危淋巴结转移区，施予至少60Gy的照射量。     

鼻咽癌双侧腹股沟淋巴转移2例报告

鼻咽癌发生颈淋巴结转移率为 79.37% ,但发生腹股沟淋巴结远地转移少见 ,我们于 1996年初至 1996年底收治 2例鼻咽癌患者均以右颈部肿块为首发症状 ,继而进一步检查鼻咽部后确诊为鼻咽癌颈淋巴结转移 ,且分别于放射治疗前后 ,同时发生双侧腹股沟淋巴结转移均经病理证实。例 1:男性 ,40岁 ,农民 ,发现右颈部巨大包块 2月 ,伴有气短半月来我院就诊 ,查体发现右颈部有 10 cm× 8cm× 8cm肿物 ,质硬、固定。左颈部未见异常。双侧腹股沟可及数枚大小不等之肿大淋巴结 ,大者约 3cm× 3cm× 2 cm ,小者约0 .5 cm× 1cm ,间接鼻咽镜检查见 ,张口受限…     

nm23－H1和CD44蛋白在鼻咽癌中的表达及其与临床的关系

目的：探讨鼻咽癌（ＮＰＣ）中ｎｍ２３－Ｈ１和ＣＤ４４的表达及其与临床的关系。方法：收集ＮＰＣ蜡块标本,应用免疫组化ＬＳＡＢ法,检测ｎｍ２３－Ｈ１和ＣＤ４４基因蛋白的表达,其中前者４８例,后者４０例,３７例同时进行了上述两种检测,将两种基因蛋白表达结果与其临床的关系进行研究分析。结果：ｎｍ２３－Ｈ１阳性表达率６０．４２％,其与颈淋巴结转移无关,但与转移之颈淋巴结大小有关;ｎｍ２３－Ｈ１的表达与放疗后     

nm23基因在人甲状腺乳头状癌的表达及其与淋巴结转移的关系

应用免疫组化ＡＢＣ法检测１００例甲状腺乳头状癌标本中ｎｍ２３基因产物二磷酸核苷激酶（ＮＤＰＫ）的表达。结果总阳性率６７％，其中无淋巴结转移组阳性率８５％（３４／４０），伴有淋巴结转移组阳性率５５％（３３／６０）（Ｐ＜０．０１）；未侵犯包膜组阳性率７９％（３０／３８），侵犯包膜组阳性率６０％（３７／６２）（Ｐ＜０．０５），提示ｎｍ２３基因在甲状腺乳头状癌的表达与淋巴结转移及包膜侵犯呈负相关关系。结果还显示，在ｎｍ２３基因表达阳性的病例中，未侵犯包膜与侵犯包膜组淋巴结转移率分别是７％（２／３０）及８４％（３１／３７），（Ｐ＜０．０１），提示尽管ｎｍ２３阳性，侵犯包膜组明显比未侵犯包膜组淋巴结转移机会大；在未侵犯包膜的病例中，ｎｍ２３（－）及ｎｍ２３（＋）病例的淋巴结转移率分别是７５％（６／８）及７％（２／３０）（Ｐ＜０．０５），提示尽管未侵犯包膜，但在ｎｍ２３阴性时，淋巴结转移的可能性仍很大。结论：本检测有助于探讨代表甲状腺乳头状癌转移趋势的分子生物学标志，更科学地选择手术方式。     

双侧甲状腺乳头状癌中央区隐匿转移相关因素分析

目的：探索双侧甲状腺乳头状癌（PTC）中央区隐匿转移的规律。方法对收治的56例中央区临床阴性（cN0期）的双侧PTC患者常规行中央区清扫,回顾性分析术后病理中央区转移的相关因素。结果全组患者中央区转移率为64.3%（36/56）,其中单侧中央区转移率为25.0%（14/56）,双侧转移率为39.3%（22/56）。在可区分轻重侧的33例患者中,无转移,双侧转移,仅轻侧转移和仅重侧转移比例分别为33.3%、39.4%、9.1%和18.2%,轻、重侧总转移概率分别为48.5%和57.6%,差异无统计学意义（χ2=0.547,P=0.459）。最大肿瘤直径﹥1 cm和颈侧转移是中央区隐匿转移的影响因素;以单侧病变为对象分析,肿瘤浸润包膜和侧颈转移是该侧中央区隐匿转移的独立危险因素。结论双侧PTC患者具有较为特殊的中央区转移规律且隐匿转移发生率较高,在情况允许下可考虑进行双侧中央区清扫。     

Comparative study of angiostatic and anti-invasive gene expressions as prognostic factors in gastric cancer

Genes involving angiogenesis and metastasis play an important role in the progression and infiltration of cancer. We examined the expressions of various angiostatic and potential invasion/metastasis suppressor genes through RT-PCR analyses in 32 gastric cancer specimens with or without distant metastasis. The expressions of the invasion/metastasis suppressor, nm23 and E-cadherin increased much more in the cancer tissue (CT) and metastatic lymph node (MLN) than in the extraneoplastic mucosa (EM) and non-metastatic lymph node (NLN), respectively. The expressions of the angiostatic factor, angiopoietin 2 and thrombospondin 2 increased in the CT and MLN as compared with the EM and NLN, respectively. The newly cloned angiostatic factor, brain-specific angiogenesis inhibitor 1 (BAI1) decreased much more in the CT and MLN than the EM and NLN, respectively. However, BAI1 increased in the CT compared with the EM among the patients with poor prognosis and distant metastasis, such as liver or peritoneum. The expressions of the invasive factor, matrix metalloproteinase-2 and its suppressor, tissue inhibitor metalloproteinase-2 (TIMP-2) increased in the CM as compared with the EM, but the increased expression pattern of these genes in the CT became blunted among the patients with good prognosis. Our results indicate that BAI1 and TIMP-2 expressions in the extraneoplastic mucosa and non-metastatic lymph nodes were not suppressed in the patients with good prognosis, but increased expressions of angiopoietin 2, thrombospondin 2, TIMP-2, nm23 and E-cadherin in the tumor tissue did not lead to a long survival after operation. It is suggested that the extent of BAI1 and TIMP-2 expression in the gastric mucosa may be an important prognostic factor for predicting survival in gastric 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.     

食管鳞癌与p53及CD44v6表达分析

 目的　分析 p5 3、CD4 4v6与食管鳞癌的预后关系。 方法　用免疫组化法测定原发食管鳞癌 p5 3癌基因、CD4 4v6的表达。结果　p5 3的阳性表达为 4 7.8% ,与肿瘤的分化程度、浸润深度呈显著相关 (P <0 .0 5 ) ,与淋巴结有无癌转移及肿瘤大小未见显著相关 (P >0 .0 5 )。CD4 4v6阳性表达为 79.9% ,分化程度高的阳性表达大于分化程度低的 ,侵及外膜、淋巴结有癌转移的表达大于无外膜受侵和无淋巴转移 ,但未见显著性 (P >0 .0 5 )。结论　p5 3阳性表达预示食管鳞癌分化程度低 ,有较强的侵袭能力。CD4 4v6作为对食管癌的浸润转移和预后标记物并不十分理想。     

Clinical significance of MUC1 and MUC2 mucin and p53 protein expression in colorectal carcinoma

BACKGROUND: Up-regulation of MUC1, down-regulation of MUC2 and p53 overexpression are seen in colorectal carcinomas. However, there have been few reports about the associations between MUC1, MUC2 and p53 expression and metastatic potential. The aim of this study was to investigate MUC1, MUC2 and p53 expression in colorectal carcinoma with special reference to regional and distant metastasis. METHODS: Eighty-six colorectal carcinomas were collected from patients undergoing tumor resection. Sections were used for MUC1, MUC2 and p53 immunostaining. Cancers were regarded as MUC1 or MUC2 positive when the positive cells were beyond 30% of cancer cells. Cancers with diffuse or nested patterns were regarded as having p53 overexpression. RESULTS: Of 86 cancers, 37 (43%) were MUC1 positive, 28 (33%) were MUC2 positive and 59 (69%) showed p53 overexpression. A difference was observed only in the frequency of MUC1 positivity with respect to depth of tumor invasion. Neither depth of tumor invasion nor histological differentiation had a positive correlation with MUC1, MUC2 and p53 overexpression. The frequency of MUC1 positive cells in Dukes' C and D tumors was significantly higher than that in Dukes' A and B tumors. The frequency of MUC1 positivity in tumors with hepatic involvement was significantly higher than that in tumors without hepatic involvement (100 vs 39%; p < 0.01). There was no difference in the frequency of MUC2 or p53 positivity in Dukes' stage or hepatic metastasis. MUC1 immunoreactivity of the surface was identical with that of the whole tumor in 81% (70/86) of carcinomas, MUC 2 in 87% and p53 in 100%. CONCLUSIONS: The results suggest that up-regulation of MUC1 is involved in the progression from the non-metastatic to the metastatic stage and that p53 abnormality is not directly involved in it. The data also imply that immunostaining of preoperative biopsy samples is useful for evaluating the immunoreactivity of the whole tumor.     

Surgery of localized cardioesophageal cancer.

In cardioesophageal cancer the 5-year survival was 52.5% for operations on patients without regional metastasis or involvement of the serous gastric membrane. When regional metastases were present, the 5-year-survival was 23.3%. When the whole wall was invaded with the tumor but there were no metastases to the regional lymph nodes, the 5-year survival increased to 38.2%. In cases involving both invasion and metastases, the percentage of 5-year survivors was 13.3%. These findings indicate the prognostic significance of metastatic spread to regional lymph nodes. When cardioesophageal tumor invasion spreads beyond the original tumor site, combined resection yields apparently similar results. The experience of this clinic permits us to conclude that potential progress in obtaining improved long-term results for esophageal cancer management is dependent on advances in lymph node dissection methods and the search for effective combinations of systemic treatment, involving chemotherapy or immunotherapy.     

186例下咽癌颈淋巴结转移规律影像学分析

本研究拟通过计算机体层摄影（CT）/磁共振成像（MRI）分析下咽癌颈部淋巴结转移特点及规律，探讨Ⅵ区淋巴结转移发生的相关影响因素，为临床治疗提供参考。方法:收集2000年8月至2010年12月期间中山大学肿瘤防治中心的下咽癌病例186例，均经病理证实，行治疗前CT/MR检查。统计学方法采用χ2检验和Logistic多因素分析。结果:下咽癌淋巴结转移率为79%，Ⅱ、Ⅲ区转移最常见，转移率分别为72.0%、54.8%。在有淋巴结转移患者中，咽后壁癌和环后区癌双侧淋巴结转移率分别为53.3%和50.0%，梨状窝癌原发灶侵犯过中线后对侧淋巴结转移率（40.0%）较未过中线者（11.1%）明显增高（P<0.001）。单因素和多因素分析显示Ⅳ区转移、咽后淋巴结转移和食管受侵与Ⅵ淋巴结转移关系密切。结论:下咽癌淋巴结转移率高，转移遵循一定的规律，跳跃性转移少见。咽后壁癌和环后区癌及梨状窝癌侵犯过中线后易发生双侧淋巴结转移。Ⅳ区转移、食管受侵和咽后淋巴结转移可能是Ⅵ区淋巴结转移的独立影响因素。