不同年龄段直肠癌患者临床病理学特征的研究

目的探讨直肠癌患者年龄与临床病理学特征的关系。方法对161例直肠癌患者的临床资料进行了回顾性分析。其中小于40岁者21例（青年组）,40-60岁者62例（中年组）,大于60岁者78例（老年组）。结果不同年龄组患者入院时的主要临床表现和肿瘤发生部位的差异无统计学意义（P〉0．05）。误诊率以青年组最高．为38．1％（8／21）,显著高于中年组（9．7％,6／62）和老年组（2．6％,2／78）,差异有统计学意义（P〈0．01）。年龄与直肠癌分化程度及TNM分期均呈负相关．随着年龄的增加．低分化和Ⅳ期直肠癌所占比例呈明显下降趋势。结论老年和青年直肠癌患者某些临床病理学特征存在明显差异．青年直肠癌患者肿瘤分化程度较老年患者为低．肿瘤分期较晚。     

青年胃癌的临床病理特征及其预后分析

目的探讨青年胃癌的临床病理及预后特征,以提高青年胃癌的治疗水平。方法回顾性分析福建医科大学附属协和医院胃外科2004年1月至2006年12月间收治的63例青年胃癌患者（青年组．小于或等于40岁）的临床病理资料及预后情况,并与同期654例中老年胃癌患者（中老年组．大于40岁）进行比较。结果青年组中女性、存在家族史及未分化型患者比例显著高于中老年组（均P〈0．05）。青年组患者根治性切除率61．9％（39／63）,低于中老年组的93．1％（595／654）,差异有统计学意义（P〈0．01）。653例（91．1％）患者获得了1～84个月的随访,青年组和中老年组术后5年生存率分别为40．5％和55．6％．差异有统计学意义（P〈0．05）。多因素预后分析显示,浸润深度、淋巴结转移和手术根治性是影响青年胃癌患者预后的独立因素（均P〈0．05）。分层预后分析显示,行根治性手术的青年组和中老年组患者术后5年生存率分别为63．2％和56．7％．差异无统计学意义（P〉0．05）：行姑息性手术后两组患者5年生存率分别为4．2％和22．2％,差异有统计学意义（P〈0．05）。结论青年胃癌恶性度高．根治性切除率低,总体预后不佳;但积极行根治性手术者可达到与中老年胃癌相似的远期疗效。     

Ⅱ期结直肠癌根治术淋巴结检出数目与患者预后的关系

目的探讨Ⅱ期结直肠癌根治术淋巴结检出数目与患者预后的关系。方法回顾性分析380例Ⅱ期结直肠癌患者的临床资料。结果本组术后5年内出现复发或转移的56例患者与无复发转移者平均淋巴结检出数分别为9．5枚／例和16．3枚／例（P〈0．01）．术后5年内死亡的97例患者与健在者平均淋巴结检出数分别为11．1枚／例和16．7枚／例（P〈0．01）．差异均有统计学意义。淋巴结检出大于或等于12枚／例组和小于12枚／例组的5年生存率分别为83．9％和62．0％（P〈O．01）,复发转移率分别为6．4％和25．7％（P〈0．01）,差异也均有统计学意义。单因素分析显示,Ⅱ期结直肠癌患者的预后与淋巴结检出数目有关（P〈0．05）。结论淋巴结检出数目多少影响Ⅱ期结直肠癌患者的预后．淋巴结检出数目多者复发转移率低．生存率较高。     

低位Ⅰ期直肠癌患者的外科治疗与预后分析

目的探讨低位Ⅰ期直肠癌的外科治疗效果及影响复发和预后的因素。方法回顾性分析166例低位Ⅰ期直肠癌患者的临床资料。结果本组根治性手术138例，均按直肠全系膜切除（TME）手术原则进行；其中93例行腹会阴联合根治术，45例行保肛手术；肿瘤局部切除术28例。局部复发率根治性手术者为5．1％（7／138），其中腹会阴联合根治术组为6．5％（6／93），保肛术组为2．2％（1／45）；局部切除术组为17．9％（5／28）。X^2检验显示，肿瘤分化程度（P=0．009）和手术方式（P=0．039）与局部复发相关。腹会阴联合根治术组5年生存率为90．4％，保肛术组为95．5％。局部切除术组为82．6％。单因素分析显示，肿瘤分化程度（P=0．000）和局部复发（P=0．000）与预后相关；多因素分析显示，局部复发是影响预后的主要因素（P=0．000）。结论低位Ⅰ期直肠癌根治性手术切除复发率低、预后好。局部切除术的选择应严格把握指征。     

小野寺预后营养指数在老年结直肠癌患者预后评估中的应用

目的探讨小野寺预后营养指数（简称小野寺指数）在老年结直肠癌患者预后评估中的应用价值。方法回顾性分析2004年11月至2006年12月间广州市第一人民医院收治的163例老年（65岁以上）结直肠癌患者的临床和随访资料。根据患者入院后首次血常规和生化检查结果,计算小野寺指数[小野寺指数=白蛋白值（g／L）＋5×淋巴细胞总数（10^9L）]。分析小野寺指数与临床病理特征、手术方式、术后并发症及胃肠道功能恢复的相关性,并通过Cox回归模型筛选影响老年结直肠癌患者的预后因素。结果163例结直肠癌患者小野寺指数为24．3～60．3（44．0±6．9）,根据小野寺指数分为营养较好组（小野寺指数大于或等于45,77例）和营养较差组（小野寺指数小于45,86例）。两组根治性切除的患者比例分别为90．9％（70／77）和62．8％（54／86）,差异有统计学意义（P〈0．01）。两组根治性切除术后总并发症发生率分别为17．1％（12／70）和53．7％（29／54）,差异有统计学意义（P〈0．01）。相关分析显示,小野寺指数与患者年龄、肿瘤部位、肿瘤大小、手术方式、术后总并发症及术后肛门排粪时间具有相关性（均P〈0．05）。营养较好组和营养较差组术后5年生存率分别为64％和24％,差异有统计学意义（P〈0．01）;多因素Cox回归分析证实,小野寺指数是影响术后总体生存的独立预后因素（RR=0．888,95％CI：0．800～0．985,P=0．025）。结论小野寺指数能较好地反映老年结直肠癌患者的营养状态、手术风险及预后,是一个较有价值的结直肠癌术前评估及预后分析指标。     

224例无淋巴结转移的进展期胃癌预后因素分析

目的探讨无淋巴结转移的进展期胃癌预后危险因素。方法回顾性分析福建省立医院1998—2008年10年间行D2胃癌根治术的236例淋巴结清扫数目在12枚以上、无淋巴结转移（N0期）的进展期胃癌患者的临床病理资料。结果本组患者中224例（94．9％）接受了随访,其5年总体生存率和5年无瘤生存率分别为75．2％和66．4％。T2期和T3期患者的复发率分别为5．8％（8／138）和14．0％（12／86）：5年总体生存率分别为82．5％和59．0％;5年无瘤生存率分别为70．4％和52．2％：差异均有统计学意义（均P〈0．05）。单因素预后分析显示,浸润深度、Lauren分型及淋巴结清扫数目与本组胃癌患者预后有关（P〈0．05）。多因素预后分析证实,浸润深度是本组患者的独立预后因素（P〈0．05）。结论T2N0期胃癌患者的预后明显优于T3N0期患者;对N0期胃癌患者决定是否行辅助治疗及制定随访策略时应考虑浸润深度这一因素。     

青年女性肺腺癌预后影响因素分析

目的 探讨青年女性肺腺癌的临床病理学特征对预后的影响。方法 回顾性分析手术治疗的青年女性肺腺癌282例，用Kaplan-Meier法计算生存率，分析临床病理学特征与预后的关系，并且进行Cox回归比例风险模型多因素分析。结果 吸烟与非吸烟组5年生存率分别为20．0％与36．4％（P=0．021）；p-TNM各分期5年生存率分别为Ⅰ期65．7％（Ⅰa期66．1％、Ⅰ期60．5％）、Ⅱ期30．9％（Ⅱa期36．3％、Ⅱb期27．5％）、Ⅲ期11．4％（Ⅲa期12．3％、Ⅲb期6．8％）、Ⅳ期3．6％，各期间生存率差异有统计学意义（P〈0．001）；淋巴结转移个数〉3个与≤3个的5年生存率分别为19．1％与38．3％（P=0．006）；高、中、低分化的5年生存率为65．2％、29．5％、19．8％（P〈0．001）。吸烟、p-TNM分期、转移淋巴结个数及分化程度与预后密切相关。多因素分析中吸烟、p-TNM分期和分化程度是独立的预后因素，相对危险比（RR）分别为3．315、2．809、1．195。结论吸烟、p-TNM分期、转移淋巴结个数及分化程度与青年女性肺腺癌的预后关系密切，吸烟、p-TNM分期和分化程度是青年女性肺腺癌的独立预后因素。因此，应当积极控制青年人群的吸烟，彻底清扫淋巴结，这对于青年女性肺腺癌预后具有重要意义。     

细胞周期蛋白E对直肠癌预后判断的价值及与血管侵袭的相关性

目的研究细胞周期蛋白（cyclin）E表达与直肠癌预后的相关性及其对血管侵袭（BVI）的影响。方法蛋白质印迹法检测130例Ⅰ～Ⅲ期直肠癌组织eyelinE的表达：抗CD34单克隆抗体免疫组化反映BVI。结果全组直肠癌组织中eye[inE高表达率为23．1％（30／130）。除病理大体类型、BVI外。eyelinE表达与其他临床病理因素无明显相关性。eyelinE高表达的患者发生BVI的危险性为低表达者的3．145倍（P=0．001）；eyelinE高表达者生存率低。其5年生存率29．2％。与低表达者的70．5％相比。P=0．001。COX回归多因素分析显示。eyelinE是影响全组直肠癌术后预后的独立因素[RR值（95％CI）3．544（1．528～8．215）。P〈0．05]；分层分析显示。eyelinE是Ⅰ～Ⅱ期直肠癌预后的主要影响因素之一[RR值（95％CI）4．066（1．217～13．39）。P〈0．01]。联合检测时．eyelinE高表达及BVI阳性的患者死亡危险度是eyelinE低表达及BVI阴性患者的6．693倍（95％CI2．539～17．646）。结论CyclinE是影响直肠癌预后的重要分子生物学指标。CyclinE高表达者易发生BVI。eyelinE与BVI联合检测有助于提高对直肠癌预后判断的准确性。     

老年人胃癌临床病理分析

目的探讨老年人胃癌的临床及病理特点，旨在为其合理诊治提供依据。方法将经手术治疗的324例胃癌病人（≥60岁）人选老年组，81例青年（〈44岁）胃癌病人作为对照。对比分析两组在临床特点及组织、病理学方面的差异。结果两组在临床症状、肿瘤部位、浸润深度、病理分期方面差异无统计学意义（P〉0．05）；在性别构成、病史长短、术前合并症、术后并发症、手术类型、住院时间等方面差异有统计学意义（P〈0．05）。根治性手术后，老年组与青年组3年生存率差异无统计学意义（P〉0．05）。结论老年胃癌病人在临床及病理学方面并未显示出比青年病人更差的结果。老年人胃癌预后的改善仍依赖于早期诊治水平的提高。     

老年人甲状腺功能亢进症糖和脂代谢特点52例分析

目的 探讨老年人甲状腺功能亢进症（甲亢）糖、脂代谢特点。方法 对52例老年甲亢患者（老年组）、68例非老年甲亢患者（非老年组）及50例健康对照者进行糖耐量试验（OGTT）、血脂及游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（S-TSH）水平测定。结果 老年组、非老年组的FT3、FT4、血糖水平明显高于对照组（P均〈0．01），甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇（LDL-C）水平低于对照组（P均〈0．01）；老年组与非老年组比较，FR水平明显降低（P〈0．001），而TG、TC、LDL及血糖水平高于非老年组（P均〈0．05）；老年组糖耐量异常为57．7％。非老年组为39．7％，两组比较差异显著（P〈0．001）。结论 甲亢可影响糖、脂代谢，FT3、FT4水平及糖、脂代谢异常程度与甲亢患者年龄有关。     

40岁以下青年人直肠癌的外科治疗及预后分析

目的探讨青年直肠癌的外科治疗效果及影响其预后的因素。方法回顾性分析中国医学科学院肿瘤医院1990年1月至2000年1月收治的40岁以下青年直肠癌患者138例的临床资料。结果全组患者均经根治性手术治疗,其中腹会阴联合根治术81例,直肠前切除术54例,经肛直肠癌局部切除术3例。全组总的3年及5年生存率分别为67.7%及50.4%。单因素分析显示Dukes分期、淋巴结转移状况、性别、围手术期输血、肿瘤T分期、组织学类型及脉管瘤栓为影响预后的主要因素,而多因素分析显示肿瘤T分期、淋巴结转移是影响预后最重要的独立因素。结论对于青年直肠癌患者,根治性手术治疗是获得长期生存的惟一方法,肿瘤T分期和淋巴结转移情况是影响预后的最重要因素。     

青年期大肠癌临床分析

目的　探讨青年期大肠癌的特点。方法　对 1 980年 1月至 2 0 0 3年 7月间收治 3 0岁以下大肠癌 5 2例的临床资料进行分析。结果　直肠癌 (71 2 % ) ,误诊率 61 5 % ,分化不良型占 75 0 %。病理分期DukesC、D期 78 9% ,手术根治率 5 9 6% ,淋巴结转移率和腹腔游离癌细胞检出率高 ,分别为 68 8%和 43 8% ,5年生存率为 3 8 7%。结论　青年大肠癌以直肠癌多见 ,且恶性程度和误诊率较高 ,病理分期较晚 ,手术根治率和 5年生存率较低。提高对青年大肠癌的认识 ,早期发现 ,早期诊断 ,及时合理的治疗 ,才能提高疗效     

Do Young Colon Cancer Patients Have Worse Outcomes?

Previous studies on colon cancer have noted rising incidence rates among young individuals and suggest that they may have more aggressive disease and worse 5-year survivals than their older counterparts. Our study uses a nationwide population-based cancer registry to analyze colon cancer presentations and outcomes in a young versus an older population. The records of patients with colon carcinoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) national cancer database (1991–1999). Two cohorts based on age at diagnosis (20–40 years, n = 1334 vs. 60–80 years, n = 46,457) were compared for patient and tumor characteristics, treatment, and 5-year cancer-specific survival. A multivariate Cox regression was performed to identify predictors of survival. The young group had a higher proportion of black and Hispanic patients than did the older group (p < 0.001). Young patients had less stage I or II disease, more stage III or IV disease (p < 0.001), and worse-grade (poorly differentiated or anaplastic) tumors (p < 0.001). The 5-year stage-specific survival was similar for stage I and III disease (p = NS) but was significantly better for young patients with stage II and IV disease (p < 0.01). Using a nationally representative cancer registry, we found that young colon cancer patients tend to have later-stage and higher-grade tumors. However, they have equivalent or better 5-year cancer-specific survival compared to older patients. This population-based finding contradicts prior single-institution reports.     

Ⅳ期直肠癌的外科治疗及预后分析

目的 探讨Ⅳ期直肠癌患者原发病灶切除的价值和适应证.方法 回顾性分析1988年1月至2005年12月在外科治疗的118例Ⅳ期直肠癌患者的临床资料,将118例分为二组,手术切除原发病灶组(105例)和仅行造瘘术组(13例).采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,应用Cox比例风险模型进行多因素分析. 结果 118例中105例行直肠原发病灶切除,同期行转移瘤切除16例;13例行造瘘术.手术切除原发病灶组总的5年生存率为8.5%.其中同期行转移瘤切除者5年生存率31.2%,行辅助化疗者5年生存率20%.手术切除原发病灶组与造瘘组中位生存期分别为15个月、13个月(X2=0.736,P=0.778).手术切除原发病灶组中转移灶切除和转移灶未切除中位生存期分别为20个月、14个月(X2=5.382,P:0.020).手术切除原发病灶加术后全身化疗为主者中位生存期为21个月.多因素分析显示原发肿瘤分化程度、肝转移瘤最大径和全身化疗是影响直肠原发肿瘤切除预后的最主要因素. 结论 对于Ⅳ期直肠癌能同时切除原发及转移病灶的患者,外科手术治疗可延长生存时间.     

Clinical study of prostate cancer: statistical analysis of 107 cases in the past 12 years

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.     

晚期前列腺癌联合雄激素阻断治疗的长期随访

目的:了解晚期前列腺癌联合雄激素阻断治疗的长期生存率。方法:选取1993年1月~2000年1月初采用联合雄激素阻断治疗的59例前列腺腺癌患者,其中28.81%和45.76%为临床局部晚期(T3-4 N0M0期)和转移(TxNxM+期)病例,全部随访5年以上。结果:全组病例3、5、7年的总体生存率分别是79.36%、61.46%、49.15%,其中,临床局部晚期和转移者的5年生存率分别为80.77%和32.65%,而高分化腺癌和低分化腺癌的5年生存率分别为86.21%和30%(P<0.01)。另外,PSA>30μg/L时其长期生存率有明显下降趋势。结论:采用内分泌治疗的晚期前列腺癌,病理低分化、临床分期达T3 c-4NxMx或TxNxM+期及PSA>30μg/L均提示预后较差,晚期前列腺癌病例的治疗应综合多因素,选择个体化方案。     

Factors affecting survival after bronchoplasty and broncho-angioplasty for lung cancer: single institutional review of 147 patients.

OBJECTIVE: We compared the results of bronchoplasty and bronchoplasty with pulmonary angioplasty (broncho-angioplasty). Multivariate analysis was done to determine potential prognostic factors for both procedures based on our 20-year single-center experience. METHODS: Between January 1985 and December 2004, 163 bronchoplastic procedures were done in 1405 patients who underwent lung resections for lung cancer at Nagasaki University Hospital. After excluding 16 carino-plasty patients, 147 patients (118 bronchoplasty and 29 broncho-angioplasty) were included. RESULTS: In the bronchoplasty group, the postoperative morbidity was 22.9% (27/118) and the 90-day postoperative mortality was 5.9% (7/118), while in the broncho-angioplasty group the postoperative morbidity was 27.6% (8/29) and the postoperative mortality was 17.2% (5/29). The 5-year survival for all patients was 56.0%. Among patients with stage I or II, the 5-year survival was 76.2% in the bronchoplasty group and 51.9% in the broncho-angioplasty group (p=0.1791). On the other hand, among patients with stage III or IV, 5-year survival was 43.5% in the bronchoplasty group and 7.9% in the broncho-angioplasty group (p=0.0192). Multivariate analysis indicated that the type of operation, postoperative complications, histologic type, and pN status were significant factors affecting survival. CONCLUSIONS: Both bronchoplasty and broncho-angioplasty are useful for the treatment of patients with lung cancer and should be performed in stage I or II. However, careful patient selection is mandatory in patients with advanced tumor stages and in those with nonsquamous cell carcinoma, especially if broncho-angioplasty is being considered.     

应用Cox模型多因素分析原发性胆囊癌预后

目的 分析影响胆囊癌预后有关的临床病理因素,探讨提高胆囊癌疗效的措施.方法 回顾性研究分析我院2006年1月至2010年12月收治的96例胆囊癌患者的临床资料,对可能影响预后的因素进行Kaplan-Meier法及log-rank检验,并通过Cox比例风险回归模型对其临床病理因素进行多因素分析.结果 全组共有89例获得随访,患者中位生存期为21.29个月,总的1年、3年、5年生存率分别为71.1%、38.2%、19.6%.经Cox比例风险回归模型分析,术前血总胆红素、手术切除类型、有无神经浸润、病灶浸润深度是影响胆囊癌患者生存时间的独立预后因素.结论 早期发现胆囊癌,并进行根治性切除是改善胆囊癌患者预后的关键因素.     

Basaloid carcinoma of the lung: a really dismal histologic variant?

BACKGROUND: Basaloid carcinoma of the lung has been reported as an uncommon and highly aggressive form of nonsmall cell lung cancers. Even in stage I and II of basaloid carcinoma, a 5-year survival rate of only 15% has been reported and it has been suggested that different treatment modalities for basaloid carcinoma should be considered. The aim of this study was to determine the prognostic implications of a basaloid carcinoma of the lung. METHODS: This study included a series of 291 surgically resected lung tumors, which were originally diagnosed as a poorly or undifferentiated carcinoma, a small cell carcinoma, or an atypical carcinoid. Of these, 35 basaloid carcinoma patients were identified and compared with 167 poorly differentiated squamous cell carcinoma (PDSC) patients in terms of the preoperative clinical data, the procedure performed, and the survival outcome. RESULTS: The overall incidence of basaloid carcinoma was 4.8%. The actuarial 5-year survival rate was 40.6% in patients with PDSC and 36.5% in those with basaloid carcinoma (p = 0.86). In stage I and II patients, the actuarial 5-year survival rate was 53.9% in the PDSC group and 57.2% in the basaloid group (p = 0.97). There were no differences in the recurrence rate and the relapse pattern (p = 0.584). Cox's proportional hazards model revealed that an age equal to 60 years old (hazard ratio 2.179, p = 0.000) and an advanced stage (hazard ratio 2.264, p = 0.000) were the risk factors for postoperative survival in both groups. CONCLUSIONS: Basaloid carcinoma of the lung does not have a worse prognosis than the other nonsmall cell lung cancers. Although it is obvious that a basaloid carcinoma is a unique histologic entity, it does not require a different treatment modality due to the similar clinical behavior with other nonsmall cell lung cancers.