大肠癌病理分期与预后

目的为找到更合理的大肠癌病理分期提供参考。方法选取1980～1995年行根治切除的大肠癌病例1235例,对其各病理分期亚期与预后的关系进行比较分析。结果当大肠癌病灶局限于粘膜或侵及粘膜下层或侵犯浅肌层或侵犯深肌层,各组病例生存率之间差异无统计学意义（P〉0．05）。病灶侵及浆膜层者其生存率较侵及深肌层者明显下降,两组病例生存率之间比较差异有统计学意义（P〈0．05）。病灶侵出浆膜外者其生存率较侵及浆膜层者明显下降,两组病例生存率比较差异有统计学意义（P〈0．05）。结论Dukes分期及TNM分期是相对较合理的大肠癌分期。     

内镜超声检查在大肠癌分期诊断中的应用

目的：探讨内镜超声检查在大肠癌术前分期诊断中的价值。方法：对大肠癌术前病人进行内镜超声检查,依ＴＮＭ标准分期,与术后Ｄｕｋｅｓ分别对照Ｘ＾２检验,结果：ＥＵＳ分期准确性高,达７０．９％,诊断淋巴结转移假阳性的７例中有５例术后病理结果为炎性肿大。结论：内镜超声检查可提供准确的大肠癌术前分期诊断,判断分期过深与淋巴结的炎性反应有关。     

青年人大肠癌的临床病理特征及预后分析

目的 探讨青年人(年龄＜30岁)大肠癌的临床病理特征及预后.方法 总结分析复旦大学附属中山医院1 109例青年人大肠癌患者的临床特点、病理特征和生存率.结果 1 109例患者的平均病程(6.5±7.8)个月,误诊575例,占51.8%,以误诊为肠炎、痔疮、痢疾多见.TNM分期Ⅲ、Ⅳ期共1 025例,占92.5%.病理类型以低分化腺癌、未分化癌、黏液腺癌、印戒细胞癌多见,共614例,占55.3%.1 109例患者中611例(55.1%)行根治性手术,根治组5年随访生存率18.9%.结论 青年人大肠癌误诊率高,恶性程度高,预后差.如何早诊和早治是提高生存率的关键.     

重视早期大肠癌,提高临床病理诊断水平

近年来大肠癌发生率呈上升趋势，而早期大肠癌的检出率却很低，因此提高对大肠癌的早期诊断有重要的临床意义。当前各种内镜技术已发展成熟，临床病理诊断水平不断提高，可以发现大肠微小病变，为早期癌诊断和治疗提供定性和定量的依据。     

大肠癌208例诊治分析

大肠癌是临床常见疾病 ,占恶性肿瘤的第四位 ,由于大肠癌临床表现无特异性 ,早期诊断困难。本文就 2 0 8例大肠癌患者的诊断和治疗进行分析。1　临床资料1 1　一般情况　男性 12 1名、女性 87名 ,中位数年龄 5 3岁 ,首诊 31例、复诊 177例 ,患大肠息肉、慢性溃疡性结肠炎或血吸虫病病史 38例。1 2　临床表现　主诉无特异性 ,主要有消化道出血、腹部包块、腹痛、腹泻与便秘、体重下降、肠梗阻。绝大多数被误诊为胆石症、胃炎、阑尾炎 ,术前被误诊为胆石症、阑尾炎、肠梗阻 17例。　1 3　检查方法　粪便隐血试验、直肠指诊、纤维结肠镜、气钡…     

胃癌临床病理分期的最新进展

胃癌的临床及病理分期对判断胃癌病程、选择合理的治疗方案 ,评估疗效和预后都有十分重要的意义 ,统一分期标准可使临床资料具有可比性 ,有利于临床医师相互学习、协作 ,提高治疗水平。近半个世纪以来 ,世界范围内曾陆续提出多种胃癌分期法 ,但因各自存在不同程度的缺陷而无一种被公认。目前在临床广泛应用的主要有“国际抗癌联盟 (ＵＩＣＣ)”制定的ＴＮＭ分期系统及日本胃癌研究会在“胃癌规约 (ＧＲＧＣＳ)”中制定的日本分期系统两大类。近几年来 ,随着胃癌研究的不断深入 ,尤其对淋巴结转移规律认识的进一步加深 ,两大系统均对胃癌的分…     

在病理诊断工作中需要正确处理的几个问题

在病理诊断工作中需要正确处理的几个问题李维华（北京解放军总医院病理科北京１００８５３）我们知道，正确的病理诊断是临床上对病人进行正确治疗的依据。因此，对每个病理医师来说，如何使自己作出的病理诊断基本上达到准确无误，这是至关重要的。如果我们的病理诊断错...     

452例大肠癌的内镜及病理分析

目的：探讨大肠癌近年来的发病情况、病理特点及诊断方法。方法：回顾性分析近5年来452例大肠癌的临床、肠镜及病理资料。结果452例大肠癌中，男276例，女176例，男女之比为1．57：1．00。结肠癌230例，直肠癌222例，结直肠癌之比为1．04：1．00，横结肠癌70例，乙状结肠癌50例，升结肠及盲肠癌47例，肝曲30例。病理为腺癌345例，黏液腺癌47例，低分化腺癌35例。结论：近年来大肠癌发病趋上升，男性发病比女性多，直肠癌与结肠癌发病接近。结肠癌近年发病增加且超过直肠癌，男性以横结肠及近肝曲为主，女性以乙状结肠为主。距肛门5cm以上直肠癌较5cm以下为多。病理仍以腺癌为主。加强对高危人群的普查和肠镜检查，可提高大肠癌的早期诊断。     

164例大肠癌结肠镜诊断与临床病理分析

目的探讨大肠癌结肠镜检查结果与临床病理特点.方法回顾该院1998年1月～2004年12月,共计2970例结肠镜检查结果,经结肠镜及病理证实的大肠癌患者共164例,对其肠镜下表现、临床及病理特点进行了分析.结果(1)大肠癌患者临床表现以血便最常见,占62.81%;(2)直肠癌检出率最高,占51.22%;(3)直肠癌肛诊阳性率为82.14%;(4)以腺癌最多见,且大部分肿瘤分化程度较好.结论大肠癌好发于直肠,且大部分大肠癌分化程度较好,生长缓慢;结肠镜检查能明确肿瘤部位、范围和程度,是诊断大肠癌的重要手段之一.     

内镜超声检查在大肠癌分期诊断中的应用(附55例报告)

目的：探讨内镜超声检查（ Ｅ Ｕ Ｓ） 在大肠癌术前分期诊断中的价值。方法：对大肠癌术前病人进行内镜超声检查,依 Ｔ Ｎ Ｍ 标准分期,与术后 Ｄｕｋｅｓ 分别对照ｘ２ 检验。结果： Ｅ Ｕ Ｓ 分期准确性高,达７０ ．９ ％ ,诊断淋巴结转移假阳性的７ 例中有５ 例术后病理结果为炎性肿大。结论：内镜超声检查可提供准确的大肠癌术前分期诊断,判断分期过深与淋巴结的炎性反应有关。     

Circulating antibodies to carcinoembryonic antigen related to improved recurrence-free survival of patients with colorectal carcinoma

This prospective study evaluated the prognostic value of antibodies to carcinoembryonic antigen (anti-CEA), detected by indirect immunosorbent assay, in the serum of colorectal carcinoma patients. Serum carcinoembryonic antigen (CEA) concentrations, measured by electrochemiluminescence immunoassay, were elevated in 26 (37.7%) of 69 patients with colorectal cancer and could not be detected among the 28 patients with benign intestinal conditions or 37 healthy individuals who comprised the control groups. Anti-CEA immuno globulin (Ig)G or IgM was detected by immunonephelometry in 44 (63.8%) patients with colorectal cancer, three (10.7%) with benign intestinal conditions and four (10.8%) healthy blood donors. Differences in antibody detection frequencies between the cancer patient group and the control groups were statistically significant. Titres of anti-CEA correlated significantly with CEA levels and Dukes' cancer stage. Antibody titre was an independent, significant, favourable predictor for 5-year recurrence-free survival. It is concluded that measurement of serum anti-CEA combined with CEA might be useful as a tumour marker and to assess prognosis. These results need to be confirmed in large, well-controlled, randomized clinical trials.     

隆突性皮肤纤维肉瘤病理诊断及预后的探讨

目的 探讨隆突性皮肤纤维肉瘤（DFSP）的病理诊断及临床病理参数，增殖细胞核抗原（PCNA）表达与预后的关系。方法 应用免疫组化方法对51例隆突性皮肤纤维肉瘤CD34、PCNA的表达进行检测。并结合病理形态学观察和随访分析。结果 所有DFSP均表达CD34，组织分级，浸润深度、局部切除范围与DFSP复合率显著相关，PCNA计数标记指数平均为41.7%，PCNA高表达组复发率显著高于PCNA低表达组。结论 CD34可作为DFSP与纤维肉瘤特异的鉴别诊断指标。组织分级，浸润深度及PCNA表达可作为判断DFSP预后的指标。扩大切除范围有助于减少复发。     

Imaging features related with prognosis of hepatocellular carcinoma

Abdominal Radiology - We discuss various imaging features that have been reported to be associated with the prognosis of hepatocellular carcinoma (HCC) but not included in the current staging...     

The chemokine CXCL9 expression is associated with better prognosis for colorectal carcinoma patients

The chemokine CXCL9 has been demonstrated to play an important role in the development of human malignancies. However, its prognostic significance in cancer patients remains unclear and less is known about its role in colonrectal carcinoma (CRC) patients. In this study, we found that the relative mRNA expression level of CXCL9 in primary colorectal tumor tissues was significantly higher than that in corresponding normal colon tissues. CXCL9 protein expression was also detected in 102 of 130 primary CRC patients by immunochemistry. Thus, CXCL9 might play a vital role in the progression of colorectal cancer. By analyzing the correlation between clinicopathological factors of patients and expression of CXCL9 protein, we showed that the expression of CXCL9 was significantly associated with tumor differentiation, tumor invasion, lymph node metastasis, distant metastasis, and vascular invasion, but not with other factors of CRC patients including age, gender, tumor location and tumor size. Furthermore, by performing Kaplan–Meier method as well as Cox’s univariate and multivariate hazard regression model, we found that the higher the CXCL9 expression, the higher overall survival rate was observed, and CXCL9 expression was a significant independent prognostic factor for CRC patients. Therefore, CXCL9 is a useful predictor of better clinical outcome in CRC patients.     

Health care factors related to stage at diagnosis and survival among Medicare patients with colorectal cancer

BACKGROUND: With the growth in enrollment of Medicare patients in HMOs the effectiveness of care received by Medicare/HMO patients continues to be of concern. By considering the relationship of insurance to stage at diagnosis, this study inquires whether HMOs emphasize early diagnosis of colorectal cancer to a greater extent than FFS plans, if particular HMO types (group/nongroup models) are more successful in doing so, and how this pertains to survival. METHODS: Data for 1329 Medicare patients with colorectal cancer, diagnosed 1987 to 1993, and residing in northern California, were acquired from a population-based cancer registry. Insurance included two types of Medicare HMOs (group and nongroup model) and three fee-for-service (FFS) categories: Medicare with private supplement, Medicare/Medicaid, and Medicare only. The relationships of insurance to AJCC stage at diagnosis and of insurance to survival following diagnosis were examined, respectively, with logistic regression models and survival analysis (controlling for age, ethnicity, tumor location, educational level, sex, and hospital type). RESULTS: Likelihood of early stage colorectal cancer was greater for Medicare patients in nongroup model HMOs or having private FFS supplements than for those in group model HMOs, Medicare/Medicaid, or Medicare alone. All-cause and colorectal cancer mortality did not differ significantly among Medicare patients with group model HMO, nongroup model HMO and private FFS supplements. Medicare/Medicaid patients experienced significantly greater all-cause mortality than private FFS patients. CONCLUSIONS: Differences within this study population in early stage diagnosis of colorectal cancer and breast cancer, respectively, by type of Medicare supplemental insurance may be attributable to which preventive screening measures are included in health plan report cards.     

子宫内膜癌961例临床病理分析

目的探讨子宫内膜癌的发病趋势和临床病理特点。方法回顾性分析天津市滨海新区塘沽妇幼保健院和天津医科大学总医院1984年至2010年收治的961例子宫内膜癌患者的临床病理资料,并分为1984-1992年、1993-2001年、2002-2010年3个时段进行对比分析。结果 1子宫内膜癌呈逐年上升趋势,3个时段发病例数也逐年增多,≤45岁患者例数逐年增多,但3个时段所占比例呈下降趋势（P〉0.05）。2发病年龄24～89岁,平均（55.8±12.8）岁,高发年龄51～60岁,占37.98%。3病理组织类型以子宫内膜样腺癌为主,占86.58%,非子宫内膜样癌逐年显著增加,占13.42%,其组织学分级、肌层浸润的深度及手术病理分期Ⅲ、Ⅳ期的比例均高于子宫内膜样腺癌,以浆液性乳头状腺癌多见,占52.71%。结论子宫内膜癌呈上升趋势,≤45岁患者例数逐年增多;非子宫内膜样癌有所增加,其分化低、侵袭性强、预后差,应高度重视。     

前列腺偶发癌的病理诊断

１９８２～１９９５年间，在５５５例ＢＰＨ术后标本中，发现ＩＤＰＣ２４例。１９８２～１９９１年，用常规方法的诊断率为１．６％（５／３１０），１９９２～１９９５年用垂直于尿道连续大切块，诊断率为７．５％（１９／２４５）。镜下特征为（１）癌灶与增生组织之间无明显分界（１００％）；（２）多与不典型增生共存（１６／２４）；（３）常为多发癌灶（２０／２４）；（４）癌灶多位于中央区（２０／２４）。按Ｍｏｓｔｏｆｉ＇ｓ系统分级，Ⅰ级８例，Ⅱ级１２例，Ⅲ级４例，而４例Ⅲ级者均不伴不典型增生。资料显示：标本的取材方法与ＩＤＰＣ的诊断率密切相关，ＩＤＰＣ的发病率伴随ＢＰＨ逐年同步增加。文中对ＩＤＰＣ的发生学及与ＢＰＨ的关系作了进一步讨论。     

大肠癌组织中端粒酶催化亚基表达对预后的影响

目的:通过观察端粒酶催化亚基(hTERT)在大肠癌组织中的表达情况,探讨其与大肠癌临床病理因素的关系。方法:采用免疫组织化学SP法检测78例大肠癌组织、20例癌旁组织和20例大肠腺瘤组织hTERT表达情况。结果:端粒酶催化亚基在大肠癌组织、大肠腺瘤组织和癌旁组织中阳性表达率分别为90%(70/78),65%(13/20)和15%(3/20),差异有显著性意义(χ2=5.731,χ2=46.799,P<0.05)。在端粒酶催化亚基阳性表达中,大肠癌的临床分期A和B两期与C和D两期、高和中分化程度与低分化程度、有无淋巴结转移差异有显著性意义(χ2=6.037,χ2=4.179,χ2=6.037,P<0.05),生存期≥5年与<5年、有无远隔转移差异无显著性意义(χ2=2.694,χ2=2.315,P>0.05)。结论:端粒酶催化亚基阳性表达与大肠癌的侵袭、转移等生物学行为有关,其表达可能在大肠癌发生、发展中起重要作用。     

乳腺小叶原位癌的病理诊断

介绍7种特殊类型的小叶原位癌，包括：旺炽型、多形型、透明型、肌样细胞型、印戒细胞型、黏液型和小小叶型。着重讨论小叶原位癌与小叶不典型增生、小叶癌化、微浸润性小叶癌、透明细胞化生和妊娠样增生等的鉴别诊断。提出腺泡扩大、肌上皮、细胞内黏液、细胞黏着性和坏死等组织学表现在鉴别诊断中的病理学意义。