趋化因子受体CCR7表达与胸中段食管癌淋巴结转移及预后的关系

目的 探讨趋化因子受体CCR7表达与胸中段食管鳞癌淋巴结转移及预后的相关性.方法 回顾2003年6月至2005年6月手术治疗184例胸中段食管癌病例临床资料.采用免疫组化进行趋化因子受体CCR7检测,Kaplan-meier法进行生存分析、用Cox回归分析判定独立预后因素.结果 CCR7表达率Ⅱ期和Ⅲ期病例分别为70.3%和85.5%(x2=5.0,P=0.02);T2和T3病例分别为64.9%和80.9%(x2=5.4,P=0.01);有、无淋巴结转移病例分别为86.4%和65.0%(x2=10.8,P=0.00)两组差异均有统计学意义.有、无CCR7表达病例的5年生存率为26.3%和66.0%,差异有统计学意义(x2=23.7,P=0.00);其中T2病例分别为35.1%和70.0%(P=0.01);T3病例分别为22.4%和60.9%(P=0.00);pN0分别为28.8%和66.7%(p=0.00);pN1分别为14.3%和63.6%(P=0.00),两组差异亦均有统计学意义.Cox回归分析结果显示,T分类、N分类和CCR7表达是预后独立的危险因素.结论 食管鳞癌不同的T、N分类中CCR7表达存在差别;CCR7表达者5年生存率降低;肿瘤的T分类、淋巴结转移和CCR7表达是独立的不利预后因素.

Abstract：

Objective To investigate the expression of chemokine receptor CCR7 and its correlation with lymph node metastasis and prognosis in esophageal cancer after esophagectomy. Methods One hundred and eighty-four patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent operation in Provincial Hospital Affiliated to Shandong University between June, 2003 and June, 2005. The expression of CCR7 was detected by immunohistochemistry. All statistic analyses were performed with SPSS 13.0 statistical software. According to the clinico-patho-logic factors, the difference of CCR7 expression was compared by x2 test. Kaplan-meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. Results The expression rate of CCR7 in stage Ⅰ , stage Ⅱ and stage Ⅲ patients was 25.0 % , 70.3% and 85.5% , respectively. The difference of CCR7 expression between stage Ⅱ and stageⅢ was statistically significant (x2 =5.0, P =0.02). The CCR7 expression rate in T1, T2 and T3 patients was 33.3% , 64.9% and 80.9% , respectively. The difference of CCR7 expression between T2and T3 was statistically significant (x2 =5.4, P =0.01). The level of expression of CCR7 in patients with lymph node metastasis was significantly higher than those without metastasis (x2 =10.8, P = 0.00). The 5-year survival rate instage Ⅰ , stage Ⅱand stage Ⅲ patients was 100.0% , 38. 3% and 22.4% , respectively. The 5-year survival rate in patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression (x2 = 23.7, P = 0.00). The 5-year survival rate in T2, T3, NO and N1 patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression The result of Cox analysis demonstrated that T , N and CCR7 overexpression were independent prognostic factors. Conclusion CCR7 expression was detected in esophageal squamous cell carcinoma and was found to be significantly associated with T stage,N stage and lymph node metastasis. The patients with CCR7 expression was significantly lower the 5-year survival rate than without CCR7 expression. T stage, lymph node metastasis and CCR7 expression were independent prognostic factors.     

肺癌纵膈淋巴结转移与血行转移相关性的临床研究

目的探讨非小细胞肺癌(NSCLC)纵隔淋巴结转移(N2)与血行转移的相关性,为对手术后的N2肺癌采取有针对性的辅助治疗措施提供依据.方法对96例根治性切除术后病理诊断为纵隔淋巴结转移(pN2)的NSCLC患者进行回顾性研究,选择无淋巴结转移(pN0)的NSCLC患者作为对照组,与pN2患者配对.术后两年内每6个月对患者进行随访复查一次,监测血行转移.计算两组患者血行转移的发生率,应用x2检验比较发生率的差别.结果pN2组患者手术后两年内血行转移的发生率为29.17%,多数为脑和肺转移(64.29%);pN0组患者血行转移的发生率为13.54%,两者的差别非常显著(P＜0.01).pN2肺癌患者术后发生血行转移的概率大约是pN0患者的3倍(OR=3.14).结论肺癌根治切除术后血行转移的发生与纵隔淋巴结转移有关,有纵隔淋巴结转移的患者血行转移的发生率增高.     

CT扫描确定胸中段食管癌手术入路

目的:探讨术前CT扫描确定胸中段食管癌手术入路的意义。方法:选择87例胸中段食管癌患者行术前胸部强化CT扫描检查(观察组),根据CT结果确定手术路径:若肿瘤与主动脉关系密切选择经左胸手术;若肿瘤侵犯奇静脉,选择Ivor-Lewis路径;其余患者根据纵隔淋巴结转移确定手术路径。另选择同期术前未行CT扫描检查、常规行Ivor-Lewis手术的118例胸中段食管癌患者为对照组。采用χ2检验及t检验比较两组肿瘤切除率及阳性淋巴结率的差别。结果:CT扫描对N分期的敏感度为74.7%(65/87),特异度为60%(39/65)。CT诊断肿瘤侵犯主动脉的敏感度为21.8%(19/87),特异度为26.3%(5/19)。观察组的肿瘤切除率为92%,对照组为81.4%,两者差异显著(P<0.05)。观察组清扫淋巴结15±2.46个,对照组清扫12±1.75个,差别无统计学意义(P>0.05)。清扫的淋巴结中,观察组的阳性淋巴结占63.2%,对照组占52.6%,两者差别显著(P<0.05)。结论:对胸中段食管癌患者可采用Ivor-Lewis手术,但若术前CT扫描有明显主动脉受侵犯或(和)左侧淋巴结转移为主时,应经左胸路径施行手术,以期提高肿瘤根治切除率。     

D2-40在胸腺上皮肿瘤中的表达及临床意义

目的 探讨D2-40在胸腺上皮肿瘤(TET)中的表达,分析D2-40表达与肿瘤侵袭和预后的关系。方法 采用免疫组织化学染色法观察D2-40在160例胸腺上皮肿瘤和40例正常胸腺标本中的表达情况,术后连续随访5年以上。应用统计学软件分析D2-40表达与肿瘤侵袭和预后的关系。结果 D2-40在TET及正常胸腺中的阳性表达率分别为58.8%(94/160)和20%(8/40),差异有统计学意义(P=0.013)。D2-40在TET中的表达与TET侵袭性有关(P<0.01)。D2-40阳性表达组和阴性表达组患者5年生存率分别为32%、90%(P<0.01)。结论 D2-40在TET中的表达高于正常胸腺组织,且随着侵袭性的增强,表达也增强。D2-40表达阳性的患者预后较差。     

肿瘤转移相关基因表达与Ⅰ期非小细胞肺癌预后的相关性

目的:探讨肿瘤转移相关基因(metastasis-associated gene 1,MTA1)蛋白阳性表达与Ⅰ期非小细胞肺癌(non-small cell lung cancer, NSCLC)复发/转移及预后的相关性.方法:应用免疫组织化学法检测60 例Ⅰ期NSCLC患者癌组织及30 例癌旁正常肺组织中MTA1蛋白的表达情况, 应用统计学方法分析MTA1蛋白表达与临床病理特征、复发/转移及预后的相关性.结果: MTA1蛋白在Ⅰ期NSCLC癌组织中阳性表达率显著高于癌旁正常肺组织(P＜0.005);MTA1蛋白阳性表达率与肿瘤分化程度(P＜0.005)和肿瘤直径(P＜0.05)具有相关性,但与患者的年龄、性别、肿瘤组织学类型及吸烟情况无关; MTA1蛋白阳性表达者与阴性表达者在术后5 年内发生复发/转移的分别为16 例(72.7%)与7 例(18.4%),经比较差异有统计学意义(P＜0.005); MTA1蛋白阳性表达者的5年生存率为40.9%,显著低于阴性表达者的84.1%(P＝0.000 1); COX 回归多因素分析结果显示,MTA1蛋白阳性表达是Ⅰ期NSCLC独立的预后因素(HR=5.23, P=0.007).结论:MTA1蛋白的检测对判断Ⅰ期NSCLC患者复发/转移有一定的预测价值,可以作为其独立的预后指标.     

影响贲门癌切除率的X线表现及其他因素分析

我院自1990～1993年期间，手术治疗贲门癌资料完整者136例，其中切除97例（71．3％），探查39例（287％）。现就其胃肠钡餐X线造影表现及其他因素与切除率的关系进行分析。临床资料一、一般资料：本组中男118例，女18例，男女之比为6‘6：1。年龄最大69岁。最小32岁，均龄54．5岁。所有病人均有吞咽困难病史。病史20天～2年，平均3．7个月。136例患者中行肿瘤切除术97例，切除率为71，3％。二、X线表现：胃肠钡餐X线造影摄片中，病变长度为1。m。10Cm，平均4，7Cm。病变长度大于scm者56例，小干scm者80例；胃泡内有软组织块影者57例，无软…