目的 探讨T3期喉癌采用支撑喉镜下CO2激光切除术和部分喉切除术两种手术治疗方式的临床治疗效果。 方法 将2003年8月－2010年7月收治的31例患者按所接受手术方式分为A、B两组（非随机分组），A组16例中男15例，女1例，年龄38～72岁，中位年龄51岁；B组15例，均为男性，年龄46～68岁，中位年龄58岁。病变均累及前联合，A组10例和B组11例累及对侧声带约1/3。A组选择支撑喉镜下CO2激光切除术，B组选择气管切开＋部分喉切除术。两组患者首次术后均未接受放射（放疗）或化学治疗（化疗）。术后第1、3、6、12、24个月门诊纤维喉镜复查。随访时间14～78个月。 结果 A组5例复发或颈部淋巴结转移，复发率31.3%；5例患者均行再次手术、颈清扫及放、化疗。B组4例复发，复发率26.7%；4例均行全喉切除双侧选择性颈清扫术，其中3例术后辅以放、化疗。两组复发率比较差异无统计学意义（P＞0.05）。 结论 采用支撑喉镜下CO2激光切除治疗T3期喉癌，有望得到类似部分喉切除的临床治疗效果。
ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
Objective To evaluate the value of plain and dual-phasic enhanced 16-slice CT in the diagnosis and preoperative TNM staging of the gastric carcinoma, and to discuss the relationship between image signs and pathologic findings. Methods Fifty-three cases of the gastric carcinoma confirmed histopathologically underwent 16-slice CT examination. The scan protocol included plain scanning, the arterial phase and portal venous phase scanning. The manifestation of the three series images and multiplanar reconstruction (MPR) images were analyzed. Results ①The accuracies of 16-slice CT for the T stage, the N stage and the M stage of the gastric carcinoma were 83.02%, 80.00% and 92.45% respectively. ②The overall accuracy of 16-slice CT for judging TNM stage was 84.91%. Conclusion The plain scan and dual phase enhanced scans of 16-slice CT, especially the thin slice and MPR with proper windows technique are helpful for the diagnosis of gastric carcinoma and the TNM stage, which is useful for the selection of the operative project and the therapy plan.
Objective To investigate the expression of Jumonji domain-containing protein 3 ( JMJD3) in lung cancer tissue. Methods The cancer tissue slides from 53 lung cancer patients with different TNMstages were immunostained with JMJD3 antibody. The relationship between the expression of JMJD3 and type of pathology, TNM stage, survival time was analyzed. Results 94. 3% lung cancer tissue expressed JMJD3 protein. The expression of JMJD3 was negatively correlated with TNMstage( r = - 0. 347,P =0. 002) . The patients with decreased JMJD3 expression had shorter survival time than the patients with high JMJD3 expression ( X2 = 17. 83, P = 0. 001) . Conclusion Decreased expression of JMJD3 may promote the lung cancer progression.
Objective To approach histologically the degree of choroidal invasions of retinoblastoma and their relations with metastasis and prognosis. Methods The pathological sections of 297 enucleated eyeballs with retinoblastom from June 1985 to 1995 were reviewed under light microscope.For the sake of assessing the risk factors of the prognosis of the disease,the graduation of the choroidal invasion was in vestigated in particular,and the follow-up of this genesis were performed as well. Results According to the degree of affection of the intraocular tissues from the tumor cells especially the choroid as the crucial structure,the choroidal invasions were classified into the following 5 categories:0，prereactive phase of retinal pigment epithelium(144/297,48.48%).Ⅰ，reactive phase of retinal pigment epithelium(81/297，27.27%).Ⅱ, early phase of choroidal invasion( 29/297,9.76%).Ⅲ, middle phase of choroidal invasion(17/297,5.72%).Ⅳ， advanced phase of choroidal in vasion(26/297,8.75%).24.24% of cases were found in phases Ⅱ-Ⅳ (so called choroidal invasion).The mortality in patients with phases 0～Ⅲ was found to be 0.4% in the average follow-up period of 51.8 months,and inpatients with phase Ⅳ was found to be 12.0%. Conclusion The retinoblastoma patient with the advanced phase of choroidal invasion (choroida l invasion with great extent) had relative high metastatic rate and poor prognos is. (Chin J Ocul Fundus Dis,1999,15:88-90)
【摘要】 目的 评价螺旋CT对原发性膀胱移行细胞癌（TCC）分期的准确性。 方法 对2000年9月-2009年9月诊治的73例原发性TCC患者，手术前行螺旋CT临床分期与手术后病理分期进行比较。 结果 TCC患者手术前螺旋CT临床分期与手术后病理分期相符率为90.5%。7例分期不符的患者中，4例螺旋CT分期低于病理分期，3例高于病理分期。 结论 螺旋CT对TCC的手术前临床分期较准确；螺旋CT分期误差产生的主要原因是不能确定肿大的淋巴结是否是癌转移。【Abstract】 Objective To investigate the value of contrast helical CT in Neopl-asm staging in patients with transitional cell carcinoma (TCC) of bladder. Methods Total 73 patients with TCC of bladder treated from september 2000 to September 2009 was analysed to compare preoperative helical CT examination with postoperative pathological diagnosis. Results The coincident staging of helical CT and pathological finding of TCC of bladder was found to be 90.5%. In the remaining seven patients, four patients were of overstaging and three patients were of understaging respectively. Conclusion The early enhancing phase of helical CT is helpful in the evaluation of the staging in patients with TCC of bladder.The cause of incorrecting staging by preoperative CT was usualy due to the difficulty in determing if lymph nodemetastasis occurs.
ObjectiveTo evaluate the prognostic significance of metastatic lymph nodes ratio (MLNR) in patients with node-positive breast cancer. MethodsThe clinical data of 94 patients with nodepositive breast cancer underwent modified radical mastectomy were retrospectively analyzed. The survival rate and prognosis factors of patients with complete follow-up data were assessed by log-rank test and multivariate regression analysis. Results The survival time of 94 patients ranged from 12-75 months, with median 64 months. The 5-year overall survival rate was 72.34% (68/94). The total MLNR was 0.31 (486/1 553). Univariate analysis demonstrated that the survival was influenced significantly by tumor size, number of lymph node metastasis, MLNR, ER status, and radiotherapy or not (Plt;0.05), but not by patient’s age, menopause or not, PR status, endocrine therapy or not, and histological type (Pgt;0.05). Multivariate analysis showed that MLNR (OR=2.565, 95%CI=1.043-6.309， P=0.040) and tumor size (OR=2.220, 95%CI=1.045-4.716， P=0.038) were independent prognostic factors for the patients with node-positive breast cancer. Conclusion MLNR is a major independent prognostic factor for the patients with node-positive breast cancer, which is more accurate than the number of metastatic lymph nodes in predicting the survival of patients with node-positive breast cancer.
ObjectiveTo evaluate the relationship between low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) of preoperation (L/H value for short) and the pathological staging of colorectal cancer. MethodsThe clinical data of 187 patients with colorectal cancer who treated in PLA General Hospital from July 2009 to June 2014 were analyzed retrospectively. ResultsThere were statistical significance in L/H value among different TNM stagings, N stagings, and M stagings (P<0.05):L/H value of TNM Ⅳ staging was higher than those of TNM Ⅰ, Ⅱ, and Ⅲ staging, L/H values of N1 staging and N0 staging were lower than that of N2 staging, L/H value of M1 staging was higher than that of M0 staging. However, there was no statistical significance in L/H value among different T stagings of colorectal cancer (P>0.05). Logistic regression results showed that L/H value were positively associated with TNM staging (OR=4.34, 95% CI:2.837-6.644, P<0.000 1), T staging (OR=1.72, 95% CI:1.175-2.512, P=0.005 3), N staging (OR=2.15, 95% CI:1.422-3.254, P=0.000 3), and M staging (OR=3.04, 95% CI:1.733-5.332, P=0.000 1) of colorectal cancer, and patient with higher L/H value took more risk of progression of tumor, lymph node metastases, and distant metastasis. ConclusionsRaise of preoperative L/H value is an independent risk factor for the progression of TNM staging, T staging, N staging, and M staging in colorectal cancer.
Objective To investigate the primary peripheral non-small cell lung cancer (NSCLC) in stage T1 of TNM (UICC2011) (the tumor size≤3 cm) and to find out the lymphadenectomy way which will benefit patients most. Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015. There were 26 males and 34 females at age of 34-76 (57.91±7.75) years. The lymph nodes dissection and metastasis were recorded. Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1, including 33 metastasis lymph nodes. The metastasis rate was 2.73%. A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method，while metastasis lymph node in section 12 and (or) 13 and (or) 14 group were found in 3 patients in our trial. The detection rate was 5.89%. For stage T1 primary peripheral NSCLC, with increasing tumor size, lymph node metastasis rate was gradually increased. The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions (pure ground-glass nodules or mixed ground-glass nodules) which generally did not find lymph node metastasis. Conclusion The lymph node metastasis rate in stage T1 primary peripheral NSCLC is related to the tumor size, nature, histological type, local pleural stretch in imaging. The dissection of lung lymph node (12+13+14 groups)may be able to find simple intrapulmonary lymph nodes metastasis. It is important to the selection of delineated staging and treatment program in stage T1 primary peripheral NSCLC.
Objective To determine the most appropriate T-stage and surgical resection range of non-small cell lung cancer(NSCLC) with adjacent lobe invasion (ALI). Methods Fifty one NSCLC patients who were confirmed as direct ALI were divided into an ALI-T2 and an ALI-T3 group according to the eighth edition of TNM classification. Cases were matched by propensity score matching method at a ratio of 2∶1. The overall survival (OS), progression free survival (PFS), postoperative hospitalization, and postoperative complications among the groups were compared. Results Patients' characteristics were comparable among the groups. Three-year or 5-year survival rate in the ALI-T2 group, the single-lobe invasion T2 (SLI-T2) group, and the T3 (SLI-T3) group was 73.90% and 61.60%, 89.60% and 89.60%, 68.90% and 61.20%, respectively. The OS of SLI-T2 group was significantly higher than that of the ALI-T2 ( P=0.042) group and with similar survival in the SLI-T3 group( P=0.955). In the survival analysis of the ALI-T3 group, the 3-year or 5-year OS of the SLI-T3 group was 70.80% and 65.70%, respectively, while in the poorest prognosis ALI-T3 group was only 31.60% and 21.00% ( P=0.009), respectively. However, no statistical difference was detected between the ALI-T3 and SLI-T4 groups ( P=0.343). The PFS of the patients in the ALI-T3 group was closer to the SLI-T4 group level while lower than that of the SLI-T3 group, but the trend had not been confirmed by statistical analysis ( P 1=0.071, P 2=0.648). The OS and PFS did not differ between the patients undergoing a lobectomy plus wedge resection (LWR) and those undergoing a bilobectomy or pneumonectomy. Compared with a bilobectomy or pneumonectomy, LWR had distinct advantages in the postoperative hospital stay (6.90±3.11days vs. 9.23± 4.43 days, P=0.030), the postoperative duration of drainage (4.41±2.98 days vs. 6.50±4.11 days, P=0.041) and complication rates (4.00% vs. 31.58%, P=0.032). Conclusions We believe that T1-2 stage tumor invading adjacent lobe should be classified as T3 and ALI-T3 tumor should be revised as T4. Beside that, LWR could be considered as a reasonable surgical option for patients with lesser invasive depth (less than 2 cm) in the adjacent lobes.