目的探讨腹腔镜直肠癌根治术中行侧方淋巴结清扫(LLND)治疗局部进展期低位直肠癌的可行性、安全性及疗效。方法回顾性分析2000年1月至2019年12月北京大学第一医院普通外科收治的行直肠癌根治术的200例进展期低位直肠癌病人的临床资料,...目的探讨腹腔镜直肠癌根治术中行侧方淋巴结清扫(LLND)治疗局部进展期低位直肠癌的可行性、安全性及疗效。方法回顾性分析2000年1月至2019年12月北京大学第一医院普通外科收治的行直肠癌根治术的200例进展期低位直肠癌病人的临床资料,术中均行LLND。根据手术方式分为腹腔镜组(77例)和开放组(123例),比较两组病人的近期疗效及中期肿瘤学结果。结果与开放组比较,腹腔镜组病人手术时间缩短[240(110~550)min vs. 310(140~780)min,Z=-8.714,P<0.001],出血量减少[100(10~1200)mL vs. 400(60~2500)mL,Z=-5.233,P<0.001],术后尿潴留发生率降低(8.8%vs. 21.1%,χ^(2)=4.607,P=0.032),术后尿管拔除时间[4(1~12)d vs. 5(2~24)d,Z=-2.722,P=0.006]和术后住院时间[11(6~59)d vs. 16(7~64)d,Z=-2.274,P=0.023]均缩短。腹腔镜组单侧侧方淋巴结检出总数[5.5(1~17)枚vs. 5.0(1~17)枚,Z=-2.134,P=0.033]和单侧髂内及闭孔动脉淋巴结检出数目[4(1~17)枚vs. 3(1~11)枚,Z=-2.234,P=0.025]均增高。两组病人总生存率及无病生存率差异均无统计学意义(78.6%vs. 79.0%,69.8%vs. 71.3%,P>0.05)。结论腹腔镜技术用于LLND有助于减少术中出血,更好地保护植物神经功能,病人术后恢复更快,可清扫更多的区域淋巴结,但中期肿瘤学结果与开放手术相当。展开更多
Background Blood coagulation factor Ⅶ （FⅦ） is physiologically synthesized in the liver and released into the blood. Binding of FⅦ to tissue factor （TF） is related to the metastatic potential of tumor cells, als...Background Blood coagulation factor Ⅶ （FⅦ） is physiologically synthesized in the liver and released into the blood. Binding of FⅦ to tissue factor （TF） is related to the metastatic potential of tumor cells, also a significant risk factor in the development of hepatic metastasis in patients with colorectal cancer （CRC）. It has been found that some cancer cells can produce FⅦ extrahepatically. However, litte is known about FⅦ and CRC. We therefore hypothesized that CRC cells may synthese FⅦ, leading to tumor invasion and metastasis.Methods We detected the expression of FⅦ protein in 55 CRC specimens by immunohistochemical staining. The FⅦ mRNA in 45 of 55 CRC cases, 6 colon cancer cell lines and one hepatoma cell line was measured by real-time reverse transcription-PCR （RT-PCR）. Transwell invasion assays were performed to evaluate the changes of cell migration and invasion of LoVo cancer cells in vitro. We further observed the likely effectors regulated by the TF/FⅦa complex Western blotting assay.Results Extrahepatic synthesis of FⅦ was detected in the cytoplasm of 32 （58.2%） CRC specimens byimmunohistochemistry, but not in normal mucosa. Liver metastasis （P=0.003） and TNM staging （P=0.005） were significantly correlated with FⅦ antigen expression. The positive ratios in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 33.3%, 40.0%,52.4% and 87.5%, respectively. The expression of FⅦ mRNA in CRC with hepatic metastasis was significantly higher than CRC without hepatic metastasis （5.33±2.88 vs. 1.47±0.51, P=0.03）. Ectopic FⅦa induced a slight increase （1.34-fold） in the number of migrating cells, which was inhibited by the specific TF antibody. The formation of TF/FⅦacomplex resulted in a marked increase in the expression of matrix metalloproteinases （MMP）-2 （3.5-fold） and MMP-9（4.7-fold） in a time-dependent and dose-dependent manner.Conclusions Extrahepatic synthesis of FⅦ by CRC cells may promote tumor invasion and metastasis. MMPs, as downstream effectors of TF/FⅦa signaling, facilitate the development of metastasis in colon cancer.展开更多
文摘目的探讨腹腔镜直肠癌根治术中行侧方淋巴结清扫(LLND)治疗局部进展期低位直肠癌的可行性、安全性及疗效。方法回顾性分析2000年1月至2019年12月北京大学第一医院普通外科收治的行直肠癌根治术的200例进展期低位直肠癌病人的临床资料,术中均行LLND。根据手术方式分为腹腔镜组(77例)和开放组(123例),比较两组病人的近期疗效及中期肿瘤学结果。结果与开放组比较,腹腔镜组病人手术时间缩短[240(110~550)min vs. 310(140~780)min,Z=-8.714,P<0.001],出血量减少[100(10~1200)mL vs. 400(60~2500)mL,Z=-5.233,P<0.001],术后尿潴留发生率降低(8.8%vs. 21.1%,χ^(2)=4.607,P=0.032),术后尿管拔除时间[4(1~12)d vs. 5(2~24)d,Z=-2.722,P=0.006]和术后住院时间[11(6~59)d vs. 16(7~64)d,Z=-2.274,P=0.023]均缩短。腹腔镜组单侧侧方淋巴结检出总数[5.5(1~17)枚vs. 5.0(1~17)枚,Z=-2.134,P=0.033]和单侧髂内及闭孔动脉淋巴结检出数目[4(1~17)枚vs. 3(1~11)枚,Z=-2.234,P=0.025]均增高。两组病人总生存率及无病生存率差异均无统计学意义(78.6%vs. 79.0%,69.8%vs. 71.3%,P>0.05)。结论腹腔镜技术用于LLND有助于减少术中出血,更好地保护植物神经功能,病人术后恢复更快,可清扫更多的区域淋巴结,但中期肿瘤学结果与开放手术相当。
基金This work was supported by the grants from the National Natural Science Foundation of China （No. 30872469） and National Natural Science Youth Foundation of China （No. 30801092）.
文摘Background Blood coagulation factor Ⅶ （FⅦ） is physiologically synthesized in the liver and released into the blood. Binding of FⅦ to tissue factor （TF） is related to the metastatic potential of tumor cells, also a significant risk factor in the development of hepatic metastasis in patients with colorectal cancer （CRC）. It has been found that some cancer cells can produce FⅦ extrahepatically. However, litte is known about FⅦ and CRC. We therefore hypothesized that CRC cells may synthese FⅦ, leading to tumor invasion and metastasis.Methods We detected the expression of FⅦ protein in 55 CRC specimens by immunohistochemical staining. The FⅦ mRNA in 45 of 55 CRC cases, 6 colon cancer cell lines and one hepatoma cell line was measured by real-time reverse transcription-PCR （RT-PCR）. Transwell invasion assays were performed to evaluate the changes of cell migration and invasion of LoVo cancer cells in vitro. We further observed the likely effectors regulated by the TF/FⅦa complex Western blotting assay.Results Extrahepatic synthesis of FⅦ was detected in the cytoplasm of 32 （58.2%） CRC specimens byimmunohistochemistry, but not in normal mucosa. Liver metastasis （P=0.003） and TNM staging （P=0.005） were significantly correlated with FⅦ antigen expression. The positive ratios in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 33.3%, 40.0%,52.4% and 87.5%, respectively. The expression of FⅦ mRNA in CRC with hepatic metastasis was significantly higher than CRC without hepatic metastasis （5.33±2.88 vs. 1.47±0.51, P=0.03）. Ectopic FⅦa induced a slight increase （1.34-fold） in the number of migrating cells, which was inhibited by the specific TF antibody. The formation of TF/FⅦacomplex resulted in a marked increase in the expression of matrix metalloproteinases （MMP）-2 （3.5-fold） and MMP-9（4.7-fold） in a time-dependent and dose-dependent manner.Conclusions Extrahepatic synthesis of FⅦ by CRC cells may promote tumor invasion and metastasis. MMPs, as downstream effectors of TF/FⅦa signaling, facilitate the development of metastasis in colon cancer.
