Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

Late recurrence of papillary thyroid cancer from needle tract implantation after core needle biopsy: A case report

BACKGROUND Papillary thyroid cancer(PTC)has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study,we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found.CASE SUMMARY A 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor,it was diagnosed as recurrence of PTC.Furthermore,results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records,the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment,the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment.CONCLUSION Needle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.

Clinicopathologic risk factors and prognostic evaluation in hepatocellular carcinoma recurrence after surgery

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Do the expressions of gap junction gene connexin messenger RNA in noncancerous liver remnants of patients with hepatocellular carcinoma correlate with postoperative recurrences?

AIM: To investigate whether the changes of gap junction gene connexin messenger RNA in the noncancerous liver tissue of patients with hepatocellular carcinoma (HCC) could play a significant role in its postresection recurrence.METHODS: Seventy-nine consecutive patients having undergone curative resection for HCC entered this study.Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, connexin (Cx) 26, connexin (Cx)32 and connexin (Cx) 43 mRNAs were determined prospectively in noncancerous liver tissues from these 79 patients and in the liver tissues from 15 controls. The correlations between connexin mRNA expression and the clinicopathological variables and outcomes (tumor recurrence and recurrence related mortality) were studied.RESULTS: Compared with liver tissues of control patients,the expression of Cx 32 mRNA in noncancerous liver tissues was significantly lower (mean: 0.715 vscontrol 1.225,P＜0.01), whereas the decreased Cx 26 mRNA (mean:0.700 vs of control 1.205,P＞0.05) and increased Cx 43 mRNA (mean: 0.241 vscontrol 0.100, P＞0.05) had no statistical significance. We defined the value of Cx 32 mRNA or Cx 26mRNA below 0.800 as a lower value. By multivariate analysis for noncancerous livers, a lower value of Cx 32 mRNA correlated significantly with a risk of HCC recurrence and recurrence-related mortality. The lower value of Cx 26 mRNA did not correlate with recurrence and mortality. The increased value of Cx43 mRNA also did not correlate with postoperative recurrence and recurrence-related mortality. By multivariate analysis, other significant predictors of HCC recurrence included vascular permeation, cellular dedifferentiation, and less encaps-ulation. The other significant parameter of recurrence related mortality was vascular permeation.CONCLUSION: The decreased expression of Cx 32 mRNA in noncancerous liver tissues plays a significant role in the prediction of postoperative recurrence of HCC.

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP).CUP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not pubhshed. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection.METHODS: A retrospective survey was carried out in 174patients undergoing resection of HCC from January 1986 toJune 1998. Six patients who died in the hospital afteroperation and 11 patients with the recurrence of the diseasewere excluded at 1 month after hepatectomy. By the end ofJune 2001, 4 patients were lost and 153 patients with curativeresection have been followed up for at least three years.Among 153 patients, 115 developed intrahepatic recurrenceand 10 developed extrahepatic recurrence, whereas the other28 remained free of recurrence. Recurrences were classifiedinto early ( ＜ / = 3 year) and late ( ＞ 3 year) recurrence. TheCLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portalthrombosis (0-1)o By contrast, portal vein thrombosis wasdefined as the presence of tumor emboli within vascularchannel analyzed by microscopic examination in this study.Risk factors for recurrence and prognostic factors forsurvival in each group were analyzed by the chi-square test,the Kaplan-Meier estimation and the COX proportionalhazards model respectively.RESULTS: The 1-, 3-, 5-, 7-, andl0-year disease-free survivalrates after curative resection of HCC were 57.2 %、 28.3 %、23.5 %、 18.8 % and 17.8 %, respectively. Median survivaltime was 28,16,10,4,and 5 mo for CLIP score 0,1,2,3, and 4to 5, respectively. Early and late recurrence developed in109 patients and 16 patients respectively. By the chi-squaretest, tumor size, micrusatsllite, venous invasion, tumortype (uninodular, muitinodular, massive), tumor extension( ＜ / = or ＞ 50 % of liver parenchyna replaced by tumor),TNM stage,CLIP score,and resection margin were the risk factors for early recurrence,whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. in univariate survival analysis,Child-Pugh stages,resection margin,tumor size,microsatellite,venous invasion,tumor type,tumor extension,TNM stages,and CLIP score were associated with prognosis.The multivariale analysis by COX proportional hazards modes showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION:CLIP score has displayed a unique superiority in predictin the tumor early and late recurrence and prognosis in the patients with HCC after resection.

Complex pattern of colon cancer recurrence including a kidney metastasis: A case report

We report a case of a 77-year-old female with a local recurrence of cancer after right hemicolectomy which infiltrated the pancreatic head affording pancreatoduodenectomy, who developed 3 years later recurrent tumor masses localized in the mesentery of the jejunum and in the lower pole of the left kidney. Partial nephrectomy and a segment resection of the small bowel were performed. Histological examination of both specimens revealed a necrotic metastasis of the primary carcinoma of the colon. Although intraluminal implantation of colon cancer cells in the renal pelvic mucosa from ureteric metastasis has been described, metastasis of a colorectal cancer in the kidney parenchyma is extremely rare and can be treated in an organ preserving manner. A complex pattern of colon cancer recurrence with unusual and rare sites of metastasis is reported.

Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression

We report an 80-year-old man who presented with spontaneous regression of hepatocellular carcinoma (HCC). He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist (PIVKA)-Ⅱ was 1137 mAU/mL. A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68mm×55mm in liver S6, with slightly high density content and without marginal enhancement. Angiography revealed that the tumor in S4 with a size of 25mm×20mm was a typical hypervascular HCC, and transarterial chemoembolization was performed. However, the tumor in S6 was hypovascular and atypical of HCC, and thus no therapy was given. In December 2000, the cystic mass regressed spontaneously to 57mm×44mm, and aspiration cytology revealed bloody fluid, and the mass was diagnosed cytologically as class Ⅰ. The tumor in S4 was treated successfully with a 5mm margin of safety around it. The PIVKA-Ⅱ level normalized in February 2001. In July 2001, the tumor regressed further but presented with an enhanced area at the posterior margin. In November 2001, the enhanced area extended, and a biopsy revealed well-differentiated HCC, although the previous tumor in S4 disappeared. Angiography demonstrated two tumor stains, one was in S6, which was previously hypovascular,and the other was in S8. Subsequently, the PIVKA-Ⅱ level started to rise with the doubling time of 2-3wk, and the tumor grew rapidly despite repeated transarterial embolization with gel foam. In February 2003, the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe. Considering the acute onset of the symptoms, we speculate that local ischemia possibly due to rapid tumor growth, resulted in intratumoral bleeding and/or hemorrhagic necrosis, and finally spontaneous regression of the initial tumor in S6.

胰腺导管腺癌行腹腔镜下胰十二指肠切除术后早期复发的列线图模型及其预测价值分析

目的探究胰腺导管腺癌(PDAC)患者行腹腔镜胰十二指肠切除术(LPD)后肿瘤早期复发的危险因素并建立预测模型。方法回顾性分析2016年4月—2022年7月于吉林大学第一医院行LPD的240例PDAC患者的临床资料,以术后肿瘤早期复发(复发时间≤12个月)为研究结局。按照7∶3比例,随机将患者分为训练组(n=168)与验证组(n=72)。训练组术后早期复发70例(41.67%),非早期复发98例(58.33%)。验证组术后早期复发32例(44.44%),非早期复发40例(55.56%)。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。Logistic回归分析影响术后早期复发的危险因素。采用受试者工作特征曲线下面积(AUC)评估模型的区分度,AUC>0.75为该模型有足够的区分度。用Bootstrap重采样法随机抽样1000次验证,并用验证组再次验证。使用校准曲线和Hosmer-Lemeshow拟合优度检验评估校准度,决策曲线评估临床实用性。结果单因素、多因素分析结果显示:术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC行LPD术后早期复发的独立危险因素[OR(95%CI)分别为6.265(1.938~20.249)、10.878(4.090~28.932)、3.679(1.435~9.433)、0.209(0.080~0.551)、0.167(0.058~0.480),P值均<0.05]。以此为基础构建列线图模型,AUC=0.895(95%CI:0.846~0.943,P<0.001),校准曲线Hosmer-Lemeshow检验表明模型具有良好的校准度(P=0.173)。决策曲线显示列线图具有良好的临床应用价值。结论术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC LPD术后早期复发的独立危险因素,以此为依据构建列线图模型可有效预测术后早期复发。

术前CT影像组学联合CT及病理特征预测局部进展期食管鳞癌术后早期复发

目的观察术前CT影像组学联合病理及CT特征预测局部进展期食管鳞癌(LAESCC)早期复发(ER)的价值。方法回顾性分析334例LAESCC,按7∶3比例将患者分为训练集(n=234)或验证集(n=100),对其进行随访,记录术后有无ER(即术后12个月内肿瘤复发)。采用单因素及多因素logistic回归比较训练集有、无ER患者临床、CT表现及术前病理资料,筛选ER独立危险因素,构建CT-术前病理模型。基于训练集静脉期CT图像提取及筛选LAESCC影像组学特征并建立影像组学模型,以之联合独立危险因素建立联合模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估各模型诊断效能。结果334例中,168例ER、166例无ER;训练集有、无ER均为117例、验证集51例ER、49例无ER。CT显示LAESCC长度、cT分期、cN分期及术前病理分化程度均为ER独立危险因素(P均<0.05);CT-术前病理模型在训练集和验证集的AUC分别为0.759和0.783。共选出10个最佳影像组学特征,以之建立的影像组学模型在训练集和验证集的AUC分别为0.770和0.730,联合模型在训练集和验证集的AUC分别为0.838和0.826。联合模型在训练集的AUC高于术前CT-病理模型及影像组学模型(P均<0.01)。结论CT影像组学联合CT及术前病理特征能有效预测LAESCC术后ER。

早期喉癌手术阴性切缘组织中PCNA、COX-2表达与肿瘤局部复发的关系

目的探讨早期喉癌手术阴性切缘组织中PCNA、COX-2的表达与肿瘤局部复发的关系。方法选择63例经CO2激光手术治疗后的早期喉癌患者标本,对切除的肿瘤组织及切缘组织中PCNA、COX-2表达进行检测,所有患者均随访2年以上,对其生存及肿瘤复发情况进行观察。结果 63例早期喉癌患者肿瘤组织中PCNA、COX-2阳性率分别为73.02%、71.43%;切缘组织中PCNA和COX-2阳性率分别为33.33%、30.16%。肿瘤组织与切缘组织中PCNA、COX-2均阳性的患者分别为41例和13例,阳性率分别为65.08%、20.63%;63例随访病例中,局部复发17例,复发率为26.98%。PCNA阳性患者复发率为71.43%,COX-2阳性患者复发率为73.68%(P<0.05)。联合检测PCNA和COX-2阳性者复发率明显高于单独阳性者(P<0.05)。结论早期喉癌手术切缘组织中PCNA、COX-2的表达是喉癌患者预后的重要生物学标志,并可根据检查结果制定针对性的后续治疗方案,联合检测二者对术后治疗具有更可靠的指导意义。

肝细胞癌复发进程中DNA修复调节的蛋白质组学分析及验证

目的分析肝细胞癌(HCC)复发进程中DNA修复调节的作用及机制。方法串联质量标签(TMT)标记的定量蛋白质组学方法分析HCC 2年内复发和5年预后良好的肝癌组织样本,分析富集在DNA复制、错配修复、碱基切除修复、核苷酸切除修复4条通路的蛋白表达差异,分析在HCC复发进程中起主要作用的调控通路及靶点,预测可能的调控机制。计量资料2组间比较采用成组t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。结果真核生物复制复合体通路MCM2(P=0.018)、MCM3(P=0.047)、MCM4(P=0.014)、MCM5(P=0.008)、MCM6(P=0.006)、MCM7(P=0.007)、PCNA(P=0.019)、RFC4(P=0.002)、RFC5(P<0.001)、LIG1(P=0.042)蛋白表达均显著降低;核苷酸切除修复通路中PCNA(P=0.019)、RFC4(P=0.002)、RFC5(P<0.001)、LIG1(P=0.042)共4个蛋白表达水平均显著减少;碱基切除修复通路PCNA(P=0.019)和LIG1(P=0.042)在HCC复发组中均显著降低;错配修复富集通路中MSH2(P=0.026)、MSH6(P=0.006)、RFC4(P=0.002)、RFC5(P<0.001)、PCNA(P=0.019)、LIG1(P=0.042)共6个蛋白在肝癌复发组织中均显著减少。差异蛋白涉及MCM复合体、DNA聚合酶复合体ε、连接酶LIG1、长补丁碱基剪切修复复合体(long patch BER)、DNA错配修复蛋白复合体的重要组分。对DNA修复调节的重要差异蛋白进行临床样本验证分析,结果表明复发组中除MCM6表现出下降趋势外,MCM5(P=0.008)、MCM7(P=0.007)、RCF4(P=0.002)、RCF5(P<0.001)和MSH6(P=0.006)蛋白相对表达量均显著降低。结论HCC复发过程中,DNA修复进程中多个复合体蛋白组分存在显著减少或缺失。

食管癌术后局限性颈部/上纵隔淋巴结转移再手术效果探讨

目的探讨食管癌术后颈部或上纵隔淋巴结转移再手术的治疗效果。方法前瞻性收集2019年1月至2022年9月在安阳市肿瘤医院胸外科复查的食管癌术后患者,发现颈部或上纵隔淋巴结转移,CT显示无外侵,可以手术切除的患者,共31例。根据患者的意愿分为观察组和对照组。观察组16例选择再手术治疗,术后辅助或不辅助放化疗;对照组15例选择单纯放化疗。对比两组的基线资料、随访生存情况,主要研究终点为局部复发和区域复发。结果两组患者的基线数据比较无明显差异,观察组出现2例颈部淋巴瘘,2例喉返神经损伤,1个月后声音嘶哑均恢复正常。手术时间平均为43 min,术后平均住院时间5.8 d,平均住院花费15042元。观察组1 a生存率100%,局部控制率为80%。对照组无治疗后并发症,1 a生存率93.3%,局部控制率为46.7%,相对危险度(relative risk,RR)为0.5,归因危险度(attributable risk,AR)为0.46,对照组平均住院时间为45 d,平均住院花费为42352元。两组比较显示:观察组1 a局部控制率显著优于对照组,以局部复发为研究终点,绘制Kaplan-Meier生存曲线,观察组显著优于对照组(P=0.048)。结论对于食管癌术后局限性颈部/上纵隔淋巴结转移的患者,再手术治疗安全、创伤小、花费低、局部控制率高。

膀胱癌组织微RNA-212、微RNA-137、微RNA-200表达与临床病理特征的相关性及预测经尿道膀胱肿瘤切除术后复发的效能研究

目的 探讨膀胱癌组织微RNA-212(miRNA-212)、微RNA-137(miRNA-137)、微RNA-200(miRNA-200)表达与临床病理特征的相关性及预测经尿道膀胱肿瘤切除(TURBT)术后复发的效能。方法 选取2017年6月至2021年6月河北燕达医院100例膀胱癌病人,比较癌组织和癌旁组织及不同病理特征病人miRNA-212、miRNA-137、miRNA-200表达,并根据术后复发情况分为复发组、未复发组。比较两组miRNA-212、miRNA-137、miRNA-200表达,采用受试者操作特征(ROC)曲线分析miRNA-212、miRNA-137、miRNA-200预测复发的价值,比较不同miRNA-212、miRNA-137、miRNA-200表达水平病人复发率。结果 癌组织miRNA-212为2.03±0.56低于癌旁组织4.52±1.18(P<0.05),癌组织miRNA-137、miRNA-200表达分别为2.69±0.45、24.56±7.39,高于癌旁组织的1.28±0.30、7.33±2.21(P<0.05);随着组织学分级、TNM分期递增,miRNA-212表达逐渐降低,miRNA-137、miRNA-200表达逐渐升高(P<0.05);肌层浸润性膀胱癌病人miRNA-212低于非肌层浸润性膀胱癌,miRNA-137、miRNA-200高于非肌层浸润性膀胱癌(P<0.05);复发组miRNA-212(1.73±0.39)低于未复发组(2.28±0.44)(P<0.05),复发组miRNA-137、miRNA-200分别为3.06±0.72、37.96±12.18,高于未复发组2.35±0.40、22.86±7.50(P<0.05);miRNA-212高水平病人复发率低于低水平病人,miRNA-137、miRNA-200高水平病人复发率高于低水平病人(P<0.05)。结论 膀胱癌组织miRNA-212、miRNA-137、miRNA-200表达与临床病理特征相关,联合检测对TURBT后复发具有良好的预测能力,可作为预测术后复发的一种方案。

CD34、MMP-9、VEGF、PCNA在骨巨细胞瘤中的表达及临床意义

目的探讨CD34、基质金属蛋白酶(MMP-9)、血管内皮生长因子(VEGF)、增殖细胞核抗原(PCNA)在骨巨细胞瘤(GCTB)组织中的表达及其临床意义,为GCTB的诊断与治疗提供临床依据。方法将2010年1月至2017年1月收治的80例GCTB手术患者纳入研究,采用免疫组化染色法检测GCTB组织中CD34、MMP-9、VEGF、PCNA的表达水平,分析其与GCTB患者年龄、性别、肿瘤大小、Jaffe分级以及预后之间的相关性。结果CD34、MMP-9、VEGF、PCNA的阳性表达与GCTB患者年龄、性别无明显相关性(P>0.05),与肿瘤大小、Jaffe分级、预后有显著相关性(P<0.05)。CD34与MMP-9、VEGF、PCNA的表达呈正相关(r=0.311,0.424,0.401;P=0.015,0.025,0.025)。结论 CD34、MMP-9、VEGF、PCNA在GCTB的发生发展中有重要作用,检测其表达水平对GCTB的诊断和预后具有一定的临床意义。

血清HBV-LP联合PRKRA对HBV相关原发性肝癌术后复发风险的预测价值

目的 分析血清乙型肝炎病毒大蛋白(HBV-LP)和干扰素诱导型双链RNA依赖性蛋白激酶激活剂A(PRKRA)水平对乙型肝炎病毒相关原发性肝癌(HBV-PLC)术后复发风险评估的价值。方法 收集确诊为HBV-PLC病人105例,根据术后是否复发分为未复发组(38例)和复发组(67例)。比较两组病人临床基线资料、生化指标结果和病理资料;采用ELISA法检测病人血清HBV-LP和PRKRA水平;采用Pearson相关性分析血清HBV-LP和PRKRA的关系,Cox回归模型分析HBV-PLC术后复发的危险因素;绘制受试者工作特征(ROC)曲线,分析HBV-LP联合PRKRA检测对HBV-PLC术后复发风险的预测价值。结果 两组病人性别、年龄、吸烟史、饮酒量、血清生化指标和肝硬化等差异无统计学意义(P>0.05),两组甲胎蛋白(AFP)<25μg/L、肿瘤大小、肿瘤包膜、肝转移、血管侵袭和肿瘤分化程度差异有统计学意义(χ^(2)=4.217~10.849,P<0.05)。与未复发组比较,复发组病人血清HBV-LP和PRKRA水平明显升高(t=6.501、3.615,P<0.01)。HBV-PLC病人血清HBV-LP与PRKRA水平呈正相关(r=0.839,P<0.01)。肿瘤直径(2~5 cm)、肿瘤包膜、肿瘤低分化、血清HBV-LP和PRKRA是HBV-PLC术后复发的危险因素(HR=1.083~6.938,P<0.05)。ROC曲线分析显示,血清HBV-LP和PRKRA水平及二者联合对HBV-PLC病人术后复发有预测价值,ROC曲线下面积分别为0.796、0.685、0.822。结论 血清HBV-LP和PRKRA水平升高是HBV-PLC病人术后复发的独立危险因素,二者联合检测对HBV-PLC病人术后复发具有良好的预测价值。

喉癌组织及手术切缘P53、PCNA蛋白表达与局部复发的关系

目的:检测喉癌组织及手术切缘中P53及PCNA蛋白表达情况,探讨两者的表达与术后局部复发的关系。方法:选择36例原发灶为鳞状细胞癌、手术切缘组织病理学肿瘤阴性者,对喉癌组织及切缘连续切片,行H-E染色,以免疫组化染色方法分别进行P53及PCNA蛋白检测。结果:36例中原发灶组织中P53阳性率是55.6%(20/36),PCNA阳性率88.9%(32/ 36);手术切缘组织P53阳性率25%(9/36),PCNA阳性率30.6%(11/36)。喉癌原发灶组织中P53及PCNA阳性者的复发率35%(7/20)和25%(8/32)高于阴性者12.5%(2/16)和25%(1/4)。手术切缘中P53及PCNA阳性者的复发率44.4%(4/9)和72.7%(8/11)高于阴性者18.5%(5/27)和4%(1/25)。喉癌组织中P53、PCNA蛋白表达同时异常,且手术切缘组织P53及PCNA蛋白表达也同时异常,术后复发率为100%(4/4)。结论:P53及PCNA蛋白检测可以作为预测喉癌术后局部危险性的生物学标志,在病理学阴性手术切缘组织中两者联合检测对于判断术后局部复发有更大的意义。

Study on the causes of local recurence of rectal cancer after curative resection:analysis of 213 cases

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Detection of BCL2-IGHrearrangement on paraffin-embedded tissue sections obtained from a small submucosal tumor of the rectum in a patient with recurrent follicular lymphoma

A 59-year-old woman was admitted to our hospital because of recurrent follicular lymphorna (FL). Colonoscopic examination revealed a rectal submucosal tumor (SMT) without any erosions and ulcers. In this patient, it was difficult to distinguish non-Hodgkin's lymphoma (NHL) invasion from other disorders of the colon including carcinoid tumor merely based on endoscopic findings. Histopathologic and immunohistochemical studies on biopsy specimens showed an infiltration of atypical lymphocytes that were positive for CD20 and BCL2 but negative for UCHL-1. Fluorescence in situ hybridization on paraffin-embedded tissue sections (T-FISH) identified a translocation of BCL2 with IGHgene.Based on these findings, the tumor was defined as an invasion of FL. T-FISH method is useful for the detection of a monoclonality of atypical lymphocytes in an SMT of the gastrointestinal tract, and particularly for the detection of chromosomal translocations specific to lymphoma subtypes.

Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy

Objective:To investigate the recurrence sites,risk factors,and prognosis of patients with persistent or recurrent squamous cell carcinoma(SCC)of the cervix within one year after undergoing concurrent chemoradiotherapy(CCRT).Methods:Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively.These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission.These 35 patients were treated during the same period(between 2006 and 2011)and selected randomly.Results:Among these 30 patients,25 exhibited distant metastases of which 14 were observed within 6 months after CCRT.Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag>10 ng/mL in the group with persistent or recurrent disease before treatment(P<0.01).Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were the independent risk factors.Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease.The 2-year survival rate was 21.7%,and the median survival time was 17 months.Conclusion:Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis.The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within 1 year after CCRT.

丙酮酸脱氢酶激酶-1在复发鼻咽癌组织中的表达及其与预后的关系

目的探讨丙酮酸脱氢酶激酶-1(pyruvate dehydrogenase kinase-1,PDK1)在局部复发鼻咽癌组织中的表达情况,并分析其与患者临床病理特征及预后的关系。方法选取2013年1月至2017年12月上海大学附属第二医院(温州市中心医院)和汕头大学医学院第一附属医院收治的92例局部复发鼻咽癌和45例初发鼻咽癌患者的临床标本,采用免疫组织化学法检测PDK1的表达情况,并分析其与患者临床病理特征的关系。采用Kaplan-Meier法进行生存分析,并采用Cox回归模型分析鼻咽癌局部复发的危险因素。结果初发鼻咽癌高表达PDK1蛋白的比例为31.11%,明显低于局部复发鼻咽癌(50.00%),差异有显著性(χ^(2)=4.38,P<0.05)。局部复发鼻咽癌组织中PDK1的表达情况与T分期、N分期、临床分期、远处转移、脑神经侵犯及颅底骨质破坏有关(P<0.05)。Kaplan-Meier生存分析表明,高表达PDK1的局部复发鼻咽癌患者5年生存率明显明显低于低表达者(P<0.05)。Cox回归模型多因素分析显示,高表达PDK1、远处转移、脑神经侵犯是鼻咽癌局部复发的独立危险因素(P<0.05)。结论高表达PDK1可能是鼻咽癌放疗后局部复发及预后不良的重要影响因素。