颈部淋巴结的最大径不是早期鼻咽癌单纯放疗的预后因素

背景与目的:2008年国内鼻咽癌分期中,颈部淋巴结的大小成为分期的依据之一,即单侧淋巴结直径>3 cm为N2,而AJCC分期对直径<6 cm的淋巴结,其大小没有考虑在分期内。本文旨在分析颈部淋巴结最大直径在早期鼻咽癌中的预后作用。方法:回顾性分析本院2000年1月—2003年12月357例经病理证实伴有颈部淋巴结转移的初治早期鼻咽癌患者临床资料。年龄10～87岁,中位年龄49岁,男性267例,女性90例。根据2002年UICC分期:T1、T2期分别为117、240例,淋巴结最大直径(Dmax)≤3 cm和3 cm<Dmax≤6 cm分别为271例、86例。鼻咽原发病灶主要采用60Co-γ线、6 MV X线常规分割照射,每次1.8～2.0 Gy,总剂量64～74 Gy。常规放疗结束后,如鼻咽镜或CT提示有肿瘤残存者,则通过耳后野、颅底野、后装及适形加量6～20 Gy。颈部放射源用60Co-γ线、180 kV X线和9 MeV电子束,预防剂量50～56 Gy,根治剂量60～68 Gy。结果:全部病例随诊时间3～90个月,中位随访54个月。共计有14例患者颈部复发,33例患者原发灶复发;47例发生远处转移,其中骨转移20例,肺转移10例,肝脏转移7例,另有10例合并2个或以上器官转移。共计有68例患者死亡,其中32例死于远处转移,23例死于局部区域失败,5例死于局部复发和远处转移,2例死于第二原发肿瘤,6例死于其他原因。总的5年生存率(overall survival,OS)为78.6%;5年无复发生存率(recurrent-free survival,RFS)、无远处转移生存率(distant metastasis free survival,DMFS)和无病生存率(disease free survival,DFS)分别为86.7%、85.6%和74.7%。颈部淋巴结的Dmax为1～6 cm,中位3 cm,均值为2.7 cm。淋巴结Dmax≤3 cm和3 cm<Dmax≤6 cm的5年OS(80.6%vs 78.3%,P=0.731)、DFS(75.8%vs 72.2%,P=0.614)、RFS(88.6%vs 85.8%,P=0.337)和DMFS(86.6%vs 82.4%,P=0.227)差异均无统计学意义。T1和T2的5年OS、DMFS、DFS分别为85.6%vs75.4%、93.4%vs 81.9%和83.5%vs 70.8%,差异有统计学意义(P<0.05);多因素分析显示,颈部淋巴结的Dmax和预后无关(P=0.972)。结论:颈部淋巴结的Dmax不是早期鼻咽癌单纯放疗的预后因素。

The expression of HER-2/neu gene in colon cancer tissues and its clinical significance

Objective：The article aims to detect the expression of HER-2/neu gene in colon cancer tissues and adjacent tissues, to analyze the relationship between dif erent pathologic types and clinical features, also to invest the distribution of patients with positive expression of HER-2 gene. Methods：The expression of HER-2 gene in the 223 samples with colon can-cer was detected by immunochemical approach. The expression of HER-2 gene in colon cancer tissues and adjacent tissues and dif erent pathologic types was analyzed byχ2 test. The correlation between the expression of HER-2 gene and clinical features was analyzed by Spearman. Results：The number of positive expression of HER-2 gene in colon cancer tissues and adjacent tissues were 74 and 0 respectively, the dif erence has statistical significance. The number of papil ary or tubular adenocarcinoma was 182, among them, 60 cases were positive expression. The number of mucinous adenocarcinoma was 41, among them, 14 cases were positive expression. The expression of HER-2/neu gene has no correlation with sex, age, the maximum diameter, general classification, degree of dif erentiation and depth of invasion, which has no statistical significance. However, the expression of HER-2/neu gene has correlation with metastasis of lymph node and Dukes stage, which has statistical significance. The expression of HER-2/neu gene was positive correlation with metastasis of lymph node and Dukes stage. The correlated coef icient index was 0.320 and 0.320 respectively. In the 74 patients with positive expression of HER-2 gene, 59.4%of them were 60-74 years old. And there was 97.3%of the patients without family history of adenocarcinoma. Conclusion：The expression of HER-2/neu gene in colon cancer tissues was higher than in adjacent tissues. The expression of HER-2/neu gene has no correlation with sex, age, the maximum diameter, general classification, degree of dif erentiation and depth of invasion, but has correlation with metastasis of lymph node and Dukes stage. The expression of HER-2/neu gene was positive correlation with metastasis of lymph node and Dukes stage. The expression of HER-2/neu gene with age of 60-74 years old and without family history of adenocarcinoma was higher than other groups.