淋巴血管间隙侵犯:一项子宫内膜癌的独立预后因素

Purpose of investigation. To evaluate whether lymphvascular space involvement (LVSI) is a risk factor for relapse of disease and lymph node metastasis in endometrial cancer. Methods. From 1978 till 2003, 609 patients with epithelial endometrial cancer were treated at the Groningen University Medical Center. The association of LVSI and relapse of disease was evaluated in the total group of 609 patients and in a ‘ low’ and ‘ high’ risk stage I endometrial cancer group. In 239 surgically staged patients, the relation of LVSI and lymph node metastasis was investigated. Results. The median age at diagnosis was 63 years (range 27- 92 years) with a median follow- up of 58 months (range 0- 236 months). More than half of the patients (56% ) received adjuvant radiotherapy. LVSI was present in 123 patients (25,6% ), and a prognostic factor for relapse of disease (multivariate analysis, P < 0.0001). In the ‘ low’ and ‘ high’ risk stage I endometrial cancer patients an increase of 2.6 times in relapse of disease was observed in the presence of LVSI. LVSI positive tumors were more likely to have metastasized to the pelvic lymph nodes (multivariate analysis, P = 0.001). In patients with proven negative nodes, LVSI was a prognostic factor for relapse of disease (univariate analysis, P = 0.02). Conclusion. LVSI is a predictor of nodal disease and an independent prognostic factor for relapse of disease in all stages of endometrial cancer. Patients with stage I endometrial cancer with positive LVSI are at risk for relapse of disease and might therefore benefit from adjuvant therapy. Content. The presence of lymphvascular space involvement (LVSI) in endometrial cancer is significantly and independently associated with an increased risk of pelvic lymph node metastases and/or relapse of disease.

淋巴血管侵犯是前列腺腺癌的独立预后因子

研究证实Gleason分级和肿瘤分期是前列腺癌的预后因子。在许多类型的肿瘤中,淋巴血管区域组织学检查发现肿瘤预示患者的预后较差,但目前的前列腺癌分级和分期系统中并未包括淋巴血管受侵情况,还不能确定淋巴血管侵犯是否为前列腺癌疾病进展的独立预测因子。作者回顾性研究了淋巴血管侵犯对前列腺癌根治性切除术后生化复发和肿瘤特异生存的预测作用。

EORTC危险评分系统对T1期非肌层浸润性膀胱癌患者的预后评价

目的：评价欧洲癌症研究与治疗组织（EORTC）膀胱癌预后风险评分表对T1期非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer，NMIBC）患者预后判断的准确性。分析T1期NMIBC复发进展相关因素，探讨更适用于T1期NMIBC的危险分层方法。方法：回顾性分析2011年1月至2013年6月天津医科大学肿瘤医院108例行经尿道膀胱肿物电切术的T1期NMIBC患者的临床病理资料。根据患者不良预后指标进行评分，应用ROC曲线获取临界值重新进行危险分层，建立新的危险评分模型。结果：108例患者中男性90例（83%）、女性18例（17%），中位年龄65（24~88）岁，21例（19.4%）复发，11例（10.2%）进展。结论：EORTC评分系统对T1期NMIBC患者复发进展预测效能不准确。肿瘤大小及既往复发概率为肿瘤复发的独立性预后因素，肿瘤分级及既往复发概率为肿瘤进展的独立性预后因素。应用新的危险评分模型能够更准确的预测T1期NMIBC患者的复发进展风险。

基于CT图像特征的肺腺癌预后因素分析

目的:提出一种基于CT图像特征的肺腺癌预后因素分析方法,旨在探究不同种类CT图像特征对肺腺癌预后的影响。方法:首先,对肺部肿瘤进行分割和特征提取;然后,使用Kaplan-Meier方法进行单因素生存分析;使用COX回归模型进行多因素生存分析,得到肺腺癌的独立预后因素。最后,利用支持向量机(SVM)建立分类器对独立预后因素的预后能力进行检验。结果:选用Lung CT-Diagnosis数据库中61例患者进行试验,单因素分析显示径向方差、边缘粗糙度、GLCM熵以及GLCM非相似性与肺腺癌患者生存率显著相关(P<0.05)。COX回归模型多因素分析发现唯有径向方差与肺腺癌患者生存显著相关(P<0.05)。SVM分类器分类结果显示径向方差能够在一定程度上对患者生存时间进行预测。结论:通过对比分析,发现径向方差、边缘粗糙度、GLCM熵、GLCM非相似性与肺腺癌预后有关;径向方差是肺腺癌的独立预后因素。通过提取分析上述图像特征,医生可以对肺腺癌患者进行更加精准的预后进而延长患者生存时间。

核糖体结合蛋白1与上皮性卵巢癌患者预后关系研究

目的研究核糖体结合蛋白1(RRBP1)在上皮性卵巢癌(EOC)中的表达及其与临床特征和预后的关系。方法本回顾性研究对106例EOC患者的肿瘤组织标本进行分析。通过qRT-PCR检测RRBP1 mRNA的表达水平,免疫组化检测RRBP1的蛋白表达情况,收集临床资料,分析RRBP1与临床病理特征和预后之间的关系。结果RRBP1在EOC中高度表达(P<0.001)。RRBP1的表达与患者肿瘤FIGO分级(P<0.001)、组织学分级(P=0.023)、组织学类型(P=0.004)和淋巴结转移(P=0.011)显著相关,但与患者年龄(P=0.391)或术前糖类抗原125水平(P=0.242)关联不显著。单变量分析显示,EOC患者的预后与患者的年龄、FIGO分级和RRBP1的表达水平有关(P<0.05)。Kaplan-Meier分析所示,RRBP1的表达水平显著影响患者的总生存期(OS,P=0.014)或无病生存期(DFS,P=0.032)。单因素生存分析发现,患者年龄、肿瘤FIGO分级也与患者预后相关(P<0.05)。多变量Cox回归分析显示,RRBP1表达水平是EOC患者OS(95%CI:1.327~4.225,P=0.009)和DFS(95%CI:1.467~3.219,P=0.007)的一个独立危险因素。结论RRBP1可以作为EOC的关键标志物,同时也有潜力成为一个潜在肿瘤治疗靶标。

有丝分裂速度作为局限性皮肤黑素瘤预后因素的重要性

Background: Tumor ulceration (TU) is considered the second most important prognostic factor after Breslow thickness for localized cutaneous malignant melanoma (CMM). However, many studies have not included mitotic rate (MR) with TU in these analyses. When both TU and MR are included in the same analysis, MR appears to be the more important than TU and TU loses its significance as an independent prognostic factor. Methods: The relative importance of TU and MR as prognostic factors in localized CMM were compared in a population- based series of 650 consecutive invasive CMM cases ascertained from the Connecticut tumor registry and reviewed by a single dermatopathologist (RLB), during the period between January 15, 1987 and May 15, 1989. Seventeen clinical and histopathological variables including tumor thickness measured in mm, TU recorded as present or absent, and MR recorded as number per mm2 were included in an unconditional logistic regression model and selected for inclusion using a backward stepwise algorithm with death as an endpoint or at least five- years follow- up. Results: Inthemultivariateregression,theindependent prognostic factors included: 1. tumor thickness in millimeters (OR=1.5, 95% CI=1.3- 1.9) 2. moderate mitotic index (between 1 and 6): (OR=8.3, 95% CI 2.4- 28.7), 3. mitotic index (>6): (OR=11.6, 95% CI=3.0- 44.6), 4. solar elastosis: (inversely associated with mortality) (OR=0.4, 95% CI=0.28). After adjustment for MR, TU lost its significance. When MR was left out of the analysis, ulceration then became an independent prognostic factor. The model with ulceration only (excluding MR) showed a relative risk (RR) of 2.4 (95% CI: 1.1- 5.1). In the model with MR only, MR had a RR of 14.5 (95% CIS.9- 53.7). Finally, regression analysis including both TU and MR yielded an RR of 11.6 for MR and 1.7 for TU. Conclusions: Our results suggest that MR as a proxy for tumor proliferation is a more important prognostic factor than TU.

Ki-67在T1期非肌层浸润性膀胱癌中的表达及意义

目的:检测Ki-67在T1期非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)组织中的表达,并探讨其与肿瘤复发和进展的关系。方法:回顾性分析2011年6月至2013年10月天津医科大学肿瘤医院102例T1期NMIBC患者的临床病理资料,利用免疫组织化学方法检测组织中Ki-67的表达,分析Ki-67表达与患者临床病理特征的关系,探讨其对T1期NMIBC复发和进展的影响。结果:中位随访时间43(24~57)个月,102例T1期NMIBC患者中20例(19.6%)复发,12例(11.8%)进展,32例(31.4%)Ki-67表达≥25%。Ki-67表达与肿瘤分级相关(P<0.05),与患者性别、年龄、肿瘤数目、肿瘤大小等无相关性(P>0.05)。单因素分析结果显示,Ki-67表达与T1期NMIBC的复发无相关性(P>0.05),Ki-67表达、肿瘤分级、肿瘤数目和既往复发率是影响T1期NMIBC进展的危险因素(P<0.05),Cox风险回归模型多因素分析结果显示,Ki-67高表达(P=0.043)和既往复发率(P=0.018)是影响T1期NMIBC进展的独立危险因素。结论:Ki-67表达是T1期NMIBC的独立预后因素,检测Ki-67表达有助于预测其进展风险,为采取及时有效治疗提供依据。

脑特异性新生血管抑制因子1在结直肠癌中的表达及其与结直肠癌患者临床病理学特征的关系

目的探究脑特异性新生血管抑制因子1(BAI1)在结直肠癌中的表达与结直肠癌患者临床病理学特征的关系。方法 2016年5月~2017年7月,购买包含有208个结直肠癌和8个正常结肠组织及其临床信息的组织芯片。查询癌症基因组图谱数据库,内含192例结直肠癌患者的m RNA表达信息。通过免疫组化检测组织芯片正常结肠组织与结直肠癌组织中BAI1表达的情况,检测BAI1表达与结直肠癌患者临床病理特征的关系,采用Kaplan-Meier法和Log-rank秩检验方法进行生存曲线。最后使用Cox回归模型进行单变量分析和多变量分析,判断BAI1对预后的判断价值。结果 BAI1在结直肠癌组织中的含量较正常组织显著上升(P<0.001)。高BAI1表达与临床分期(P=0.004)和肿瘤浸润(P=0.006)相关。癌症基因组图谱(TCGA)中结直肠癌患者的BAI1m RNA表达进一步提示了较晚的临床分期(P=0.027)、较严重的肿瘤浸润(P=0.021)的结直肠癌中BAI1表达水平更高。Kaplan-Meier生存曲线提示BAI1 m RNA高表达的患者比低表达水平的患者总生存期明显减少(P=0.02)。BAI1 m RNA的高表达是结直肠癌预后的独立影响因素(HR=2.895,95%CI:1.012~8.281,P=0.047)。结论 BAI1与结直肠癌的恶性相关。BAI1的高表达可能提示结直肠癌患者的不良预后。

ZMPSTE24表达水平与原发性胶质瘤的关系:一项基于CGGA数据库的研究

目的探讨ZMPSTE24表达水平与原发性胶质瘤的关系。方法从中国脑胶质瘤基因组图谱计划(CGGA)下载325例胶质瘤患者的临床数据和mRNA测序数据。提取ZMPSTE24基因表达量并与临床数据配对合并,同时剔除相关临床数据缺失的病例。依据ZMPSTE24基因在原发性胶质瘤患者(n=210)组织中表达量的中位值(18.61)将入选病例分为高表达组(105例)和低表达组(105例)。采用Wilcoxon符号秩检验和Logistic回归分析ZMPSTE24表达水平与各临床因素的相关性。使用Cox回归和Kaplan-Meier方法评估ZMPSTE24表达水平与胶质瘤患者总生存期的影响。通过基因富集和共表达分析,推测ZMPSTE24可能参与的分子通路和上下游分子。用STRING数据库,寻找与ZMPSTE24存在相互作用的分子并评价其价值。利用TIMER2.0数据库探究ZMPSTE24表达水平与胶质瘤免疫浸润细胞之间的相关性。最后利用人类蛋白图谱数据库(HPA)和临床胶质瘤病理组织行免疫组织化学和蛋白免疫印迹实验进行验证。结果在CGGA数据库中,原发性胶质瘤患者ZMPSTE24高表达组的总生存率显著低于低表达组(P<0.001),并与WHO分级、IDH分型、年龄等相关(P<0.001)。Cox回归分析显示,ZMPSTE24可能是胶质瘤患者的独立预后因素(P<0.001)。蛋白印迹实验提示,肿瘤分级级别越高,ZMPSTE24的表达水平相对越高。结论ZMPSTE24表达水平越高,提示胶质瘤肿瘤分级较高,预后较差。

女性肝细胞癌存活率较高:与口服避孕药有关?

Background: Hepatocellular carcinoma (HCC) has an indisputable male predominance. “Gender" as an independent prognostic factor for survival is, however, controversial. Goals: Determine the influence of gender on survival in HCC patients, and identify factors that may account for the difference. Methods: A retrospective analysis on a prospectively collected database in a 15-year period, from 1989 to 2003. Results: A total of 3,171 HCC patients were managed in our institution (946 with curative treatment, 1,388 with palliative treatment, and 837 with supportive treatment) and studied. Female patients (n = 520) were 4.3 years older (P = 0.000), had a lower proportion of smokers and drinkers (P = 0.000), and were less likely to be hepatitisB carriers (P = 0.000). Therewas no difference in Child-Pugh status, tumor size, and the use of different treatments between genders. The overall median survival was 25.7 months longer in females after curative treatment (73.6 vs. 47.9 months; P = 0.012). The survival benefit in female patients was observed in early-stage diseases and persisted when only hepatitis B surface antigen-positive patientswere analyzed (96.4 vs. 47.9 months; P = 0.044). With multivariate analysis, gender, indocyanine green test value at 15 minutes, number of tumor nodules, size of tumor, major vascular invasion, invasion of adjacent organs, and tumor rupture were the independent variables for survival. More importantly, in female patients, history of using oral contraceptive was an independent factor with survival benefit (P = 0.004). Conclusion: Gender is an independent variable for survival after curative treatment of HCC. A survival benefit was observed in females. History of using oral contraceptive is associated with a better long-term survival in female patients.

腹腔镜和开腹直肠癌全系膜切除后标本质量的比较

背景对肿瘤标本的人体观察是直肠全系膜切除（7ME）后肿瘤转归的一个独立预后因子。本研究旨在评估腹腔镜和开腹直肠癌全系膜切除后人体上所观察到的标本质量。患者和方法72例低位直肠癌患者接受了开腹（n=39）或腹腔镜（n=33）TME。在所有标本中，对直肠中段前侧的腹膜切缘、腹膜会阴筋膜、从后面和侧面覆盖直肠系膜的脏层筋膜以及直肠系膜下的肠壁进行了人体观察。结果结局直肠吻合口在腹腔镜组要显着低于开腹姐（P〈0.001）。

索拉非尼联合射频消融治疗BCLC 0-B1期肝癌显著优于单用射频消融治疗

背景和目的目前研究已表明索拉非尼、肝动脉栓塞化疗术（TACE）与射频消融（RFA）联用对不可切除的肝癌患者有效。由此,本项多中心回顾性队列研究旨在比较联用索拉非尼和RFA及单用RFA对BCLC 0-B1期肝癌的疗效,为临床联用索拉非尼及RFA提供证据。方法研究最终纳入了来自中国多个地区12个中心的128名肝癌患者,其中64名患者接受索拉非尼＋RFA治疗,与之配对的余下64名患者仅接受RFA治疗。入选标准包括：18~75岁、病理确诊或至少两项影像学研究同时证实诊断、肿瘤数目≤3个、最大肿瘤直径≤7 cm、肿瘤为BCLC0-B1期、不愿行肝切除或肝移植术、肝功能储备良好、ECOG状态评分≤2分。剔除标准为：主要血管癌栓形成和/或肝外转移、既往或现在有难以控制的腹水、肝性脑病或食管胃底静脉曲张出血、有其他恶性肿瘤史、心、肾或其他器官严重功能不全、除外病毒性肝炎的感染活动期。索拉非尼的剂量为400 mg Bid,并在RFA治疗前后60天内开始应用。在毒副反应较大的患者中,减少索拉非尼剂量至200 mg Bid,如还无缓解则停药。研究人员定期对患者进行随访,主要包括临床评估、肝功能、AFP、超声检查、动态CT扫描等。随访至2013年10月31日。结果两组的主要治疗并发症均包括消化道出血、胸腔积液、发热等。索拉非尼＋RFA组总并发症发生率为9.38%,RFA组为4.69%,无统计学差异。RFA组中位肿瘤复发时间为41.1周,1年、2年、3年的累积复发率分别为62.8%、85.4%和92.7%。索拉非尼＋RFA组患者中位肿瘤复发时间为65.1周,1年、2年、3年的累积复发率分别为40.5%、62.9%和74.5%。RFA组中位生存时间为118.6周,1年、2年、3年、4年的累积生存率分别为80.7%、47.2%、30.9%和30.9%。索拉非尼＋RFA组中位生存时间为161.8周,1年、2年、3年、4年的累积生存率分别为85.6%、64.0%、58.7%和50.3%。统计学分析提示：索拉非尼＋RFA组的肿瘤复发时间、总体生存时间显著长于RFA组,复发率显著低于RFA组。Cox回归显示,应用索拉非尼、TNM分期、肿瘤数目及大小是影响患者总体生存的独立预后因素;应用索拉非尼、TNM分期、肿瘤数目、抗病毒治疗、TACE治疗史则是影响肿瘤复发的独立预后因素。结论该研究证实了索拉非尼和RFA联用较单用RFA能更为有效地降低肝癌复发率、延长无瘤及总体生存期。可认为索拉非尼联合RFA是治疗局部体积较小的原发性或复发性肝癌的一种安全而有效的方案。

年轻患者的直肠癌

PURPOSE:The purpose of this national study was to evaluate the results of treatment for young rectal cancer patients.METHODS:This prospective study from the Norwegian Rectal Cancer Project includes all 2,283 patients younger than aged 70 years with adenocarcinoma of the rectum from November 1993 to December 1999.Patients younger than aged 40 years(n = 45) ,40 to 44 years(n = 87) ,45 to 49 years(n = 153) ,and 50 to 69 years(n = 1998) were compared for patient and tumor characteristics and five-year overall survival.Patients treated for cure(n = 1,354) were evaluated for local recurrence,distant metastasis,and disease-free survival.RESULTS:Patients younger than aged 40 years had significantly higher frequencies of poorly differentiated tumors(27 vs.12-16 percent;P = 0.014) ,N2-stage(37 vs.13-18 percent;P = 0.001) ,and distant metastases(38 vs.19-24 percent;P = 0.019) compared with older patients.Among those treated for cure,56 percent of the patients younger than aged 40 years developed distant metastases compared with 20 to 26 percent of the older patients(P = 0.003) .Overall five-year survival was 54 percent for patients younger than aged 40 years compared with 71 to 88 percent for the older patients(P = 0.029) .Age younger than 40 years was a significant independent prognostic factor and increased the risk for metastasis and death.CONCLUSIONS:Patients younger than aged 40 years had a more advanced stage at the time of diagnosis and poor prognosis compared with older patients.Young patients treated for cure more often developed distant metastases and had inferior survival.

ATP细胞活力试验在测量宫颈癌固有放射敏感性中的应用前景

Background. Intrinsic radiosensitivity using the clonogenic assay and the cell surviving fraction at 2 Gy (SF2) has been shown to be an independent prognostic factor for patient response to radiotherapy in carcinoma of the cervix. The clonogenic assay has significant shortcomings, making it unsuitable for routine clinical use. The ATP cell viability assay (ATP- CVA) has been shown to have a high tumor evaluability rate, technical simplicity, and reproducibility in chemosensitivity testing. Aims. This study compares the ATP- CVA with the clonogenic assay in the in vitro radiosensitivity testing of cervical cancer cell lines. Correlation of in vitro radiosensitivity and in vivo patient response was also determined. Methods. Five cervical carcinoma cell lines (SiHa, HeLa, Caski, C- 33A, and C4- 1) were tested using the ATP- CVA and the clonogenic assay. Survival curves were plotted and the mean SF2 values obtained by the two different assay methods were compared using ANOVA to see if there were significant differences. Mean SF2 values obtained from 27 cervical cancers were compared with clinical outcomes. Results. The SF2 values for the cell lines ranged from 0.28 to 0.67 when tested using the ATP- CVA. Using the clonogenic assay, the SF2 values ranged from 0.27 to 0.70. ANOVA with Bonferroni pairwise multiple comparison showed no significant difference between the mean SF2 values for the individual cell lines between the two assay methods. Twenty- three cervical cancer samples (85% ) were evaluable for SF2 using ATP- CVA. The mean SF2 values of patients who had locoregional failure were significantly higher than those who achieved local control (P < 0.01). Conclusions. Testing intrinsic radiosensitivity using the surviving fraction at 2 Gy (SF2) is comparable using the two assay methods of ATP- CVA and clonogenic assay. The ATP- CVA should be further investigated in the testing of intrinsic radiosensitivity in patients with cervical cancer.

术前的营养支持

营养不良是术后并发症的独立预后因素,多数医生和患者都对术后营养支持尤为重视。但其实,术前营养支持也很重要,尤其是大型、复杂手术后预计出现应激态危重病人往往不能耐受长时间营养缺乏,须在术前进行营养治疗。一、术前营养风险筛查首先需要运用营养筛查工具找出存在营养风险的患者,目前临床上使用比较多的是营养风险筛查表(NRS2002)。

使用紫杉醇-铂类预处理的卵巢癌患者二线治疗中疾病稳定状况是否为存活的有效指标

Objective. Recurrent ovarian carcinoma is considered an incurable dis ease and second-line chemotherapy is administered for extension of survival and palliati on. The impact of continued antineoplastic treatment in patients with stable dis ease without a demonstrable response is uncertain. The aim of this analysis was to assess the value of a stabilization of the tumor size in second-line chemoth erapy as an indicator of survival. Methods. Retrospective, single-institution s tudy of 487 consecutive patients with primary epithelial ovarian carcinoma. Incl usion criteria: (1) FIGO stage IC-IV epithelial ovarian carcinoma; (2) first-l ine chemotherapy with Paclitaxel and a Platinum-compound; (3) refractory, persi stent, or recurrent disease diagnosed by imaging methods; and (4) intravenous se cond-line chemotherapy with single Topotecan or Paclitaxel-Carboplatin. Univar iate and multivariate analyses of survival with theWorld Health Organization (WH O) tumor response parameter included as a time-dependent variable were performe d. Results. The response rates were (N = 100): complete response (CR) 27%, part ial response (PR) 14%, stable disease (SD) 41%and progressive disease (PD) 18 %. In a multivariate Cox regression analysis of survival, SD was found to be an independent prognostic factor for survival and the death hazard ratio was 0.37 (SD versus PD; 95%CI: 0.16-0.86; P = 0.02). There was no statistically signifi cant difference in survival between patients with PR and SD (P = 0.09). Conclusi on. In secondline chemotherapy of ovarian cancer,patients demonstrating SD have a survival benefit compared to patients with PD measured by theWHO tumor respons e criteria.

Loss of heterozygosity: An independent prognostic factor of colorectal cancer

AIM: Colorectal cancers result from the accumulation of several distinct genetic alterations. This study was to investigate the frequency and prognostic value of loss of heterozygosity (LOH) and microsatellite instability (MSI) at 14 genetic loci located near or within regions containing important genes implicated in colorectal tumorigenesis. METHODS: We studied colorectal cancers with corresponding normal mucosae in 207 patients (139 males and 68 females, mean age at the time of tumor resection 66.2±12.4 years, range 22-88 years). There were 37 right-sided colonic tumors, 85 left-sided colonic tumors and 85 rectal tumors. The distribution of tumor staging was stage Ⅰ in 25, stage Ⅱ in 73, stage Ⅲ in 68, and stage Ⅳ in 41. We analyzed the LOH and MSI of HPC1, hMSH2, hMLH1, APC, MET, P53, NH23-H1, DCC, BAT25, BAT26, D17S250, MYCL1 and D8S254 with fluorescent polymerase chain reaction and denatured gel electrophoresis. High-frequency LOH was determined to be greater than three, or more than 50% of the informative marker with LOH. High-frequency MSI (MSI-H) was determined as more than four markers with instability (>30%). Correlations of LOH and MSI with clinical outcomes and pathological features were analyzed and compared. RESULTS: The occurrence of MSI-H was 7.25%, located predominantly in the right colons (7/15) and had a higher frequency of poor differentiation (6/15) and mucin production (7/15). LOH in at least one genetic locus occurred in 78.7% of the tumors and was significantly associated with disease progression. Of the 166 potentially cured patients, 45 developed tumor recurrence within 36 mo of follow-up. Clinicopathological factors affecting 3-year disease-free survival (DFS) were TNM staging, grade of differentiation, preoperative CEA level, and high LOH status. Patients with high LOH tumors had a significantly lower DFS (50%) compared with patients with low LOH tumors (84%). Of the patients developing subsequent tumor recurrence, the number and percentage of LOH were 2.97 and 46.8% respectively, similar to the stage IV disease patients. TNM staging had the most significant impact on DFS, followed by high LOH status. CONCLUSION: Clinical manifestations of LOH and MSI are different in colorectal cancer patients. High-frequency LOH is associated with high metastatic potential of colorectal cancers.

腋淋巴结阴性乳腺癌的预后因素分析

目前公认腋窝淋巴结状态是乳腺癌患者最重要的独立预后因子，腋窝淋巴结阴性乳腺癌患者的无瘤生存及总生存期较淋巴结阳性乳腺癌患者有明显延长。但对腋窝淋巴结定性的标准仍有争议。其一是淋巴结的病理检查方法不标准。如：一些病理学家仅从淋巴结切下单张切片在显微镜下细阅，淋巴结的大部分组织未被检查，就可能遗漏出现假阴性结果。