Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma

AIM:The prognosis of early gastric carcinoma (EGC) is generally excellent after surgery. The presence or absence of lymph node metastasis in EGC is an important prognostic factor. The survival and recurrence rates of node-negative EGC are much better than those of node-positive EGC. This study examined the factors related to lymph node metastasis in EGC to determine the appropriate treatment for EGC.METHODS: We investigated 748 patients with EGC who underwent surgery between January 1985 and December 1999 at the Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hospital. Several clinicopathologic factors were investigated to analyze their relationship to lymph node metastasis: age, sex, tumor location, tumor size, gross type, histologic type, depth of invasion, extent of lymph node dissection, type of operation,and DNA ploidy.RESULTS:Lymph node metastases were found in 75 patients (10.0%). Univariate analysis showed that male sex, tumor size larger than 2.0cm, submucosal invasion of tumor, histologic differentiation, and DNA ploidy pattern were risk factors for regional lymph node metastasis in EGC patients. However, a multivariate analysis showed that three risk factors were associated with lymph node metastasis:large tumor size, undifferentiated histologic type and submucosal invasion. No statistical relationship was found for age, sex, tumor location, gross type, or DNA ploidy in multivariate analysis. The 5-year survival rate was 94.2% for those without lymph node metastasis and 87.3% for those with lymph node metastasis, and the difference was significant (P<0.05).CONCLUSION: In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore,a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.

不吸烟女性肺癌危险因素病例-对照研究

目的 探讨不吸烟女性患肺癌的危险因素。方法 对沈阳市已确诊的 12 6例不吸烟女性原发性肺癌进行 1∶1配对的病例对照研究。调查内容包括一般状况、家族史、疾病史、居住史、被动吸烟史、职业史、饮食史、烹饪史及室内微小环境等。结果 腺癌是女性肺癌的主要组织类型 ,占 6 2 .7%。生育次数越多 ,患肺癌的危险性越高 (OR =1.46 6 ,95 %CI =1.0 6～ 2 .0 1)。肥胖指数 (BMI)越小 ,肺癌的危险性越高 (OR =2 .0 82 ,95 %CI =1.2～ 3.6 0 ) ,而且随着BMI的增加 ,肺癌的危险性降低。大量食用动物内脏 (OR =1.891,95 %CI=1.45～ 2 .46 )、玉米高粱 (OR =1.5 38,95 %CI =1.2 2～ 1.93)等能增加肺癌的危险性。使用液化石油气作燃料 (OR =1.741,95 %CI =1.2 9～ 2 .34)和室内燃煤 (OR =1.785 ,95 %CI =1.33～ 2 .38)是不吸烟女性肺癌的危险因素。一级亲属中有肺癌患者 ,不吸烟女性的肺癌危险性增高 (OR =3.18,95 %CI =2 .43～ 4.15 )。结论 低BMI、多次生育、大量食用动物内脏及玉米高粱、室内燃煤、使用液化石油气作燃料均会增加不吸烟女性患肺癌的危险性。

非吸烟女性肺癌与月经生育史病例对照研究

目的探讨月经史、生育史及避孕药的使用与非吸烟女性肺癌的关系。方法对沈阳市区内非吸烟女性肺癌进行病例对照研究,共收集了新诊断的非吸烟原发性肺癌病例409例及按配比年龄与性别在一般人群中选对照436例。调查内容包括人口特征、月经史、生育史以及避孕药服用史。用Logistic回归模型分析危险因素。结果妊娠总数大(趋势检验P=0.018)、绝经年龄大(趋势检验P=0.065)的非吸烟女性,肺癌发生的危险性大。使用口服避孕药可增加肺癌发生的风险,其OR值为1.56(P=0.05)。结论雌激素可能在非吸烟女性肺癌发生中起一定作用。

肺癌患者术后呼吸功能衰竭影响因素分析及静息肺功能临床评估价值研究

目的探讨肺癌患者术后发生呼吸功能衰竭的影响因素,分析静息肺功能检测的临床评估价值。方法选取2007年1月—2011年12月我院收治的肺癌术后发生呼吸功能衰竭的患者63例为研究组,另随机抽取同期术后未发生呼吸功能衰竭的肺癌患者126例为对照组。统计两组患者各临床指标,采用多因素Logistic回归分析呼吸功能衰竭的影响因素。检测两组患者静息肺功能指标,取各项实测值和理论预期值的相对百分比表示。结果研究组较对照组患者年龄、吸烟率、合并慢性阻塞性肺疾病(COPD)、术前肺功能程度、手术时间、术中液体输入量、切除范围及严重并发症发生率均降低,差异有统计学意义(P<0.05);而两组的性别、合并糖尿病、高血压、冠心病及肿瘤部位、病灶长度比较,差异均无统计学意义(P>0.05)。研究组较对照组静息肺功能指标肺活量(VC%)、用力肺活量(FVC%)、第1秒用力呼气容积(FEV1%)、最大自主通气量(MVV%)、用力呼气25%肺活量瞬间流速(FEF25%%)、用力呼气50%肺活量瞬间流速(FEF50%%)、最大呼气流量(PEF%)和最大呼气中期流量(MMEF%)均降低,差异均有统计学意义(P<0.05);而FEV1/FVC%、FEV1/VC%、用力呼气75%肺活量瞬间流速(FEF75%%)比较,差异均无统计学意义(P>0.05)。以呼吸功能衰竭为因变量,以单因素分析差异有统计学意义的指标为自变量,进行Logistic回归分析,结果显示,患者年龄、术前肺功能障碍、术中液体输入量、全肺切除和术后严重并发症进入回归模型。结论高龄、术前肺功能障碍、术中液体输入量、全肺切除、严重并发症是肺癌患者术后发生呼吸功能衰竭的危险因素,静息肺功能指标可以评估呼吸功能情况。

女性肺癌危险因素的病例对照研究

目的探讨女性肺癌的危险因素。方法采用成组匹配的病例-对照研究方法,调查女性肺癌患者208例和对照组208例。内容包括一般人口学特征、居住史、饮食习惯及结构、吸烟和饮酒史等。应用非条件Logistic回归进行单因素和多因素分析,并按体质指数（Body Mass Index）和教育程度调整。结果室内烹调油烟（OR=4.405,95%CI=2.243~8.644）、家庭（OR=2.009,95%CI=1.262~3.200）和工作场所被动吸烟（OR=2.630,95%CI=1.270~5.446）、使用农药（OR=2.394,95%CI=1.212~4.726）是女性肺癌的可能危险因素。经常食用新鲜水果（OR=0.175,95%CI=0.078~0.395）、饮茶（OR=0.565,95%CI=0.335~0.952）、经常进行锻炼（OR=0.455,95%CI=0.266~0.780）以及初潮年龄〉16岁（OR=0.536,95%CI=0.299~0.959）则是肺癌的可能保护因素。结论改善住宅通风、安装抽油烟机,增加新鲜水果摄入和饮茶有助于预防肺癌。

北京市肺癌危险因素的病例对照研究

［日的］探索北京市肺癌主要危险因素。［方法］抽取３５０例原发性肺癌患者进行１：１配对病例对照研究，并用条件 Ｌｏｇｉｓｔｉｃ回归模型对所获资料进行单因素和多因素分析。［结果］研究提示效应较强的危险因素有肺部疾病史，吸烟史，住宅附近 ５００米内有大气污染，因亲人去世、家庭不和、工作失意等导致的精神创伤以及家族肿瘤史等；而保护性因素有经常食用新鲜水果 和体育锻炼。［结论］为了解北京市肺癌的流行规律并为其防治和研究提供了依据。

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). CLIP 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 published. 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 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP 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 portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma 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 multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.

女性肺癌的危险因素和筛查现状

中国女性肺癌病人吸烟率很低,尽管目前国内大多肺癌筛查试验及项目已关注被动吸烟的群体,但较少关注有其他危险因素暴露的非吸烟女性高危人群,很多筛查研究尚存在非吸烟女性覆盖率不足的问题。总结女性肺癌的危险因素,并就目前国内外基于低剂量CT的主要筛查试验及项目的女性纳入情况作一述评,以期为肺癌筛查纳入标准的完善及优化提供帮助。

天津地区肺癌危险因素研究

目的 探讨天津地区肺癌危险因素 ,进一步为肺癌危险因素的监测提供依据。方法采用病例 对照研究方法 ,调查年龄在 3 0～ 75岁之间的、原发性肺癌患者 193例和正常对照组 2 59例 ,内容包括一般情况、生活居住环境、生活习惯、既往病史和家族病史等。通过非条件logistic回归模型进行单因素和多因素分析。结果 单因素分析显示 ,吸烟、被动吸烟、饮酒和恶性肿瘤家族史、职业均与肺癌有关。多因素分析结果显示 ,影响肺癌发病的主要因素为吸烟、被动吸烟、10年前月人均收入、10年前人均住房面积和体质指数 (OR分别为 3 .3 0 2 ,1.193 ,1.0 0 3 ,1.0 67和 0 .913 )。结论 吸烟和被动吸烟为肺癌的独立危险因素 ;随着 10年前月人均收入和 10年前人均住房面积的增加 ,肺癌发生的危险性增大 ;

京、津、沪、渝四城市肺癌危险因素病例对照研究

目的 分析肺癌危险因素 ,探讨监测指标。方法 利用《常见恶性肿瘤发病、死亡及危险因素监测方法研究》课题第 1次现场调查中京、津、沪、渝四市城区病例对照调查资料 ,运用多因素条件logistic回归分析方法。结果 在调整年龄、受教育程度、人均月收入和控制其他因素作用的基础上 ,吸烟 (OR =3 46 )、体质指数小 (OR =1 18)、长期精神压抑 (OR =2 6 4)、情绪调节能力差 (OR =2 71)、既往呼吸系疾病史 (OR =2 2 8)、家族肿瘤史 (OR =1 79)、职业接触 (OR =1 43)与肺癌的关联有显著性 ,体育锻炼 (OR =0 81)、新鲜蔬菜摄入多 (OR =0 75 )与肺癌呈负关联 ,四市肺癌的主要危险因素结果基本一致。结论 吸烟、心理因素、既往呼吸系疾病史、家族肿瘤史是四市肺癌共同的主要危险因素 ;环境烟雾、食物等有待于进一步研究。

月经和生育因素对妇女肺癌危险度的影响

目的 验证雌激素可能对肺癌危险度产生的影响 方法 1994～1998年在甘肃省陇东地区进行了一项女性人群的病例对照研究,分析了月经和生育因素与肺癌危险度之间的关系。病例组为109例女性肺癌病例和435名女性为对照组,对照组是根据人口调查资料,按年龄和地区与病例频数匹配得到的。结果 初潮年龄晚(趋势检验P=0.015)、绝经年龄晚(趋势检验P=0.074)的女性,其肺癌比值比较低。结论 尽管有局限性,上述发现表明雌激素在女性肺癌病因学中起到一定作用。

肺癌危险因素配对分析中对照人群选择的探讨

目的 探讨肺癌危险因素配对分析中人群对照的选择方法 ,为开展肺癌危险因素监测提供依据。方法 利用《常见恶性肿瘤发病、死亡及危险因素监测方法研究》课题中北京、天津、上海、重庆 4市城区的调查资料 ,运用条件logistic回归分析方法对 3组 1∶1邻居 ,1∶1正常人 ,1∶2正常人匹配病例对照资料进行分析。结果 3组资料肺癌主要危险因素的OR值一致 ,食物因素等的结果有一定差异 ;邻居对照和正常人对照之间因素暴露率的差异很小。结论 在城市肺癌危险因素监测中 。