Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer

AIM: To evaluate the role of peritoneal lavage cytology (PLC) and carcinoembryonic antigen (CEA) determination of peritoneal washes (pCEA) in predicting the peritoneal metastasis and prognosis after curative resection of gastric cancer.METHODS: PLC and radioimmunoassay of CEA were performed in peritoneal washes from 64 patients with gastric cancer and 8 patients with benign diseases.RESULTS: The positive rate of pCEA (40.6%) was significantly higher than that of PLC (23.4%) (P<0.05).The positive rates of PLC and pCEA correlated with the depth of tumor invasion and lymph node metastasis (P<0.05). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared to PLC. The 1-, 3-, and 5-year survival rates of patients with positive cytologic findings or positive pCEA results were significantly lower than those of patients with negative cytologic findings or negative pCEA results (P<0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer.CONCLUSION: Intraoperative pCEA is a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared to PLC method.

Clinical significance of lymph node metastasis in gastric cancer

Gastric cancer,one of the most common malignancies in the world,frequently reveals lymph node,peritoneum,and liver metastases.Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection,which results in poor prognosis.Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer.Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials,it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year followup study.Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide,but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis.It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer.Besides,the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer.

Prognostic significance of malignant ascites in gastric cancer patients with peritoneal metastasis: A systemic review and meta-analysis

BACKGROUND Recent evidence indicates that malignant ascites may be associated with the high malignancy and poor prognosis of gastric cancer(GC)with peritoneal metastasis(PM),but no robust consensus has been reached until now.AIM To evaluate the prognostic significance of malignant ascites in GC patients with PM.METHODS Two independent authors conducted database searches.The searches were performed in the EMBASE,PubMed,and Cochrane Library databases,and the terms used to search included stomach neoplasms,GC,ascites,peritoneal effusion,survival,and survival analysis.Outcomes included overall survival and hazard ratios with 95%confidence intervals(CIs).Three pairs of comparisons for measuring survival were made:(1)Patients with ascites vs those without ascites;(2)Patients with massive ascites vs those with mild to moderate ascites;and(3)Patients with massive ascites vs those with no to moderate ascites.RESULTS Fourteen articles including fifteen studies were considered in the final analysis.Among them,nine studies assessed the difference in prognosis between patients with and without malignant ascites.A pooled HR of 1.63(95%CI:1.47-1.82,P<0.00001)indicated that GC patients with malignant ascites had a relatively poor prognosis compared to patients without ascites.We also found that the prognosis of GC patients with malignant ascites was related to the volume of ascites in the six other studies.CONCLUSION GC patients with malignant ascites tend to have a worse prognosis,and the volume of ascites has an impact on GC outcomes.

Correlation of integrin β3 mRNA and vascular endothelial growth factor protein expression profiles with the clinicopathological features and prognosis of gastric carcinoma

AIM:To investigate integrin β3 mRNA and vascular endothelial growth factor (VEGF) protein expression in gastric carcinoma, and its correlation with microvascular density, growth-pattern, invasion, metastasis and prognosis. METHODS: In situ hybridization (ISH) of integrin β3 mRNA and immunohistochemistry of VEGF and CD34 protein were performed on samples from 118 patients with gastric cancer. RESULTS: The positive rate of integrin β3 mRNA in non- tumor gastric mucosa (20%) was significantly lower than that of the gastric cancer tissue (52.5%, χ2 = 10.20, P < 0.01). In patients of infiltrating type, stage T3-T4, vessel invasion, lymphatic metastasis, hepatic or peritoneal metastasis, the positive expression rates of integrin β3 mRNA were significantly higher than those in patients of expanding type (P < 0.01), stage T1-T2 (P < 0.01), non-vessel invasion (P < 0.01), without lymphatic metastasis (P < 0.01), without hepatic and peritoneal metastasis (P < 0.01), respectively. In patients of infiltrating type, stage T3-T4, vessel invasion, lymphatic metastasis, hepatic or peritoneal metastasis, the positive expression rates of VEGF protein were significantly higher than those in patients of expanding type (P < 0.01), stage T1-T2 (P < 0.01), non-vessel invasion (P < 0.01), without lymphatic metastasis (P < 0.01), without hepatic and peritoneal metastasis (P < 0.01), respectively. In patients of infiltrating type, stage T3-T4, vessel invasion, lymphatic metastasis, hepatic orperitoneal metastasis, the mean MVD were significantly higher than those in patients of expanding type (P < 0.01), stage T1-T2 (P < 0.01), non-vessel invasion (P < 0.01), without lymphatic metastasis (P < 0.01), without hepatic and peritoneal metastasis (P < 0.01), respectively. It was found that the positive expression rate of integrin β3 mRNA was positively related to that of VEGF protein (P < 0.01) and MVD (P < 0.05), meanwhile the positive expression rate of VEGF protein was positively related to MVD (P < 0.05). The mean survival period in patients with positive expression of integrin β3 mRNA and VEGF, and MVD ≥ 54.9/mm2 was significantly shorter than that in patients with negative expression of integrin β3 mRNA (P < 0.05) and VEGF (P < 0.01), and MVD < 54.9/mm2 (P < 0.01). Five-year survival rate in patients with positive expression of integrin β3 mRNA and VEGF, and MVD ≥ 54.9/mm2 was significantly lower than those with negative expression of integrin β3 mRNA (P < 0.05), VEGF (P < 0.05), and MVD < 54.9/mm2 (P < 0.01). CONCLUSION: Integrin β3 and VEGF expression can synergistically enhance tumor angiogenesis, and may play a crucial role in invasion and metastasis of gastric carcinoma. Therefore, they may be prognostic biomarkers and novel molecular therapeutic targets.

Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis,and provide a foundation for rational opera- tions. METHODS The operations and prognosis of 102 primary gastric carci- noma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who under- went a resection operation,the 6-month,1-and 2-year post-operative sur- vival rates were 61%,42%and 7%.There was a statistically significant dif- ference in survival between resected and non-resected patients(P=0.000) In gastric carcinoma cases with H2 metastasis,resection operations resulted in 54%,16%and 8%respective survival rates,with no significant difference compared to patients not receiving a resection(P=0.132).Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%,13%and 0%respective survivals with no significantly better prognosis compared to the non-resected cases(P=0.135).There was no statistical y significant difference in survival between the cases with or without peritoneal metastasis(P=0.152). CONCLUSION A resection operation provides a better prognosis for gas- tric carcinoma patients with H1 metastasis independent of peritoneal metas- tasis,but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis.Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.

THE EFFECTS OF CHINESE DRUGS FOR SUPPORTING HEALTHY ENERGY AND REMOVING BLOOD STASIS ON POSTOPERATIVE METASTASIS OF GASTRIC CARCINOMA AND ORNITHINE DECARBOXYLASE

32 postoperative cases of gastric carcinoma were treated by traditional Chinese medicine (TCM) drugs for supporting healthy energy and removing blood stasis, and their therapeutic results were compared with those in the control group treated by western medicine. After 6 months of treatment, in the TCM group, the rate of metastatic recurrence was significantly reduced, and the level of ornithine decarboxylase was also markedly lowered. Therefore, it is considered that the action of anti-metastatic recurrence of TCM drugs in postoperative cases of gastric carcinoma is probably related to the lowered activity of ornithine decarboxylase.

胃癌组织中KLF6和PTTG1的表达与胃癌淋巴结转移及预后的关系

目的:探讨Kruppel样因子6(KLF6)、垂体肿瘤转化基因1(PTTG1)在胃癌组织中的表达,并分析两者与胃癌淋巴结转移及预后的关系。方法:选取2018年4月—2019年10月诊治的80例胃癌患者,收集患者术中切除的癌组织及癌旁正常组织。采用免疫组织化学法对KLF6、PTTG1的表达进行检测;Spearman法分析胃癌组织中KLF6和PTTG1表达的相关性;Logistic回归分析影响淋巴结转移的因素;Kaplan-meier法分析胃癌组织中KLF6和PTTG1表达与患者预后的关系;Cox回归分析患者预后的影响因素。结果:与癌旁正常组织相比,胃癌组织中KLF6低表达率、PTTG1高表达率明显升高(P<0.05);胃癌组织中KLF6、PTTG1表达呈负相关(r=-0.502,P<0.05);胃癌淋巴结转移患者KLF6低表达、PTTG1高表达比例明显高于无淋巴结转移患者(P<0.05);KLF6是淋巴结转移的保护因素(P<0.05),PTTG1是淋巴结转移的危险因素(P<0.05)。KLF6高表达组生存率显著高于低表达组(χ^(2)=8.557,P<0.05),PTTG1低表达组生存率显著高于高表达组(χ^(2)=5.637,P<0.05);KLF6是患者预后的保护因素(P<0.05),淋巴结转移、PTTG1是患者预后的危险因素(P<0.05)。结论:胃癌组织中KLF6低表达、PTTG1高表达,均与胃癌淋巴结转移及预后有关。

早期胃癌伴淋巴结转移患者远期预后的影响因素分析

目的:探讨影响早期胃癌伴有淋巴结转移患者远期预后的独立危险因素,评估淋巴结转移数量对预后影响的优化分类方法。方法:回顾分析2005年2月至2021年12月外科手术治疗并经术后病理证实为早期胃癌淋巴结转移的348例患者的临床病理资料,依据第八版美国癌症联合委员会指南N分期标准分为T1N1与T1N2+组,其中T1N1组140例,T1N2+组208例。采用Cox回归分析,探讨影响早期胃癌伴有淋巴结转移患者远期预后的独立危险因素,并通过log-rank检验筛选淋巴结转移数量对预后影响的最优分类。结果:T1N1组3年总体生存率高于T1N2+组(83.9%vs.61.9%),差异有统计学意义(P<0.01)。单因素COX回归分析结果显示,患者年龄、N分期、肿瘤大小、脉管癌栓与早期胃癌伴淋巴结转移患者的远期预后相关(P<0.05)。多因素分析结果显示,年龄≥60岁(P=0.04)、肿瘤N分期较晚(P=0.002)、肿瘤>3 cm(P=0.016)是影响总体生存的独立危险因素。进一步以淋巴结转移数量为截断点进行log-rank检验,结果表明,淋巴结转移数量等于6时,log-rank检验的χ^(2)值最大(77.5%vs.56.0%,log-rankχ^(2)=23.109,P<0.001),有助于更好地区分不良预后患者。结论:对于早期胃癌淋巴结转移的患者,年龄≥60岁、肿瘤>3 cm、肿瘤N分期较晚是影响远期预后的独立危险因素。其中淋巴结转移数量等于6可作为反映早期胃癌淋巴结转移预后的有效分类指标。

Examined lymph node count for gastric cancer patients after curative surgery

Lymph node(LN)metastasis is the most common form of metastasis in gastric cancer(GC).The status and stage of LN metastasis are important indicators that reflect the progress of GC.The number of LN metastases is still the most effective index to evaluate the prognosis of patients in all stages of LN metastasis.Examined LN(ELN)count refers to the number of LNs harvested from specimens by curative gastrectomy for pathological examination.This review summarizes the factors that influence ELN count,including individual and tumor factors,intraoperative dissection factors,postoperative sorting factors,and pathological examination factors.Different ELN counts will lead to prognosis-related stage migration.Fine LN sorting and regional LN sorting are the two most important LN sorting technologies.The most direct and effective way to harvest a large number of LNs is for surgeons to perform in vitro fine LN sorting.

那不勒斯预后评分预测FIGO分期Ⅰ~Ⅱ期宫颈癌患者术后复发和转移的临床价值

目的:探讨那不勒斯预后评分(Naples prognostic score,NPS)在国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期Ⅰ~Ⅱ期宫颈癌患者术后复发和转移的预测价值。方法:回顾性收集186例FIGOⅠ~Ⅱ期宫颈癌患者的临床资料,根据NPS分为低危组(0分)、中危组(1~2分)和高危组(3~4分),比较各组间临床特征的差异。根据患者是否复发和转移分为无复发转移组(147例)和复发转移组(39例),比较2组患者的临床特征差异。采用COX回归分析患者复发转移的影响因素,采用Kaplan-Meier法比较不同NPS患者的无病生存期(disease free survival,DFS)。结果:NPS低危、中危和高危组白蛋白、中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR),淋巴细胞-单核细胞比值(lymphocyte-monocyte ratio,LMR)、分化程度和宫旁浸润比例比较,差异均有统计学意义(均P<0.05)。COX回归分析结果显示,NPS是宫颈癌患者复发转移的独立预后因素(HR_(高危vs.低危)=14.304,95%CI:3.214~63.656,P<0.001)。亚组分析结果显示,鳞癌患者NPS高危组的DFS明显低于中危组和低危组(Log-rankχ^(2)=23.267,P<0.001);FIGO分期Ⅰ期和Ⅱ期患者NPS高危组的DFS明显低于中危组和低危组(Log-rankχ^(2)分别为15.760和8.294,P<0.05)。结论:NPS是FIGO分期Ⅰ~Ⅱ期宫颈癌患者术后复发转移的独立影响因素,NPS较高的患者DFS相对较短。

CEA和幽门螺杆菌抗体分型检测与胃癌患者病理特征及预后的关系

目的探讨癌胚抗原(CEA)和幽门螺杆菌(Hp)抗体分型检测与胃癌患者病理特征及预后的关系。方法选择2019年12月—2021年1月收治的胃癌53例设为胃癌组,均已接受手术治疗。另选取同期健康体检人群59例设为健康体检组。比较2组CEA和Hp抗体分型表达情况,分析胃癌组CEA和Hp抗体分型表达与病理特征的关系;统计胃癌患者术后1年的预后情况,采用多因素Logistic回归分析探讨影响胃癌患者预后的危险因素。结果胃癌组CEA和Hp抗体分型阳性率[(83.02%(44/53)和79.25%(42/53)]高于健康体检组[6.78%(4/59)和27.12%(16/59)](P<0.01)。CEA和Hp抗体分型表达在不同疾病分期、分化程度、浸润深度、淋巴结转移胃癌患者中比较差异有统计学意义(P<0.05,P<0.01)。疾病分期、分化程度、浸润深度、淋巴结转移、CEA和Hp抗体分型表达是影响胃癌患者预后的独立危险因素(P<0.05)。结论CEA和Hp抗体分型与胃癌患者的病理特征具有相关性,参与了该病的发生和发展,也是影响患者预后的独立危险因素,可以作为诊断胃癌和评估病情严重程度的指标。

结直肠癌根治术后复发转移患者的预后因素分析

目的探讨影响结直肠癌根治术后复发转移患者生存时间的临床病理因素,为治疗方案的选择提供更多理论依据。方法收集2002年1月1日-2007年12月31日收治的住院与随访资料完整的132例结直肠癌根治术后复发转移患者的临床资料,回顾性分析其临床病理因素与生存时间的关系。结果单因素分析结果显示,单发转移者生存率高于多发转移者,直肠癌复发转移者生存率高于结肠癌复发转移者,再次手术治疗者生存率高于采用非手术治疗者。Cox回归模型多因素分析表明,复发转移后的治疗方式、复发转移部位的数目、原发肿瘤的侵袭深度、淋巴结转移等与患者的生存时间相关,其中复发转移后的治疗方式是最重要的影响因素。结论结直肠癌根治术后复发转移者以直肠癌居多,但其预后优于结肠癌复发转移者;复发转移后再次手术治疗有助于改善预后。

胃癌术后复发转移类型及其对放疗靶区设计的临床意义

目的总结胃癌术后复发转移类型和部位,探讨术后预防性放疗的照射范围。方法回顾性分析139例胃癌根治术后出现复发转移的患者,所有患者出现复发转移均经CT影像学检查作出临床诊断,其中残胃和吻合口复发36例均由病理组织学证实。结果139例中65例为多部位复发转移,其中残胃复发为9.4%(13/139),吻合口复发为16.5%(23/139),肝脏转移为38.8%(54/139),腹腔淋巴结转移为62.6%(87/139),腹壁转移为11.5%(16/139),盆腔种植为7.9%(11/139),肺转移为2.9%(4/139)。腹腔淋巴结转移患者中胃周淋巴结转移为13.8%(12/87),胰周淋巴结转移为31.0%(27/87),腹主动脉旁淋巴结转移为55.2%(48/87),其中原发于胃底贲门癌患者腹腔淋巴结转移仅为4.6%(4/87),原发于胃体部的胃癌患者腹腔淋巴结转移为32.2%(28/87),原发于胃窦部的胃癌患者腹腔淋巴结转移为63.2%(55/87)。结论胃癌患者根治术后局部复发转移的部位主要发生在区域淋巴结,并以胰周和腹主动脉旁淋巴结转移多见,胃体和胃窦部肿瘤患者根治术后较易出现淋巴结转移,因此术后预防性放疗应主要针对胃体和胃窦部的胃癌患者,放射野应包括胰周和腹主动脉旁淋巴结范围。

^(18)F-FDG PET/CT显像对胃癌治疗后临床再分期及治疗决策的影响

目的探讨18氟标记的氟脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像/电子计算机断层扫描(PET/CT)显像在胃癌治疗后随访中的价值,分析其对胃癌治疗后临床再分期及治疗决策的影响。方法选取我院收治的胃癌治疗后患者55例,分别于静脉注射18F-FDG后60 min及120 min行PET/CT早期及延迟显像。延迟显像于患者饮水使胃适度充盈后进行。必要时行增强CT检查。分别从肿瘤复发、淋巴结转移及淋巴结外转移3个方面评价18F-FDG PET/CT显像在胃癌治疗后随访中的价值,分析18F-FDG PET/CT显像对临床再分期及治疗决策的影响。分别测量胃癌复发与吻合口炎症早期及延迟显像最大标准化摄取值(SUVmax)及SUVmax变化率(△SUVmax%),评价饮水胃充盈后18F-FDG PET/CT延迟显像的价值。所有患者的诊断以病理组织学检查结果为金标准。采用SAS 9.13统计学软件进行统计分析。结果 (1)18F-FDG PET/CT诊断胃癌复发的准确性96.4%(53/55)高于CT(85.5%),诊断淋巴结转移的灵敏度(92.0%)、准确性(96.4%)、阴性预测值(93.8%)均高于CT(60.0%、81.8%、75.0%),诊断淋巴结外转移的灵敏度(81.8%)、准确性(90.9%)均高于CT(45.5%、76.4%),差异均有统计学意义(P<0.05)。(2)18F-FDG PET/CT显像使34.5%(19/55)的患者TNM分期发生改变,21.8%(12/55)的患者治疗方案改变。(3)胃癌复发患者及吻合口炎症患者△SUVmax%分别为(22.8±9.8)%、(8.6±13.3)%,差异有统计学意义(P<0.05)。结论18F-FDG PET/CT显像可早期探测胃癌复发、转移,将成为胃癌治疗后有效的监测手段;且18F-FDG PET/CT显像对临床再分期及合理治疗决策的制定具有重要指导作用;饮水胃充盈后18F-FDG PET/CT延迟显像有助于肿瘤复发与吻合口炎症的鉴别。

结肠癌临床病理因素与复发转移的相关性研究

目的：探讨结肠癌根治术后复发转移的相关因素。方法：应用单因素和多因素分析方法，回顾性分析1990年1月～1999年12月282例结肠癌根治术病例的临床病理因素。结果：复发转移率16．3％（46／282），复发转移在术后2年内出现者占71．7％（33／46），3年内出现者占89．1％（41／46）。最常见的远处转移位置是肝（56．8％，21／37）。单因素分析显示，结肠癌患者的Dukes，分期、淋巴结转移、肠壁浸润深度、大体类型与复发转移有关。多因素分析显示，结肠癌的淋巴结转移、肠壁浸润深度是复发转移独立预后因素。结论：结肠癌根治术后最常见的远处转移位置是肝，淋巴结转移、浸润深度是影响结肠癌术后复发转移独立预后因素。

健脾益肾方对小鼠移植性前胃癌术后复发转移及生存期的影响

目的:观察健脾益肾方对615小鼠移植性前胃癌术后肿瘤局部复发和肺转移的治疗作用及对生存期的影响。方法:以615小鼠前胃癌术后肺转移模型为对象,应用健脾益肾方治疗,并与5-FU化疗组和模型组进行对比,观察术后肺转移和局部复发及生存期。结果:模型组肺转移率为94.4%,复发率为94.44%,健脾益肾方治疗组肺转移率为68.4%,转移抑制率为27.5%,复发率为78.95%,复发瘤抑制率为65.35%;健脾益肾方治疗组荷瘤小鼠术后平均生存期及中位生存期明显延长,生命延长率为100%。结论:健脾益肾方对小鼠移植性前胃癌术后局部肿瘤复发及远处肺转移有一定的抑制作用,并延长生存期。

早期胃癌术后复发的临床分析

目的分析早期胃癌术后复发情况，为制定防治策略提供依据。方法收集解放军总医院1983-2005年间发现的早期胃癌308例，其中245例术后进行了随访，对可能影响早期胃癌术后复发的临床病理特征进行单因素及多因素分析。结果30例出现胃癌复发（中位时间28个月），1、3、5、7、10、15年复发率分别为5．49％、8．44％、11．27％、14．83％、16．39％、37．79％。黏膜内癌复发13例（中位时间24个月），1、3、5、7、10、15年复发率分别为4．23％、6．68％、7．75％、9．34％、9．34％、28．24％。黏膜下癌复发17例（中位时间31个月），1、3、5、7、10、15年复发率分别为7．39％、11．14％、16．54％、24．49％、29．69％、64．85％。Cox回归分析提示浸润黏膜下层（P-O．044，OR-2．172）增加术后肿瘤复发危险，癌周黏膜明显肠化（p-0．047，0R-0．460）者术后肿瘤复发较少。30例复发者中23例（76．7％）无根治手术指征，未再次手术治疗；7例（23．3％）有再次根治手术指征，其中4例再次手术治疗，术后病理提示3例为残胃早期胃癌，无淋巴结转移，1例为残胃进展期胃癌，伴区域淋巴结转移（已无瘤存活28个月），另3例因身体原因未再手术治疗。Logistic回归分析提示癌周黏膜明显肠化（P-0．016，OR=17．000）为有再次根治手术指征的独立影响因子。86．7％（26／30）的复发患者至少每1～2年进行一次包括胃镜检查方式在内的复查。结论早期胃癌累及黏膜下层者术后更易出现复发；癌周明显肠化者术后复发较少，即使出现复发，也有再次进行根治手术的可能；每1～2年进行一次复查有助于早期发现残胃再发癌，但对提高复发转移者再次根治手术机会帮助不大。

胃癌根治术后早期复发的临床病理特点及预后分析

目的:探讨胃癌根治术后早期复发的相关因素及预后分析。方法:回顾性分析235例胃癌根治术后复发患者的临床病理资料,对相关参数进行单因素和多因素分析。Kaplan-Meier法进行预后的生存分析。结果:235例患者平均复发时间为术后24.3个月,其中早期复发145例(≤2年),晚期复发90例(>2年)。单因素分析显示手术方式、肿瘤大小、脉管侵犯、浸润深度、淋巴结转移、TNM分期、术后化疗与早期复发相关(P<0.05)。多因素分析显示肿瘤大小(P=0.001)、淋巴结转移(P=0.007)、术后化疗(P=0.011)是早期复发的独立影响因素。生存分析显示肿瘤大小(P=0.013)、TNM分期(P<0.01)是预后的独立影响因素。结论:肿瘤大小、淋巴结转移、术后化疗是胃癌早期复发的独立影响因素,且预后与肿瘤大小、TNM分期密切相关。

血清CA15-3和CEA对转移性乳腺癌化疗疗效的预测作用

目的分析转移性乳腺癌患者在接受化疗时及化疗后随访期间血清CA15-3和CEA的变化情况,探讨二者对化疗疗效的预测作用。方法治疗期间每2个周期以及随访期间每3月检测血清CA15-3和CEA,并通过影像学检查判断化疗疗效,分析血清标志物变化与化疗疗效的关系。结果疗效部分缓解(PR)的患者CA15-3及CEA在化疗期间明显降低(P<0.05);疾病稳定(SD)<1年组CA15-3和CEA出现明显升高,而SD≥1年组CA15-3在治疗第4周期时出现降低(P<0.05)。疾病进展(PD)患者血清CA15-3及CEA在治疗期间出现明显升高(P<0.05)。再次PD组患者CA15-3在进展前3月与进展时均有明显升高(P<0.05);CEA则在进展时出现有意义的升高。分析CA15-3升高组、CEA升高组、CA15-3及CEA同时升高组无进展生存情况,发现CA15-3和CEA同时升高组无进展生存率最低,肿瘤复发进展最快。结论CA15-3与CEA明显升高多可提示转移性乳腺癌化疗期间或随访期间的疾病进展,若出现明显降低则可能预示化疗疗效较好,二者同时检测,其结果较单一标志物准确度高。

经皮超声引导下射频消融治疗胃癌肝转移疗效分析

目的探讨经皮超声引导下射频消融(RFA)治疗胃癌肝转移的疗效及预后因素。方法回顾性分析55例接受经皮超声引导下RFA治疗的胃癌肝转移患者临床及影像学资料,观察评价患者总体生存率及预后影响因素。结果55例(102个病灶)胃癌肝转移患者1、2、3、5年总体生存率分别为70.45%、42.90%、20.32%及10.16%。RFA治疗后1个月,肿瘤灭活率94.12%(96/102),肿瘤局部复发率15.69%(16/102),肝内新生转移灶发生率52.73%(29/55)。单因素分析示年龄(P=0.015)、肿瘤数目(P=0.011)、RFA前是否有肝外转移(P=0.026)、RFA后是否化疗(P=0.031)是影响患者生存的重要因素。多因素分析示年龄(P=0.033)、肿瘤数目(P=0.004)、RFA后是否化疗(P=0.001)是独立预后因素。RFA治疗后严重并发症的发生率为1.82%(1/55),未发生治疗相关性死亡。结论经皮超声引导下RFA是一种安全、有效的胃癌肝转移治疗方式,年龄、肿瘤数量、RFA后联合化疗是影响患者预后的独立因素。