Risk factors,prognostic predictors,and nomograms for pancreatic cancer patients with initially diagnosed synchronous liver metastasis

BACKGROUND Liver metastasis(LM)remains a major cause of cancer-related death in patients with pancreatic cancer(PC)and is associated with a poor prognosis.Therefore,identifying the risk and prognostic factors in PC patients with LM(PCLM)is essential as it may aid in providing timely medical interventions to improve the prognosis of these patients.However,there are limited data on risk and prognostic factors in PCLM patients.AIM To investigate the risk and prognostic factors of PCLM and develop corresponding diagnostic and prognostic nomograms.METHODS Patients with primary PC diagnosed between 2010 and 2015 were reviewed from the Surveillance,Epidemiology,and Results Database.Risk factors were identified using multivariate logistic regression analysis to develop the diagnostic mode.The least absolute shrinkage and selection operator Cox regression model was used to determine the prognostic factors needed to develop the prognostic model.The performance of the two nomogram models was evaluated using receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA),and risk subgroup classification.The Kaplan-Meier method with a logrank test was used for survival analysis.RESULTS We enrolled 33459 patients with PC in this study.Of them,11458(34.2%)patients had LM at initial diagnosis.Age at diagnosis,primary site,lymph node metastasis,pathological type,tumor size,and pathological grade were identified as independent risk factors for LM in patients with PC.Age>70 years,adenocarcinoma,poor or anaplastic differentiation,lung metastases,no surgery,and no chemotherapy were the independently associated risk factors for poor prognosis in patients with PCLM.The C-index of diagnostic and prognostic nomograms were 0.731 and 0.753,respectively.The two nomograms could accurately predict the occurrence and prognosis of patients with PCLM based on the observed analysis results of ROC curves,calibration plots,and DCA curves.The prognostic nomogram could stratify patients into prognostic groups and perform well in internal validation.CONCLUSION Our study identified the risk and prognostic factors in patients with PCLM and developed corresponding diagnostic and prognostic nomograms to help clinicians in subsequent clinical evaluation and intervention.External validation is required to confirm these results.

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.

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.

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.

Relations of proliferative activities of gastric carcinoma cells to lymphatic involvement, venous invasion and prognosis

Background This study was to evaluate bivariate bromodeoxyuridine(BrdUrd)/DNA flow cytometric analysis in detection of gastric carcinoma and to study the relations of cellular BrdUrd labeling indices (LI), G_2/M-phase fraction(G_2/MPF) and DNA ploidy pattern to lymphatic involvement, venous invasion and prognosis.Methods Fresh tumor samples from 60 patients with gastric carcinoma were analyzed by bivariate BrdUrd/DNA flow cytometry. The results were correlated with lymphatic vessel invasion, lymphatic node metastasis, the number of matastatic lymphatic nodes, and venous invasion. Propidium iodide (PI) was used as a fluorescent probe for total cellular DNA, and a monoclonal antibody against BrdUrd was used as a probe for BrdUrd incorporated into DNA. Fluorescent-labeled goat anti-mouse antibody was used as a second antibody. S-phase fractions were measured by in vitro BrdUrd labeling, and DNA ploidy and G_2/MPF were also measured. Comparison of survival was performed with the log-rank test, the Chi-square test for qualitative data, and Student’s t test for quantu data. Results BrdUrd LI and G_2/MPF values were significantly higher in tumors with lymphatic vessel invasion than in those without invasion respectively (P<0.01); the patients who had tumors with lymphatic vessel invasion showed a significantly poor prognosis (P<0.01). Both BrdUrd LI and G_2/MPF values were significantly higher in tumors with lymphatic node metastasis than in those without metastasis (P<0.01). A statistical significant difference was noted in the 5-year survival rates between the patients with lymph node metastasis and those without metastasis. Compared with diploid carcinoma, the incidence of lymph node metastasis was significantly higher in aneuploid carcinoma (P<0.05), and the patients with aneuploid carcinoma showed a significantly poor prognosis (P<0.05). BrdUrd LI was significantly higher in patients with more than 5 metastatic lymph nodes than those with 1-4 metastatic lymph nodes (P<0.05) and those without metastasis (P<0.01). G_2/MPF values in those patients either with more than 5 metastatic lymph nodes or 1-4 metastatic lymph nodes were higher than those without metastasis (P<0.01 and P<0.05). A statistical significance was seen in the 5-year survival rates among the patients with no metastatic lymph node, 1-4 metastatic nodes and more than 5 metastatic nodes (P<0.01). G_2/MPF values were significantly higher in patients with venous invasion than in those without invasion (P<0.01).Conclusions Positive correlations exist between cellular BrdUrd LI, G_2/MPF with lymphatic involvement and prognosis, and DNA aneuploid with lymphatic involvement and prognosis. The same was true between G_2/MPF value and venous invasion in gastric carcinoma.

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.

Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy

Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.

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.

Effects of Linomide on growth and metastasis of implanted human gastric cancer in nude mice

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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.

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。

PNI与NLR对结直肠癌同时性肝转移患者预后的预测价值

目的探讨预后营养指数(prognostic nutrition index,PNI)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对结直肠癌同时性肝转移(colorectal cancer synchronous liver metastasis,CRSLM)患者预后的预测价值。方法回顾性分析2012年1月~2020年9月在徐州医科大学附属医院经病理确诊的102例CRSLM患者的临床资料,根据受试者操作特征(ROC)曲线确定PNI、NLR的最佳临界值,将患者分别分为高、低水平组。通过Kaplan-Meier法绘制生存曲线,比较不同组间的无进展生存期(progression free survival,PFS)和总生存时间(overall survival,OS),通过COX比例风险回归模型分析影响患者预后的因素。结果PNI、NLR最佳临界值为50.45、3.80,高PNI组比低PNI组PFS和OS更长(12个月vs 7个月,P<0.01;26个月vs 14个月,P<0.01),低NLR组比高NLR组PFS和OS更长(9个月vs 8个月,P=0.025;22个月vs 15个月,P=0.014)。多因素分析结果显示,低PNI、未行根治手术、高临床危险评分(clinical risk score,CRS)是PFS独立预后不良因素,低PNI、未行根治手术、年龄>60岁、高CRS是OS的独立预后不良因素。结论PNI可作为CRSLM患者有效的预后指标,PNI降低提示预后不良。

手术治疗胃癌肝转移的预后分析

目的:探讨手术治疗胃癌肝转移的预后因素。方法:对25例患者临床病理特征及生存应用多元分析其与预后的关系。结果:20例行同时性肝切除,5例行异时性肝切除,1、3、5年生存率分别为84.0%,28.0%,21.0%。肝转移灶数目(孤立和多灶),转移灶分布(单叶和多叶),肝切除方式,原发灶组织学类型,淋巴结转移及脉管瘤栓与预后相关,多元分析显示多灶肝转移,原发灶淋巴结转移、脉管瘤栓是其预后独立危险因素。结论:对出现孤立转移灶、原发灶无淋巴结转移且无脉管瘤栓的胃癌肝转移患者应手术切除以获得更好的预后。

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。

基质金属蛋白酶-9,CD34的表达与肝癌侵袭转移的关系

目的探讨基质蛋白酶-9(MMP-9)CD34在肝细胞癌的表达与侵袭转移过程中的表达关系。方法应用免疫组织化学SABC法,分析38例手术切除的肝癌标本MMP-9,CD34的变化,应用图象分析法进行定量分析MMP-9,应用血管记数分析CD34,并与临床病理相对照。结果 MMP-9的表达在有门脉癌栓或肝内转移者显著高于无门脉癌栓或肝内转移者。有门脉癌栓或肝内转移者11例,MMP-9在癌组织的表达量为8.07±0.48;无门脉癌栓或肝内转移者其表达量为5.04±0.22,P<0.05。在有侵袭转移情况下MMP-9在癌组织的表达量(8.07±0.48)显著高于癌旁组织(4.97±0.23),P<0.05 MMP-9在癌边缘组织的表达(8.56±0.60)显著高于癌旁组织(4.97±0.23),P<0.05,CD34的表达在有门脉癌栓或肝内转移者(96.65±17.65)显著高于无门脉癌栓或肝内转移者(74.25±15.25),P<0.05,在有侵袭转移情况下CD34在癌组织的表达量(96.65±17.65)显著高于癌旁组织(10.25±6.54),P<0.05。在无侵袭转移情况下CD34的表达在癌组织(74.25±15.25)、癌边缘组织(73.50±13.60)、癌旁组织(69.20±13.60)中无差异(P>0.05)。MMP-9CD34进行相关分析r=0.74,P<0.01为正相关。结论肝细胞癌在有侵袭转移情况下MMP-9在癌组织与癌边缘组织的表达明显增高。它与肿瘤的侵袭转移有关,它不仅破坏ECM而且调节血管生长使肿瘤容易扩散。而CD34在有侵袭转移情况下能反映肿瘤血管生长活跃,与肿瘤的侵袭转移有关。MMP-9的作用是促进肝细胞癌的侵袭转移,CD34可以反映肿瘤的血管情况。两者有正相关,MMP-9,CD34可作为判断肝细胞癌转移、预后的指标。

胃癌组织中H-ras和VEGF的表达与血管生成的关系及其临床意义

目的:探讨胃癌组织H-ras表达与血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)表达和血管生成的关系。方法:应用免疫组织化学ABC法对60例胃癌组织进行H-ras、VEGF表达和微血管密度(micro-vasculardensity,MVD)检测。结果:MVD与胃癌病灶的大小、浸润深度、淋巴结转移和TNM分期密切相关,t值分别为-2·18、-3·46、-4·52和-3·85,P值分别为0·040、0·001、0·001和0·004;VEGF亦与胃癌病灶的大小、浸润深度、淋巴结转移和TNM分期密切相关,χ2值分别为12·80、11·49、10·43和11·52,P值分别为0·002、0·001、0·005和0·003。H-ras的表达与胃癌分化和Lauren分型相关,χ2值分别为11·85和8·87,P值分别为0·001和0·003;并与VEGF的表达相关,χ2=10·79,P=0·001。生存分析显示,MVD和VEGF的表达均影响胃癌的预后,但仅MVD是影响预后的独立因素;H-ras的表达对胃癌的预后影响较小。结论:激活的H-ras可上调VEGF的表达,参与胃癌血管生成的调节,并影响胃癌组织的分化。

胃癌肝转移肝切除的预后分析

目的 分析胃癌肝转移后实施肝切除患者的预后因素。方法 对1996-2003年间实施肝切除的45例胃癌肝转移患者的临床资料进行回顾性研究，分析临床病理学指标与患者生存期之间的关系。结果 45例接受肝切除的患者有2例死于术后严重并发症。获得随访的39例患者的1，3，5年的总体生存率分别为54％，32％和21％。中位生存时间为29．5月，6例患者存活时间超过5年。胃周淋巴结转移、侵袭深度、辅助化疗、肝脏转移灶数目以及胃癌患者的组织学分级均与患者生存期之间存在不同程度的相关。但年龄、性别、肝脏转移灶的最大直径以及是否进行肝脏介入治疗与患者的生存期之间未见相关性。结论 无腹腔淋巴结广泛转移的胃癌肝转移后实施肝切除术可以延长患者的生存期。

中性粒细胞相关载脂蛋白表达与胃癌进展、转移及预后的关系

目的:探讨中性粒细胞相关载脂蛋白(NGAL)在胃癌组织中的表达及与胃癌进展、转移及预后的关系。方法:应用免疫组化法检测NGAL在102例胃癌、32例正常胃组织中的表达,分析其与胃癌临床病理特征及预后的关系。结果:NGAL在胃癌组织中的阳性表达率为56.9%,明显高于在正常胃组织中的21.9%(χ2=11.938,P<0.01),不同胃癌组织学分型患者NGAL阳性表达差异有统计学意义(χ2=10.180,P<0.05),胃癌患者NGAL表达与浆膜侵犯、TNM分期、淋巴结转移以及T分期呈正相关(rs分别为0.307、0.211、0.220、0.201,P<0.05或P<0.01)。NGAL表达阳性组和阴性组5年累积生存率分别为24.3%和43.7%,差异有统计学意义(P=0.018)。结论:NGAL在胃癌中表达上调,与胃癌进展和淋巴结转移显著相关,提示预后不良,可作为评价胃癌预后新的生物学指标。