482 例非小细胞肺癌远处转移临床特征的回顾性分析

目的：探讨不同病理类型IV 期非小细胞肺癌(NSCLC)患者远处转移的临床特征。方法：回顾性分析我科收治的482 例诊断 明确IV 期NSCLC 患者的临床资料，比较不同病理类型患者各器官远处转移发生率，并进行统计学分析。结果：482 例IV 期 NSCLC 患者中，鳞状细胞癌188 例(39.0%)，腺癌275 例(57.1%)，大细胞癌5 例(1.0%)，腺鳞癌14 例(2.9%)。平均年龄55.2 岁，男 女比例为2.30：1，高发年龄为40～60 岁。各器官远处转移的发生率从高到低依次为：骨217 例(45.0%)，胸膜170 例(35.3%)，双肺 138例(28.6%)，脑113 例(23.4%)，肝85 例(17.6%)，肾上腺33 例(6.8%)，心包36 例(7.5%)。单器官转移221 例(45.9%)，多器官转移 261例(54.1%)。T4 期患者所占比例高达44.8%，N2+3 组患者所占比例明显高于N0+1 组患者，差异有统计学意义。单纯骨、脑、肝、 肾上腺转移发生率分别为28.1%、23.9%、12.9%和15.2%。结论：NSCLC 以骨和胸膜转移最为常见，原发肿瘤情况、淋巴结转移情 况与远处转移存在一定关系，多数M1b 期患者初诊时已发生全身多部位远处转移。     

女性甲状腺癌的病理与预后分析

目的:探讨女性甲状腺癌的病理特点以及预后影响因素。方法:收集2005年1月至2009年8月,齐齐哈尔和平医院收治的女性甲状腺癌患者148例,回顾分析其临床病理特点以及预后影响因素。结果:病理检查显示131例(88.5%)甲状腺乳头状癌(PTC),6例(4.1%)为滤泡状癌(FTC),3例(2.0%)为髓样癌(MTC),6例(4.1%)为未分化癌(ATC);病理分期Ⅰ-Ⅱ期占45.3%,Ⅲ-Ⅳ期占54.7%;27例(18.24%)为周围组织侵犯,9例(6.1%)为远处转移,10例(6.76%)对侧甲状腺转移,56例(37.84%)颈部淋巴结转移;1年、3年、5年生存率依次为97.3%、93.2%、83.8%;年龄、病理床分期、病理类型、淋巴结转移、远处转移以及周围组织侵犯均是影响临床预后的重要因素(P0.05)。结论:女性甲状腺癌存在病理分期晚、病理分型差、淋巴结转移、远处转移及局部侵犯率高等不良预后因素,早期影像学检查对临床治疗具有指导意义。     

老年宫颈癌50例临床及预后分析

目的:探讨老年宫颈癌的临床病理特征及预后影响因素。方法:对50例老年宫颈癌患者的临床特点及生存情况进行回顾性分析。结果:鳞状细胞癌45例(90.0%),腺癌4例(8.0%),透明细胞癌1例(2.0%);≤Ⅱa期占16.0%,≥Ⅱb期占84.0%;主要临床症状为绝经后不规则阴道流血,全组1、3、5年生存率分别为82.0%,66.0%,54.0%。多因素分析结果显示病理类型、临床分期及淋巴结转移情况是老年宫颈癌患者预后的独立影响因素(均P<0.05)。结论:KPS评分≥70分、鳞癌、临床分期为Ⅰ期、Ⅱ期,无淋巴结转移的患者预后较好,病理类型、临床分期及淋巴结转移情况是老年宫颈癌患者预后的独立影响因素。     

老年宫颈癌的临床病理特征分析及预后影响因素探讨

为探讨老年宫颈癌的临床病理特征及预后影响因素,以为宫颈癌的防治提供依据,本研究回顾性分析我院收治的107例老年宫颈癌患者的临床资料,并比较其临床病理特征和生存情况。经分析比较发现,107例患者中鳞状细胞癌92例(85.98%),腺癌11例(10.28%),透明细胞癌4例(3.74%);临床分期:≤Ⅱa期28例(16.47%),≥Ⅱb期79例(73.83%);患者1、3、5年生存率分别为81.31%、64.37%、51.79%。病理类型、临床分期和淋巴结转移是老年宫颈癌患者预后影响因素(p0.05),其中KPS评分70分的非鳞癌患者Ⅲ期或Ⅳ期及淋巴结转移患者预后较差。     

多层螺旋CT动态增强扫描对不同类型小肾癌的诊断价值研究

目的:探讨多层螺旋CT动态增强扫描对不同类型小肾癌的诊断价值。方法:回顾性分析2013年4月至2016年4月间我院收治的经病理证实的小肾癌患者62例的CT平扫及三期动态增强扫描征象进行分析与比较。结果:肾透明细胞癌患者、肾乳头状细胞癌患者及肾嫌色细胞癌患者一般资料无统计学差异(P0.05)。62例患者共检出低密度14例,等密度38例以及高密度10例。透明细胞癌以等密度居多(60.00%),乳头状细胞癌以等密度居多(70.43%),嫌色细胞癌以低密度居多(66.67%)。不同类型小肾癌患者CT平扫结果之间差异显著(P0.05)。透明细胞癌以明显强化居多(77.14%),乳头状细胞癌以轻度强化居多(90.48%),嫌色细胞癌以中等强化居多(66.67%),不同类型间强化程度比较有统计学差异(P0.05)。不同类型间强化模式以均匀强化及典型强化居多,三组差异不显著(P0.05)。透明细胞癌三期CT值均显著高于乳头状细胞癌及嫌色细胞癌,差异有统计学意义(P0.05),而乳头状细胞癌及嫌色细胞癌各期差异不显著(P0.05)。三种类型小肾癌实质期CT值均显著高于其他两期,三期比较差异显著(P0.05)。结论:多层螺旋CT动态增强扫描对于不同类型小肾癌的鉴别诊断具有积极的意义。     

Bmi-1 在非小细胞肺癌中的表达及相关性探讨

目的:探讨Bmi-1在非小细胞肺癌(NSCLC)组织中的表达及其与临床病理特征的关系。方法:采用RT-PCR检测30例非小细胞肺癌及20例癌旁组织中Bmi-1mRNA的表达情况,同时应用免疫组织化学SP法检测52例非小细胞肺癌及30例癌旁组织中Bmi-1蛋白表达情况。结果:非小细胞肺癌组织中Bmi-1mRNA表达量明显高于癌旁组织(t=5.188,P<0.01)。肺癌组中Bmi-1蛋白的阳性表达率为67.3%(35/52),明显高于癌旁组13.3%(4/30),且表达量差别有高度统计学意义(Z=-4.837,P<0.01);肺癌组中Bmi-1蛋白阳性表达与癌组织的TNM分期及有无淋巴结转移有关(Z=-2.567,-2.366,P<0.05),而与患者的性别、年龄、组织类型、分化程度等无关(P均>0.05);结论:Bmi-1在非小细胞肺癌中的高表达与肿瘤发生发展及转移相关,可成为早期诊断肺癌及判断转移的重要参考指标。     

TEM1mRNA 在非小细胞肺癌中的表达及临床意义*

目的:揭示TEM1其与非小细胞肺癌侵袭和转移的可能关系,为靶向治疗提供理想的药物作用靶点。方法:实时荧光定量PCR方法检测56例非小细胞肺癌肿瘤组织及癌旁组织中TEM1 mRNA表达水平,分析其在不同组中的表达差异。结果:TEM1在56例非小细胞肺癌组织中都有表达。TEM1表达水平在肿瘤组织中比癌旁组织表达高,并且其表达水平与淋巴结转移及肿瘤分期密切相关(P<0.05),但与患者的病理类型,年龄及性别无关(P>0.05)。结论:TEM1表达水平与非小细胞肺癌分期密切相关,表明其可能是一个参与非小细胞肺癌侵袭及转移有价值的分子标记物。TEM1可能成为潜在的基因治疗靶点。     

TK1在肺癌患者血清中的表达水平及其与肿瘤临床病理特征及预后的关系

目的:探讨肺癌患者血清胸腺嘧啶核苷激酶1(TK1)与肿瘤临床病理特征及预后的关系。方法:选择2012年1月-2014年1月在我院接受治疗的肺癌患者79例作为研究对象,另选择同期在我院接受健康体检的志愿者53例作为对照组。采用化学发光法检测两组研究对象血清中TK1的表达情况,并分析TK1表达与肿瘤临床病理特征及预后的关系。结果:TK1在肺癌患者血清中的阳性表达率(56.96%)显著高于健康对照组(16.98%),差异具有统计学意义(P0.05)。肿瘤分期为晚期的患者血清中TK1的阳性表达率高于肿瘤分期为早期的肺癌患者,差异具有统计学意义(P0.05);肿瘤远处转移的患者血清中TK1的阳性表达率高于未发生远处转移的患者,差异具有统计学意义(P0.05)。TK1在性别、抽烟史、淋巴结转移及病理类型不同患者血清中的阳性表达率比较,差异无统计学意义(P0.05)。TK1阳性患者两年生存率(42.22%)低于TK1阴性患者(64.71%),差异具有统计学意义(P0.05)。结论:肺癌患者血清中TK1呈高表达,其表达水平与肿瘤远处转移、TMN分期及预后有关。     

VM在NSCLC中的发生机制及其与化疗疗效关系的探讨

目的:研究血管生成拟态在非小细胞肺癌患者中的发生机制及其与化疗敏感性的关系。方法:收集42例NSCLC患者,分为早期组(I+II期,共19名)和晚期组(III+IV期,共23名)。20名接受手术治疗,22名仅行铂二联化疗,并且化疗组按2周期化疗疗效分有效组(疗效评价CR+PR,7名)和无效组(疗效评价SD+PD,15名)。对比分析VM与分期、化疗疗效、HIF-1α及各种临床病理特征是否有关。结果:早期组NSCLC患者VM阳性率明显高于晚期组(68.4%VS 26.1%,p=0.006),VM阳性组HIF-1α阳性率明显高于VM阴性组(P=0.034)。化疗有效组与无效组之间VM未见明显差异(P0.05)。淋巴结转移及无远处转移组分别较无淋巴结转移及远处转移组VM阳性率高(P0.05)。VM与患者性别、年龄、病理类型、肿瘤大小及分化程度无关(P0.05)。结论:VM作为一种新发现的肿瘤供血方式,其形成主要在NSCLC早期,并且VM的存在与淋巴结转移有关,随着疾病进展,VM逐渐减少。目前尚未发现VM与NSCLC化疗敏感性有关,但HIF-1α在VM形成中起重要作用,VM有可能成为一个新的靶向治疗的靶点,为临床分期及诊疗提供帮助。     

非小细胞肺癌组织MAGE-A3、HIF-1α、MTA1表达与临床病理参数及复发转移的关系研究

目的:探讨非小细胞肺癌组织黑色素瘤相关抗原-A3(MAGE-A3)、缺氧诱导因子-1α(HIF-1α)、转移相关蛋白1(MTA1)表达与临床病理参数及复发转移的关系。方法:选择2015年2月至2018年1月我院诊治的130例非小细胞肺癌患者进行临床研究,采用免疫组织化学染色法检测其非小细胞癌组织及癌旁组织中MAGE-A3、HIF-1α、MTA1的表达,分析MAGE-A3、HIF-1α、MTA1的表达与各项临床病理参数的关系。对比不同MAGE-A3、HIF-1α、MTA1表达情况患者的转移率及复发率。结果:130例非小细胞肺癌组织中MAGE-A3、HIF-1α、MTA1阳性率分别为70.77%、74.62%、79.23%,明显高于癌旁组织的25.38%、22.31%、17.69%(P<0.05)。非小细胞肺癌组织中MAGE-A3、HIF-1α、MTA1表达与淋巴结转移和TNM分期相关(P<0.05)。MAGE-A3、HIF-1α、MTA1阳性患者转移/复发率明显高于MAGE-A3、HIF-1α、MTA1阴性患者(P<0.05)。结论:MAGE-A3、HIF-1α、MTA1在非小细胞肺癌中阳性表达率升高,并且均与非小细胞肺癌淋巴结转移、TNM分期和转移复发相关,在非小细胞肺癌的诊断和预后评估中具有一定临床意义。     

肺癌脑转移预后的多因素分析

目的:探索肺癌患者脑转移的预后影响因素。方法:回顾性分析我院2001~2010年216例肺癌患者的临床资料。运用SPSS软件包,通过比例风险模型(Cox模型)进行单因素和多因素分析,采用Kaplan-Merer法进行生存分析并描绘生存曲线和进行Log-rank时序检验。结果:通过单因素分析显示PS评分(p=0.006)、脑转移病灶数目(P=0.038)、有无脑转移的症状(P=0.001)、有无颅外器官转移(P=0.037)和治疗方法(P=0.045)等对生存期有影响,而年龄(P=0.887)、性别(P=0.207)、病理类型(P=0.727)、肺癌的部位(P=0.104)、脑转移病灶部位(P=0.401)对生存期无影响。多因素分析显示影响肺癌脑转移预后的主要因素依次为PS评分、有无脑转移的症状和治疗方法,而有无颅外器官转移和脑转移灶的数目等因素被削弱。结论:PS评分、有无颅外器官转移和脑转移病症灶的多少是脑转移肺癌患者的独立预后因素。     

Comparison of Predictive Immunohistochemical Marker Expression of Primary Breast Cancer and Paired Distant Metastasis using Surgical Material: A Practice-Based Study

Parallel studies of primary breast carcinomas and corresponding distant metastases samples reveal considerable differences. Our aim was to highlight this issue from another perspective and provide further data based on 98 patient samples: 69 primary breast carcinoma and 85 distant metastases from bone, central nervous system (CNS) and lung (56 paired). Two independent series of immunohistochemical reactions with different antibodies for estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (Her2), along with HER2 fluroscence in situ hybridization (FISH) were performed on tissue microarrays to classify breast carcinoma and distant metastases samples into Luminal A, Luminal B-proliferating, Luminal B-HER2+, HER2+ and triple negative (TNBC) surrogate breast cancer groups. Correlation and agreement between the two assessments of ER and PgR were fair-to-moderate, and almost perfect for HER2 and Ki67. There was 40% discordance concerning immunophenotype between breast carcinomas and distant metastases. Most common metastatic site of ER+ breast carcinoma was the skeletal system (59.2%), whereas that of TNBCs was the CNS (58.8%) and lungs (23.5%). Distant metastases in bones were mostly luminal (54.3%), in the CNS, Luminal B (53.2%), and in the lung, TNBC (37.5%). The change of drugable properties of primary breast cancers in the respective bone and CNS metastases suggests that characterization of the metastasis is necessary for appropriate treatment planning.     

Clinical characteristics that distinguish eosinophilic organ infiltration from metastatic nodule development in cancer patients with eosinophilia

ABSTRACT: BACKGROUND: When new space-occupying lesions are observed together with peripheral blood eosinophilia in patients diagnosed with cancer, the possibility of eosinophilic organ involvement should be differentiated from metastasis of primary cancer, since a misdiagnosis could lead to unnecessary chemotherapy. The aim of this study is to identify the clinical characteristics of eosinophilic organ involvement that distinguish it from distant metastasis in patients with primary cancer. METHODS: The medical records of 43 cancer patients who developed hepatic or pulmonary nodules with peripheral blood eosinophilia between January 2005 and February 2010 in the Asan Medical Center (Seoul) were reviewed. Eosinophilic infiltration and distant metastasis were identified on the basis of pathological findings and radiological features. Fisher's exact test, chi2 test or Mann-Whitney test were used for statistical analysis. RESULTS: In total, 33 patients (76 %) were diagnosed with eosinophilic infiltration, 5 (12 %) with cancer metastasis and 5 (12 %) had undetermined diagnoses. Compared to the patients with metastases, the patients with eosinophilic infiltration were significantly more likely to have serology indicating a parasitic infection, a history of eating raw food, high serum levels of total IgE, normal liver function, normal C-reactive protein levels, a normal erythrocyte sedimentation rate, and fewer and smaller nodules. The most common underlying malignancy in the eosinophilic organ infiltration group was stomach cancer. Physicians tended to neglect the eosinophilia in patients with a history of cancer. CONCLUSIONS: Several clinical characteristics of eosinophilic organ infiltration distinguish it from cancer metastasis. Physicians should make greater efforts to determine the causes of organ involvement with peripheral blood eosinophilia, especially in cancer patients.     

鼻息肉与鼻咽癌标本VEGF水平及微血管密度对比及其临床意义

目的:对比研究鼻咽癌和鼻息肉标本中VEGF表达强度及MVD差异,同时分析VEGF、MVD和鼻咽癌临床特征的相关性。方法:纳入我科就诊的鼻咽癌患者57例,鼻息肉患者50例。采用免疫组化SABC法检测癌组织、癌旁组织、及息肉组织中中VEGF蛋白的表达,及MVD强度。分析VEGF、MVD和鼻咽癌患者性别、临床分期、颈部淋巴结转移、远处转移、血清EBV-Ig A阳性、WHO病理分型相关性。统计分析随访结果,对可能影响鼻咽癌预后的因素进行Cox回归模型分析。结果:鼻咽癌组织、鼻咽癌旁组织、鼻息肉组织中VEGF表达、MVD强度具有明显差异(p0.05)。不同鼻咽癌临床分期、是否发生远处转移、不同WHO病理分型和VEGF表达、MVD强度具有明显差异(p0.05)。Cox回归方程显示,远处转移、病理分型、VEGF表达强度是影响鼻咽癌生存的独立危险因素(p0.05)。结论:鼻咽癌高表达VEGF,促进新生血管,形成高密度微小血管,和鼻咽癌远处转移密切相关,降低其生存率。     

Girdin 表达与非小细胞肺癌侵袭转移及预后的关系

目的:探讨肌动蛋白结合蛋白Girdin与非小细胞肺癌(Non small cell lung cancer,NSCLC)侵袭转移的关系及其对预后的影响。方法:应用免疫组织化学法检测167例非小细胞肺癌患者的病理组织标本中Girdin蛋白和MMP-9的表达。结果:在167例组织标本中Girdin蛋白高表达率为38.9%,其表达水平与患者分期、淋巴结转移、远处转移及生存状况密切相关,差异有统计学意义(P0.05),而与患者性别、年龄、吸烟指数、评分、病理类型及分化程度均无关(P均0.05)。Girdin蛋白的高表达往往伴有MMP-9的高表达,两者显著相关,且差异有统计学意义(P0.05)。Kaplan-Meier单因素生存分析显示Girdin高表达为非小细胞肺癌患者预后的不良因素(P0.05)。COX多因素回归分析显示Girdin的表达水平和分期是判断预后的独立指标(P0.05)。结论:Girdin蛋白在非小细胞肺癌的侵袭和转移中可能发挥着重要的作用,在判断非小细胞肺癌患者预后方面具有一定的价值。     

Survival after intratumoral interleukin-2 treatment of 72 melanoma patients and response upon the first chemotherapy during follow-up

Systemic high-dose interleukin-2 (IL-2) treatment achieves long-term survival in a subset of advanced patients with melanoma. As we reported previously, intratumoral IL-2 induced complete local responses in more than 60% of melanoma patients. This study aimed to analyze the long-term outcome of 72 patients treated in two prior trials. Melanoma patients (49 stage III, 23 stage IV) with injectable metastases received intratumoral IL-2 injections thrice weekly at individually escalated doses (median duration, 6.5 weeks; median total IL-2 dose, 72 MIU; median number of injected metastases, 10). The observed 2-year overall survival rates were 95.5% for stage III patients with cutaneous metastases only (stage IIIB), 72% for those with combined cutaneous and lymph node involvement (stage IIIC), 66.7% for stage IV patients with disease limited to distant soft-tissue metastases (stage IV M1a), and 9.1% for those with visceral metastases (stage IV M1b and stage IV M1c). Thirty patients who reported recurrence of unresectable distant metastases subsequently received chemotherapy in the further course of disease and showed an overall response rate of 36.7% (16.7% complete responses, 20% partial responses). A high total dose of IL-2 and a dacarbazine/temozolomide-based chemotherapy regimen were variables correlated with a clinical response. In conclusion, patients with cutaneous metastasis without lymph node involvement in stage III and with soft-tissue metastasis without visceral involvement in stage IV showed unexpected favorable survival rates after intratumoral treatment with IL-2. Furthermore, the intratumoral IL-2 treatment seemed to be associated with increased complete and partial responses in subsequent chemotherapies.     

Tissue inhibitor of matrix metalloproteinase-2 in nasopharyngeal carcinoma

By regulating matrix metalloproteinase (MMP) activity and controlling the breakdown of extracellular matrix components, tissue inhibitors of metalloproteinases (TIMPs) play an important role in the process of tumor invasion and metastasis. The present study was designed to clarify the role of TIMP-2 in nasopharyngeal carcinoma (NPC) patients and to evaluate its importance relative to clinicopathologic parameters. It was carried out in 30 patients with NPC and 20 controls. Tissue biopsies were studied and graded pathologically, and Western blot analysis was performed to assess TIMP-2 protein expression. Clinically, in accordance with TNM classification (T: tumor size, N: lymph node involvement, M: distant metastasis), 8 cases were diagnosed as stage II, 12 as stage III, and 10 cases as stage IV; however, pathologic typing with use of the World Health Organization (WHO) classification revealed the presence of 9 specimens of squamous cell carcinoma (WHO type 1), 6 cases of nonkeratinizing carcinoma (WHO type 2), and 15 cases of undifferentiated carcinoma (WHO type 3). The difference in percentage of TIMP-2 positivity between NPC patients (76.6%) and normal controls (30%) was statistically highly significant (P < .01). In addition, there was a significant positive correlation between TIMP-2 protein positivity and either the clinical staging or the histopathologic typing (P < .01) using Chi-square test (x(2)), suggesting that TIMP-2 can be used as a marker of the severity of NPC.Accordingly, we can assume that TIMP-2 may play a role in regional lymph node and/or distant metastasis and in progression of squamous cell carcinoma. Further studies are needed to investigate the role of TIMP-2 as a marker for tumor progression and to evaluate its potential value in the follow-up of patients.     

CD40 expression on human lung cancer correlates with metastatic spread

 Purpose: The poor prognosis associated with lung cancer is related to the high incidence of regional and distant metastasis. There is a crucial need to identify parameters that can predict a tendancy to metastatic spread to allow better prognostic evaluation and therapeutic approach. Methods: Using flow cytometry we evaluated 18 human lung cancer cell lines for the expression of different surface markers on lung cancers suggested to be possible prognostic parameters, including epidermal growth factor receptor (EGFR), intercellular adhesion molecule 1 (ICAM-1), Fas and CD40. Results: No correlation was found between tumor prognosis and EGFR, ICAM-1 or Fas. However, a statistically significant correlation was found between the surface expression of CD40 and the metastatic spread of the tumor. In this study, 14 of 18 lung cancer cell lines (78%) expressed CD40 on their surface. All of the 4 tumors that were CD40-negative, were stage I tumors, without any evidence of regional or distant metastasis. Of the 14 tumors that expressed CD40, all but 1 (93%) had either nodal or systemic metastasis at the time of diagnosis. Patients whose tumors were CD40-negative showed a significantly better N stage, overall stage at presentation and survival than those patients with CD40-positive patients. No significant differences between the two groups were observed in tumor size, gender, age, histology, differentiation or preoperative therapy. Conclusions: These results suggest that CD40 expression on lung cancer may play a role in metastatic spread, and also may serve as a prognostic marker and an indicator of advanced disease. Received: 30 August 1999 / Accepted: 22 December 1999