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主动脉旁淋巴结转移在可切除胰腺癌预后中的含意
胰腺癌病人手术切除后的生存曲线在1年内呈直线下降,而后下降相对缓慢.此类病人短的生存期可能与导致肿瘤快速复发的某种临床病理学因素是相一致的.
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乳腺癌淋巴结转移诊治进展
淋巴结转移是乳腺癌重要的转移形式,一直受到临床医生的高度关注.针对淋巴结的外科治疗是改善乳腺癌临床疗效的重要方面.随着人们对疾病本质的深入了解和治疗理念的不断变化,对乳腺癌淋巴转移的意义和治疗观点也在发生明显变化.时至今日,乳腺癌淋巴结转移在评价病情、准确分期、指导综合治疗和判断预后等方面仍具有重要作用.近年来,在乳腺癌淋巴转移的诊断方法、治疗模式和评价体系方面已取得重要进展,但仍存在诸多尚待探索和解决的问题.对乳腺癌淋巴结转移的深入认识和研究将有助于进一步改善临床疗效.
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左肺下叶血管外皮细胞瘤伴淋巴结转移1例
患者女,42岁。2014年9月无明显诱因出现间断性咳嗽,咳白色泡沫痰,无咳血、胸痛、胸闷、气促等不适,就诊于新疆伊犁州友谊医院,行肺部CT示左肺下叶外基底段见球状高密度影,紧贴胸膜,大小3.5 cm ×2.8 cm,右肺上叶见比较集中的多发斑点状高密度影,余未见异常(图1)。后行左肺下叶包块穿刺病理检查示肺腺泡状软组织肿瘤,不除外转移性病变,免疫组化Vimentin (+), Ki67(+)<1%,其余均为阴性。 PET-CT提示左肺下叶外基底段胸膜处见较为分散的FDG代谢轻度增高,SUVmax:1.7,CT值37~57 Hu,边界清晰,考虑为低度恶性病变,良性病变不除外。双肾及输尿管未见明显异常浓聚。子宫内可见局灶性FDG代谢增高影,CT见子宫外形不大,形态轮廓基本规则,未见明显异常密度影,考虑生理性摄取。余扫描范围内未见明显恶性肿瘤征象。
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胃癌淋巴结转移研究的进展与新规定
近年,胃癌外科治疗取得较大进步,这些成绩与其外科基础研究不断深入相伴而行,相辅相成.本文仅就目前胃癌淋巴结转移的数点研究,结合作者经验体会简述如下.
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口腔颌面部恶性肿瘤颈淋巴结转移的外科诊治指南
口腔颌面部恶性肿瘤具有较高的淋巴道转移倾向,颈部淋巴结转移的诊断和治疗是口腔颌面部肿瘤治疗中的重要内容.为与国际接轨,统一国内诊治标准,便于学术交流,特制定口腔颌面部不同部位及不同病理类型肿瘤颈淋巴结转移的诊治指南.
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erbB4和PTEN在皮肤鳞状细胞癌组织中的表达
目的 观察并探讨erbB4和FFEN在皮肤鳞状细胞癌(鳞癌)组织中的蛋白表达及其临床意义.方法 采用免疫组化Elivision法,检测52例皮肤鳞癌(其中11例伴有淋巴结转移,41例无转移)、10例正常人皮肤标本中erbB4和VIEN蛋白表达.结果 皮肤鳞癌组中39例erbB4蛋白呈阳性表达,阳性率为75%;对照组中仅1例阳性表达,两组阳性率比较,x2=12.77,P<0.01;皮肤鳞癌患者中在有淋巴结转移组erbB4蛋白阳性表达率(100%)明显高于无淋巴结转移组(68.29%),两组阳性率比较,P<0.05.PTEN蛋白在皮肤鳞癌组中25例阳性表达,阳性率为48.08%,对照组10例均为阳性表达,两组阳性率比较,x2=9.20,P<0.01;在鳞癌高分化组及中低分化组中的阳性率分别为78.57%、36.84%,两组差异有统计学意义(P<0.05);有淋巴结转移组PTEN阳性率(9.09%)明显低于无转移组(58.54%)(P<0.01).皮肤鳞癌erbB4蛋白与PTEN蛋白表达呈负相关(r=-0.42,P<0.01).结论 erbB4与PTEN可能参与了皮肤鳞癌的发生、恶性进展及转移.
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Objective:Lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while necessity No.14v lymph node dissection for lower GC is still controversial.Methods: A total of 311 GC patients receiving D1+ (D1+7, 8a, 9) or D2 plus No.14v lymph node dissection in our center were enrolled. Patients were categorized into two groups based on No.14v lymph node status: positive group (PG) and negative group (NG).Results:Fifty patients (16.1%) had No.14v lymph node metastasis. Metastasis to No.4d, No.6 lymph node and distant metastasis were independent variables affecting No.14v lymph node metastasis. Patients with positive No.14v lymph node had a significant lower overall survival (OS) rate than those without (3-year OS, 34.0% vs. 67.0%,P<0.001).Conclusion:GC patients with positive No.4d and No.6 lymph node often metastasis to No.14v lymph node. Status of No.14v lymph node was an independent prognostic factor for GC staged TNM III. Patients with positive No.14v lymph node usually have a poor prognosis, while such patients without distant metastasis may beneift from a curative surgery.
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Objective:A retrospective study was conducted to investigate the rules of lymph node metastases in distal gastric cancer and its clinical significance.Methods: This study was performed on 129 patients who had distal gastric cancer with lymphadenectomy for radical cure, whose specimens were obtained during surgery.Results:Among 129 patients with distal gastric cancer, lymph node metastases were found in 80 patients (62.02%) with a total collection of 3,295 lymph nodes and an average of 25.54 lymph nodes per patient.Conclusion:According to the clinical and pathological factors and combining it with the characteristics of lymph node metastasis by groups and stations in different areas and then properly choosing and extending the extent of lymph node resection, the objective of radical cure for distal gastric cancer could be achieved individually when it is performed radical lymphadenectomy.
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Objective:D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while necessity No.14v lymph node dissection for distal GC is still controversial. Methods: A total of 920 distal GC patients receiving at least D1+ (D1+7, 8a, 9) or D2 lymph node dissection in our center were enrolled in this study, of whom, 243 patients also had the No.14v lymph node dissected. Other 677 patients without No.14v lymph node dissection were used for comparison.Results:Forty-five (18.5%) patients had No.14v lymph node metastasis. There was no significant difference in overall survival (OS) rate between patients with and without No.14v lymph node dissection. Following stratiifed analysis, in TNM stages I, II, IIIa and IV, No.14v lymph node dissection did not affect OS. In multivariate analysis, No.14v lymph node dissection was found to be an independent prognostic factor in patients with TNM stage IIIb/IIIc GC (HR =0.670, 95% CI, 0.506~0.886, P=0.005).Conclusion:Adding No.14v lymph node to D2 lymphadenectomy may be associated improved OS for middle and lower GC staged TNM IIIb/IIIc.
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Objective:Immunoglobin G (IgG) molecules are not only produced by differential B lymphocytes but also expressed in numerous epithelial cancer cells. hTey play important roles in promoting tumor cell growth and survival. However, their expression and function in gastric cancer remains unkown, this study was designed to investigate IgG expression and function in gastric cancer.Methods: IgG expression was evaluated by immunohistochemistry.The relationship between IgG expression and clinicopathological features and clinical outcomes were statistically analyzed. Results:Statistical analyses showed that IgG expression was more frequently detected in patients with cardiac cancer, intestinal type and no lymph node metastasis. Moreover, IgG expression was significantly related to the overall survivalin patients with tumor TNM stages I-III.Multivariate Cox regression analyses revealed that IgG expression was an independent prognostic factor in patients with tumor TNM stages I-III for OS.Conclusion:Our findings demonstrate that IgG was related to gastric cancer progression, and its expression can serve as a novel prognostic biomarker in gastric cancer patients.
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Patients with late-stage cancer commonly have distant lymph node metastasis;however, poor health often contraindicates surgical treatment. Although the quality of life and overal survival for these patients are low, there is neither a consensus nor a guide for treatment. Ablation technique and surrounding tissue damage are two possible reasons for limited study of radiofrequency ablation in patients with superficial distant lymph node metastasis. Here, we report two patients treated successfully with ultrasound-guided radiofrequency ablation for superficial distant lymph node metastasis. In these patients, deionized water was injected to the surrounding tissues of the lymph node to decrease heat injury. Results from these patients suggest that radiofrequency ablation may play an important role in the treatment of patients with distant lymph node metastasis.
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肿瘤淋巴结转移过程中树突状细胞的变化
大多数上皮源性恶性肿瘤患者,即使未患有免疫系统疾病,其肿瘤原发灶仍然能够逃避机体的免疫监控继续生长并发生淋巴结转移,终可导致患者死亡.因此,研究肿瘤的免疫逃避机制有着重要的意义.树突状细胞(dendritic cells,DC)是体内重要的免疫细胞,是目前已知的强的专职抗原提呈细胞,具有捕获、提呈抗原并能在体内外直接激活静息期T细胞,促进辅助T细胞和细胞毒性T细胞的生成,在诱导抗肿瘤免疫反应中起关键的调控作用.本文就肿瘤淋巴结转移过程中DC的变化作一综述.