The principle of surgical treatment for gastric cancer is the radical resectioning although the suitable resecting range for different cases of gastric cancer is still being argued upon[1-9]. However, the diagnostic accuracy of early gastric cancer (EGC) without lymphatic metastasis has obviously improved with an improvement in the diagnostic technique and due to the accumulation of knowledge on the biological profiles of EG C[10-17]. The D2 lymph node excision was used as a regular operation to treat the EGC previously. But the concept for the EGC without lymphatic metastasis has gradually changed and the less invasive resections has been applied in some cases[18-20]. This study aimed at investigating the risk factors of lymphatic metastasis in EGC in order to find out the proofs for the suitable indications for less invasive operations such as endoscopic mucosal resectioning (EMR), laparoscopic and laparotomic resectioning.

喉癌组织淋巴管密度和淋巴管生成因子表达与颈淋巴转移的关系

应用酶组织化学5'-核苷酸酶(5'-Nase)染色和逆转录聚合酶链反应(reverse transcription polymerase chain reaction,RT-PCR)方法分别探讨喉癌癌内和癌旁组织中淋巴管生成、淋巴管生成因子表达与颈淋巴转移之间的关系,报道如下.

声门上型喉癌中微淋巴管密度的意义及其与颈淋巴转移的关系

声门上型喉癌患者有无颈部淋巴转移对其预后有着重要的影响.为探索颈淋巴转移与淋巴管形成的关系,我们采用5'-核苷酸酶-碱性磷酸酶(5‘-Nase-ALPase)双重染色法检测声门上型喉癌中微淋巴管密度(lymphatic microvessel density,LMVD),以期对其有所了解.

染色Ⅰ、Ⅱ号标记胃癌转移淋巴结临床应用研究

1.目的和意义胃癌是我国常见的消化道恶性肿瘤,其治疗效果主要取决于早期诊断、早期手术.而手术效果又取决于能否彻底根治,特别是彻底切除引流区域的淋巴结.但是,目前临床上淋巴结是否有转移是根据其大小、硬度和形状进行判定并按规约进行清除的.至于切下的淋巴结那些癌那些是非癌淋巴结,是否有遗漏,临床上缺乏直观、实用的标识方法.我院普外科受吉林省卫生厅资助于1994年3月～1996年6月对105例Ⅱ-Ⅲ期胃癌患者进行了胃癌淋巴结标记研究,试图寻找一种使胃癌淋巴结特异性标记或能提高胃癌淋巴结清除率的方法,用来指导术中清扫淋巴结,以达到术式合理、清除彻底的目的.

Objective:To study explores the effect of HLEC on the secreted proteins of epithelial ovarian cancer (EOC) cells (SKOV3-PM4) with directional highly lymphatic metastasis.
Methods:Supernatants of four groups of cultured cells, namely, SKOV3 (A), SKOV3+HLEC (B), SKOV3-PM4 (C), SKOV3-PM4+HLEC (D), were collected, and their proteins were detected by antibody arrays and iTARQ-2D-LC-MALDI-TOF/TOF/MS. Signiifcantly differential proteins were further analyzed via bioinformatics and validated in human serums and cell media via ELISA.
Results:Results of antibody arrays and mass spectrometry demonstrated that GRN and VEGFA were upregulated in group C (compared with group A), whereas IGFBP7 and SPARC were downregulated in group D (compared with group C). Comprehensive bioinformatics analysis results showed that IGFBP7 and VEGFA were closely linked to each other. Further validation with serums showed statistical signiifcance in VEGFA and IGFBP7 levels among groups of patients with ovarian cancers, benign tumors, and control groups. Two proteins were upegulated in the ifrst group. VEGFA in the control group was downregulated. For IGFBP, upregulation in the control group and down-regulation in the ifrst group were also observed.
Conclusion:The HLEC microenvironment is closely associated with directional metastasis to lymph nodes and with differential proteins including cell stromal proteins and adhesion factors. hTe upregulation of VEGFA and GRN and the downregulation of SPARC and IGFBP7 are closely associated with directional metastasis to lymph nodes in EOC cells.

LYVE-1和VEGF-C在胃癌中的表达及与淋巴结转移的关系

血管内皮生长因子-C(vascular ericlothalgrowth factor-C,VEGF-C)和淋巴管内皮透明质酸受体-1(lymphatic vessel endothelial hvaluronan re-ceptor-1,LYVE-1)[1,2]都是淋巴管内皮细胞的标记物,其中LYVE-1是新近发现的较特异的淋巴管内皮细胞标记物.但目前国内外关于LYVE-1与肿瘤淋巴结转移之间关系的研究报道较少,也未见有关LYVE-1、VEGF-C表达的相互关系及与胃癌淋巴结转移的相关研究.本研究通过免疫组化染色,探讨VEGF-C和LYVE-1的表达在胃癌淋巴结转移过程中的作用和可能机制及其临床意义.

Objective:To explore the potential mechanisms of lymphatic metastasis of GC cells regulated by ring finger protein (RNF180).Methods:Associations between clinicopathologic, survival data, and RNF180 expression in GC tissues were analyzed. The effects of RNF180 re-expression and genome microarraywere determined in growth, proliferation, invasion, and lymphangiogenesis assays.Results:RNF180 was silenced or down-regulated in 76.1%of GC tissues compared with 41.8% of paired non-tumor tissues. RNF180 protein expression in GC tissues was negatively related to the number of metastatic lymph nodes. RNF180 was down-regulated in 100% (7 of 7) of GC cell lines. Re-expression of RNF180 in HGC-27 GC cells reduced colony formation, proliferation, migration and invasion in vitro, and tumor growth and tumor lymphangiogenesis in mice it also down-regulated HGF, MMP-2, MMP-14, VEGF-C/D and CCR-7 in vitro, and Podoplanin in tumor tissue of mice.Conclusion:RNF180 is a suppressor gene involved inthe several biological events of GC cell including the proliferation, invasion, and tumor lymphangiogenesis.

Heparanase Expression Correlates with Angiogenesis and Lymphangiogenesis in Human Lung Cancer

Background and objective Heparanase has been thought to be a good molecular marker of tumor, and the heparanase expression level was correlated closely with tumor metastasis. In this study, we investigate the effects of heparanase on angiogenesis and lymphangiogenesis of lung cancer and the relationship between heparanase expression and vascular endothelial growth factor (VEGF), vascular endothelial growth factor-C (VEGF-C).Methods Immunohistochemistry was used to detect the expression of heparanase, VEGF, VEGF-C protein and microvascular density (MVD), lymphatic vessel density (LVD) in 115 cases of non-small cell lung cancer (NSCLC) and 45 cases of adjacent normal tissue samples.Results Our results showed that heparanase expression was significantly increased in 91 (79.13%) of the 115 cases and correlated with lymph node metastasis (node positive rate 87.0%; node negative rate 36.8%; P=0.003). Heparanase positive expression cases have significantly higher concentration of microvascular density (MVD) and lymphatic vessd density (LVD) as compared with heparanase negative expression cases (P<0.01, P<0.01, respectively), heparanase expression was significantly correlated with VEGF, VEGF-C expression in NSCLC.Conclusion Heparanase overexpression was associated with angiogenesis and lymphangiogenesis of lung cancer, targeting ofheparanase may represent a significant therapeutic potential for lung cancer.

Surgical Therapeutic Strategy for Non-small Cell Lung Cancer with Mediastinal Lymph Node Metastasis(N2)

Background and objective Approximately 30% of patients who are diagnosed with non-small cell lung cancer(NSCLC)are classified as N2 on the basis of metastasis to the mediastinal lymph nodes.The effectiveness of surgery for these patients remainscontroversial.Although surgeries in recent years are proved to be effective to some extent,yet due to many reasons,5-yearsurvival rate after surgery varies greatly from patient to patient.Thus it is necessary to select patients who have ahigh probability of being be cured through an operation,who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.Methods 165 out of l73 patients with N2NSCLC were treated with surgery in our department from January 1999 to May 2003,among whom 130 were male,43 female and the sex ratio was 3:1,aver age age 53,ranging from 29 to 79.The database covers the patients'complete medical history including the information of their age,sex,location and size of tumor date of operation,surgical methods,histologic diagnosis,clinical stage,post-operative TNM stage,neoadjuvant treatment and chemoradiotherapy.The methods of clinical stage verification include chest X-ray,chest CT,PET,mediastinoscopy,bronchoscope(+?),brain CT or MRI,abdominal B ultrasound (or CT),and bone ECT.The pathological classification was based on the international standard for lungcancer(UICC1997).Survival time was analyzed from the opemtion date to May 2008 with the aid of SPSS(Statistical Package forthe Social Sciences)program.Kaplan-Meier survival analysis,Log-rank test and Cox multiplicity were adopted respectively to obtain patients'slLrvival curve,survival rate and the impact possible factors may have on their survival rate.Results The median survival tinle was 22 months.with 3-year survival rate reaching 28.1%and 5-year survival rate reaching 19.0%.Age,sex.different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-yearsurvival rate.In all N2 subtypes,5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P<0.01),reaching 30.4%and 27.3%respectively.5-year survival rate for single station lymph node metastasis were 27.8%.much higher compared with 9.3% for multiple stations(P<0.001).Induction therapy which downstages proven N2 in 73.3%patients gains them the opportunity of surgery.The 5-year survival rate were 23.6%and 13.0%for patients who had complete resection and those who had incomplete resection(P<0.001).Patients who underwent lobectomy(23.2%)have higher survival rate,less incidence rate of complication and mortality rate,compared with pneumonectomy(14.8%)(P<0.01).T4patients has a 5-year survival rateaslow as 11.1%,much less than T1(31.s%)and T2(24.3%)patients(P=0.01).It is noted through Cox analysis that completeness of resection,number ofpositive lymph node stations and pnmary T status have significant correlativity with 5-year survival rate.Conclusion It is suggested that surgery(lobectomy preferentially)is the best solution for T1 and T2 with primary tumor have not invaded pleura or the distance to carina of trachea no less than 2 cm,unexpected N2 discovered at thoractomy when a complete resection can be applied,and proven N2 discovered during preoperative work-up and is down-staged after induction therapy.Surgical treatment is the best option,lobectomy should be prioritized in operational methods since ite rate of complication and morality are lower than that of pneumonectomy.Patients'survival time will not benefit from surgery if they are with lymph nodes metastasis of multiple stations(Bulky N2 included)and T4 which can be Partially removed.Neoadjuvant chemotherapy increases long-term survival rate of those with N2 proven prior to surgery.However,postoperative radiotherapy decreases local recurrence rate but does not contribute to patients'long-term survival rate.

Diagnostic Value of Sialic Acid in Pleural Effusion

The present study was conducted in 30 patients of malignant pleural effusion and 30 patients of non malignant pleural effusion.Pleural fluid and blood samples were taken at the time of admission,before starting any treatment.Sialic acid levels were estimated in seruln and pleural fluid by Warren'S TBA method.In the present study,serum sialic acid levels were higherin group II as compared to group I.In the present study, pleural fluid sialic acid levels and PF/S ratio was higher in malignant pleural effusion(though difference was not statistically significant).Smokers in group II had higher serum sialic acid as compared to group 1(p<0.05).The sensitivity and specificity of pleural fluid/serum sialic acid ratio with cut off value of 0.7 were 76.67%and 20%respectively,while taking the cut of value of 70 mg/dL for pleural fluid sialic acid in malignant pleural effusions,the sensitivity was 63.33%, specificity 60%and positive predictive value 46.34%.These findings indicate that determination ofsialicacid levels in pleural fluid has diagnostic value as a cheap,simple and reliable marker for malignant pleural effusion.

CT引导下弯针穿刺化学消融术治疗恶性肿瘤腹膜后淋巴结转移性病变

恶性肿瘤患者中、晚期淋巴结转移主要表现为淋巴结肿大及融合成团块状,因其位置深在且包埋血管、神经而引起相应的临床症状.外科手术难以切除,全身化疗常常引起较多的并发症.局部化疗能使药物在肿大淋巴结内达到较高浓度,降低系统毒性,使肿大淋巴结坏死从而达到治疗的目的[1].笔者对45例恶性肿瘤腹膜后淋巴结转移性病变,采用CT引导下弯针经皮穿刺化学消融,取得了满意疗效,现报告如下.