Dukes分期

摘要： 目的:探究磁共振成像动态增强(DCE-MRI)检查直肠癌相关影像学参数与生物学指标、Dukes分期的关联性。方法:选取2019年3月—2020年3月我院直肠癌患者98例,均行DCE-MRI检查,统计相关影像学参数,并测定相关生物学指标[人类表皮生长因子受体2(CerbB-2)、Ki67]水平,评估Dukes分期。比较不同生物学指标、Dukes分期直肠癌患者DCE-MRI检查影像学参数,分析直肠癌患者DCE-MRI检查影像学参数与生物学指标、Dukes分期的相关性及联合检测对C~D期直肠癌患者的诊断价值。结果:直肠癌CerbB-2、Ki67高表达患者DCE-MRI检查影像学参数Ktrans、Kep大于低表达患者(P<0.05);随着直肠癌患者Dukes分期的提升,Ktrans、Kep呈逐渐升高趋势(P<0.05);经Spearman相关性分析,Ktrans、Kep与生物学指标CerbB-2、Ki67、Dukes分期呈正相关(P<0.05);联合诊断C~D期直肠癌AUC值、敏感度、特异度高于单一检测(P<0.05)。结论:DCE-MRI检查相关影像学参数能反映直肠癌患者生物学行为与Dukes分期,为临床诊断治疗提供科学合理参考依据。

摘要： 目的:探讨直肠癌患者经动态对比增强磁共振成像(DCE-MRI)检查的定量参数值与其Dukes分期的关联性。方法:回顾性收集2017年10月-2020年9月我院91例直肠癌患者临床资料,均行DCE-MRI检查,分析容量转移常数(K^(trans))、速率常数(K_(ep))、容积分数(Ve=K^(trans)/K_(ep))、平均磁共振表观扩散系数值(ADC_(mean))等DCE-MRI定量参数与Dukes分期的相关性。结果:病变肠管壁K_(ep)、K^(trans)、Ve较正常肠管壁高,ADC_(mean)较正常肠管壁低(P<0.05);随着直肠癌Dukes分期增加,ADC_(mean)呈降低趋势,K_(ep)、K^(trans)呈升高趋势(P<0.05);随着分化程度增加,ADC_(mean)呈升高趋势,Ve、K^(trans)呈降低趋势(P<0.05);K_(ep)、K^(trans)与直肠癌患者Dukes分期呈正相关,ADC_(mean)与直肠癌患者Dukes分期呈负相关(P<0.05);Ve、K^(trans)与直肠癌患者分化程度呈负相关,ADC_(mean)与直肠癌患者分化程度呈正相关(P<0.05)。结论:DCE-MRI检查的定量参数值可反映直肠癌患者生物行为,辅助临床判断Dukes分期,为直肠癌治疗方案选择提供参考。

摘要： Objective Correlation of primary tumor location, preoperative CEA level and Dukes stage with lung metastasis after colorectal cancer surgery. Methods Randomly selected 73 cases after colorectal cancer surgery and analyze the clinicopathological characteristics of the patients. Results 30 cases of simple lung metastasis patients, the location of primary metastasis of lung metastases was related to lung metastasis. Twenty-one patients had rectal cancer, nine had colon cancer, 18 had unilateral lung metastases, and 12 had bilateral lung metastases. The time of primary tumor operation to lung metastasis was 2 ～ 39 months, with a median time of (11.7 ± 3.6) months. The incidence of lung metastasis in patients with the location of primary tumor, lymph node metastasis, preoperative CEA level (＞ 5 μg/L) and Dukes stage C was significantly higher than that in patients without lymph node metastasis, preoperative CEA level ＜ 5 μg/L and Dukes stage B (P ＜ 0.05). However, there was no significant difference in the size of tumor, the pathological type of primary tumor, the number of lymph node dissection and the incidence of pulmonary metastasis in patients with vascular invasion (P＞ 0.05). Multivariate logistic regression analysis showed that the risk factors of lung metastasis included the location of primary tumor, preoperative CEA level and Dukes stage (P ＜ 0.05), but not lymph node metastasis (P＞ 0.05). Conclusion The location of primary tumor, preoperative CEA level and Dukes stage were significantly correlated with lung metastasis after colorectal cancer surgery.%目的 研究原发肿瘤部位、术前CEA水平及Dukes分期与结直肠癌术后肺转移的相关性.方法 随机选取术后结直肠癌患者73例,对患者的不同临床病理特征进行统计分析.结果 单纯性肺转移30例,肺转移原发肿瘤部位:21例患者为直肠癌,9例患者为结肠癌;在肺转移部位方面,18例患者为单侧,12例患者为双侧.原发肿瘤手术到肺转移确诊时间在2～39个月之间,中位时间为 (11.7±3.6) 个月.原发肿瘤部位、淋巴结转移、术前CEA水平≥5μg/L、Dukes分期C期患者的肺转移发生率均显著高于无淋巴结转移、术前CEA水平＜5μg/L、Dukes分期B期患者 (P ＜0.05);不同肿瘤大小、原发灶病理类型、淋巴结清扫数目、脉管浸润患者的肺转移发生率之间的差异无统计学意义 (P＞0.05).多因素Logistic回归分析模型分析结果表明,肺转移危险因素包括原发肿瘤部位、术前CEA水平、Dukes分期 (P＜0.05),但不包括淋巴结转移 (P＞ 0.05).结论 原发肿瘤部位、术前CEA水平及Dukes分期与结直肠癌术后肺转移显著相关.

摘要： Objective To detect the serum levels of IGF-1 in patients with colorectal cancer before and after operation by enzyme-linked immunosorbent assay (ELISA) , and to explore the changes of serum levels before and after operation and the development of colorectal cancer.Methods A total of 30 patients with primary colorectal cancer resection were enrolled in the First Affiliated Hospital of Jiamusi University. The fasting venous blood was collected in the early morning before surgery and 30 d after surgery. At the same time, 30 healthy subjects in the same period of physical examination were selected as the control group, and fasting venous blood was collected on the day of physical examination. Serum IGF-1 levels were measured by Elisa method. The changes of serum IGF-1 levels in the two groups were observed. The relationship between IGF-1 and clinical parameters of colorectal cancer was analyzed. Results The preoperative serum IGF-1 level in the observation group was (200.48±42.25) ng/ml, which was higher than that in the observation group (164.52 ±35.45) ng/ml and the control group (146.26 ±43.14) ng/ml, the difference was statistically significant (P 0.05). The high-differentiation and moderately differentiated patients had low serum IGF-1 level. In the poorly differentiated, the difference was statistically significant (P 0.05);高分化、中分化者血清IGF-1水平低于低分化者, 差异有统计学意义 (P<0.05);Dukes分期中A+B和C+D期之间比较, 差异有统计学意义 (P<0.05) .结论 结直肠癌患者血清IGF-1参与结直肠癌的病变过程, 是一种有促进细胞增殖、分化等多种生物学活性的细胞因子, 可能作为结直肠癌发生、发展的重要预测指标及手术切除后手术效果的评定指标之一.

摘要： 目的 研究分析直肠癌相关贫血患者骨髓穿刺涂片诊断及与病理分期的关系.方法 直肠癌患者215例,均接受骨髓穿刺涂片检查,采集血红蛋白(Hb)水平,通过Dukes分期法判断患者肿瘤分期,探讨直肠癌相关贫血患者病理分期情况.结果 在215例直肠癌患者中,贫血发生率为53.95％(116/215);男性和女性直肠癌患者贫血发生率比较,差异无统计学意义(P>0.05);Dukes分期A、B、C、D直肠癌患者贫血发生率比较差异具有统计学意义(P<0.05);Dukes分期A、B、C、D患者贫血类型比较,具有显著的差异(P<0.05).结论 骨髓穿刺涂片有利于诊断直肠癌相关贫血,直肠癌相关贫血发生率较高,贫血发生与病理分期有关,为疾病治疗方法的制定提供参考依据.

摘要： 目的探究分析错配修复基因(mismatch repair gene, MMR)蛋白中的h MLH1、h MSH2、h MSH6以及整合素β1(Integrinβ1)和Ki-67在结直肠癌组织表达水平以及对预后的影响.方法收集来我院治疗的结直肠癌患者的肿瘤标本162例,采用免疫组织化学染色法测定标本中hMLH1、hM SH2、hM SH6、Integrinβ1和Ki-67的表达水平,分析其影响因素,进行统计学分析比较.结果 (1)162例标本中有36例标本存在hMLH1、hMSH2、hMSH6的表达缺失,缺失率为22.22%;(2)MMR蛋白表达缺失在肿瘤直径(P=0.0005)、Dukes分期(P=0.0248)、肿瘤家族史(P=0.0042)和淋巴结转移(P=0.0014)等方面差异具有统计学意义(P<0.05);(3)Integrinβ1阳性表达水平在Dukes分期(P=0.0002)方面差异存在统计学意义(P <0.05),Ki-67的阳性表达水平在Dukes分期(P=0.0002)、淋巴结转移(P=0.0111)等方面差异具有统计学意义(P <0.05);(4)MMR蛋白表达缺失、Integrinβ1阳性表达和Ki-67的阳性表达与Dukes分期(P=0.006)、淋巴结转移(P=0.023)有关,差异具有统计学意义(P <0.05);(5)dMMR组患者5年的生存率为88.89%,pMMR组患者5年的生存率为59.52%,差异具有统计学意义(P=0.0010); Integrinβ1阳性表达组患者5年生存率为59.69%,阴性表达组患者5年生存率为90.91%,差异具有统计学意义(P=0.0007); Ki-67的阳性表达组患者5年生存率为63.27%,阴性表达组患者5年生存率为93.33%,差异具有统计学意义(P=0.0192).结论患者的MMR蛋白、Integrinβ1和Ki-67的表达水平与患者肿瘤的Dukes分期及淋巴结是否转移具有统计学意义上的相关性,且这三种因素均与患者的预后有关.其中, MMR蛋白表达缺失, Integrinβ1和Ki-67的阴性表达的患者预后情况较好,患者的5年生存率较高.

摘要： 目的 探讨固醇调节元件结合蛋白(SREBP)-1在结直肠癌中的表达特征及其与患者病情及预后的相关性.方法 临床收集56例结直肠癌患者肿瘤组织及相应的癌旁组织,逆转录聚合酶链式反应(RT-PCR)及免疫组化(IHC)技术检测组织中SREBP-1的表达,分析结直肠癌组织SREBP-1 mRNA的表达水平与患者年龄、体重、性别、肿瘤大小、临床Dukes分期及病理学分级的相关性,比较SREBP-1阳性率与患者临床资料间的关系,Kaplan-Meier生存分析法分析患者结直肠癌组织SREBP-1 mRNA的表达与预后的关系.结果 RT-PCR结果显示结直肠癌组织SREBP-1mRNA表达水平显著高于癌旁组织(P＜0.05),IHC的结果示结直肠癌组织中细胞SREBP-1阳性率显著高于癌旁组织(P＜0.05).Spearman相关性分析显示患者结直肠癌组织SREBP-1的表达与患者年龄、性别、体重及肿瘤大小无显著相关性(P＞0.05),与患者临床Dukes分期及病理学分级呈显著正相关(P＜0.05).kaplan-Meier生存分析示癌组织中高表达SREBP-1的患者预后不良.结论 SREBP-1高表达于结直肠癌组织,且与肿瘤恶性程度、进展及患者不良预后密切相关,是潜在的结直肠癌标志物.

摘要： 目的 探讨结肠癌的分期对实施完整结肠系膜切除的应用价值及远期疗效.方法 采用结肠癌分期标准Dukes分期方法进行术前分期,Dukes A期20例、B期35例、C期28例、D期17例.所有患者都实施完整结肠系膜切除术,制定10年的远期疗效观察目标.结果 淋巴结清扫量:Dukes A期(21.25±4.02)枚,B期(20.56±3.89)枚,C期(13.32±2.88)枚,D期(12.23±2.45)枚,Dukes A、B期数量明显多于C、D期数量;平均出血量、并发症发病率:Dukes A期Dukes分期对评估完整结肠系膜切除的可行性及远期疗效具有一定的临床指导价值.%Objective To explore the application value and long-term efficacy of colon cancer staging for patients with complete resection of the mesocolon .Methods Dukes stages of colon cancer staging received standard methods of preoperative staging,Dukes A was 20 cases,Dukes B was 35 cases,Dukes C was 28 cases,Dukes D was 17 cases.All patients received com-plete resection of mesocolon , and 10 years long-term efficacy of observation target were determined .Results The number of lymph node dissection,Dukes A was 21.25 ±4.02 medals,B was 20.56 ±3.89 medals,C was 13.32 ±2.88 medals,D was 12.23 ±2.45 medals.Dukes A,B were significantly more than those of the Dukes C ,D;The average blood loss ,complication rate:Dukes A