【摘要】 目的 評價螺旋CT對原發性膀胱移行細胞癌（TCC）分期的準確性。 方法 對2000年9月-2009年9月診治的73例原發性TCC患者，手術前行螺旋CT臨床分期與手術后病理分期進行比較。 結果 TCC患者手術前螺旋CT臨床分期與手術后病理分期相符率為90.5%。7例分期不符的患者中，4例螺旋CT分期低于病理分期，3例高于病理分期。 結論 螺旋CT對TCC的手術前臨床分期較準確；螺旋CT分期誤差產生的主要原因是不能確定腫大的淋巴結是否是癌轉移。【Abstract】 Objective To investigate the value of contrast helical CT in Neopl-asm staging in patients with transitional cell carcinoma (TCC) of bladder. Methods Total 73 patients with TCC of bladder treated from september 2000 to September 2009 was analysed to compare preoperative helical CT examination with postoperative pathological diagnosis. Results The coincident staging of helical CT and pathological finding of TCC of bladder was found to be 90.5%. In the remaining seven patients, four patients were of overstaging and three patients were of understaging respectively. Conclusion The early enhancing phase of helical CT is helpful in the evaluation of the staging in patients with TCC of bladder.The cause of incorrecting staging by preoperative CT was usualy due to the difficulty in determing if lymph nodemetastasis occurs.
ObjectiveTo explore the surgical outcome of Duckett urethroplasty-urethrotomy for staged hypospadias repair.
MethodsFifty-three patients with hypospadias were treated by 2 stages between August 2013 and September 2014. The age ranged from 10 months to 24 years and 3 months (median, 1 year and 10 months). There were 5 cases of proximal penile type, 2 cases of penoscrotal type, 36 cases of scrotal type, and 10 cases of perineal type. Urethroplasty was performed with tubed transverse preputial island flap only in 27 cases or combined with urethral plate in the other 26 cases, thus a urethrocutaneous fistula was intentionally created; stage II fistula repair was carried out at 1 year after stage I repair.
ResultsThe length of the new urethra ranged from 2 to 8 cm with an average of 3.6 cm. The patients were followed up 5-17 months with an average of 8 months after stage II repair. After stage I repair, urethral fistula was noted at other site in 3 cases, skin necrosis in 1 case, glandular stricture in 2 cases, cicatric curvature in 1 case, and position and morphology of urethral orifice not ideal in 4 cases. After stage II repair, urethral fistula was noted in 2 cases, mild urethral diverticulum in 2 cases, and stricture at temporary repair site in 1 case. HOSE score was 12-16 at 3 months after stage II repair (mean, 14.5). At 3-14 months after stage II repair, the maximum flow rate ranged from 3.9 to 22.7 mL/s with an average of 8.6 mL/s.
ConclusionDuckett urethroplasty-urethrotomy can be used as staged repair for primary treatment of hypospadias because of high safety, low complication incidence, and satisfactory appearance.
ObjectiveTo analyze the relative factors of lymph-nodes metastasis (LM) in patients with cervical cancer.
MethodsThe clinico-pathological data of 136 patients with stageⅠ A-Ⅱ A of cervical cancer who underwent surgical therapy from January 2005 to December 2010 were retrospectively analyzed. The correlation between clinico-pathological parameters and LM was analyzed by univariable χ2 analysis and multivariable logistic analysis.
ResultsThe total LM rate (LMR) was 14.0% (19/136). The rate of LM in obturator was the highest (63.2%), and then the rate between the external and internal iliac was 42.1%. The rate of deep inguinal lymph nodes and para-aortic lymph node was 0.0%. There was correlation between the clinic staging, depth of stromal invasion, histologic subtype, parametrial invasion, vaginal invasion and LM in univariable analysis (P<0.05). While in multivariable analysis, the correlation with LM was only existed between the clinic staging, histologic subtype, depth of stromal invasion and LM.
ConclusionClinic staging, histologic subtype, depth of stromal invasion are high risk factors of LM.
ObjectiveTo elaborate constitute, definition, and interpretation of stage module of colorectal cancer in the Database from Colorectal Cancer (DACCA) in the West China Hospital.MethodThe article was described in the words.ResultsIn the DACCA, the columns were selected by the colorectal cancer staging module. The overall stages included: the stage during surgery, cpi comprehensive stage, and TNM stage. The classified stages included: the T, N, and M stages of pathology, clinical, and imaging; The risk factors included the cancerous contamination and high-risk factors. Then these items were subdivided and detailed for their definition, form, label and structure, error correction and update, and how to be used in the analysis of data in the DACCA.ConclusionsThrough detailed description and specification of current stage module of colorectal cancer in DACCA in West China Hospital, it can provide a reference for standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
Objective To establish a predictive model for long-term tumor-specific survival after surgery for patients with intermediate to advanced medullary thyroid cancer (MTC) based on American Joint Committee on Cancer (AJCC) TNM staging, by using the Surveillance, Epidemiology, and End Results (SEER) Database. Methods The data of 692 patients with intermediate to advanced MTC who underwent total thyroidectomy and cervical lymph node dissection registered in the SEER database during 2004–2017 were extracted and screened, and were randomly divided into 484 cases in the modeling group and 208 cases in the validation group according to 7∶3. Cox proportional hazard regression was used to screen predictors of tumor-specific survival after surgery for intermediate to advanced stage MTC and to develop a Nomogram model. The accuracy and usefulness of the model were tested by using the consistency index (C-index), calibration curve, time-dependent ROC curve and decision curve analysis (DSA). Results In the modeling group, the multivariate Cox proportional hazard regression model indicated that the factors affecting tumor-specific survival after surgery in patients with intermediate to advanced MTC were AJCC TNM staging, age, lymph node ratio (LNR), and tumor diameter, and the Nomogram model was developed based on these results. The modeling group had a C-index of 0.827 and its area under the 5-year and 10-year time-dependent ROC curves were 0.865 [95%CI (0.817, 0.913)], 0.845 [95%CI (0.787, 0.904)], respectively, and the validation group had a C-index of 0.866 and its area under the 5-year and 10-year time-dependent ROC curves were 0.866 [95%CI (0.798, 0.935)] and 0.923 [95%CI (0.863, 0.983)], respectively. Good agreement between the model-predicted 5- and 10-year tumor-specific survival rates and the actual 5- and 10-year tumor-specific survival rates were showed in both the modeling and validation groups. Based on the DCA curve, the new model based on AJCC TNM staging was developed with a significant advantage over the former model containing only AJCC TNM staging in terms of net benefits obtained by patients at 5 years and 10 years after surgery. Conclusion The prognostic model based on AJCC TNM staging for predicting tumor-specific survival after surgery for intermediate to advanced MTC established in this study has good predictive effect and practicality, which can help guide personalized, precise and comprehensive treatment decisions and can be used in clinical practice.
摘要:目的: 探討64排多層螺旋CT(MSCT)和血清淀粉樣蛋白A(serum amyloid A protein, SAA)聯合術前評估直腸癌在腫瘤分期診斷中的作用。 方法 :納入經根治術治療的直腸癌患者通過MSCT掃描進行評估,同時取患者靜脈血測量術前SAA水平,行MSCT分期與MSCT和SAA聯合分期以比較二者的診斷價值。 結果 :本研究納入患者121例。MSCT檢測T分期的準確度為851%。在評估淋巴結轉移方面,MSCT和SAA聯合分期的準確度為760%,明顯高于MSCT分期(595%, 〖WTBX〗P lt;0001)。MSCT正確判斷所有遠處轉移。同單一的MSCT檢測相比,MSCT和SAA聯合評估能顯著的提高術前TNM分期的準確率(785% vs. 636%,〖WTBX〗P =0011)。 結論 :MSCT聯合SAA檢測比單一的MSCT檢測顯著提高了直腸癌術前腫瘤分期和淋巴結轉移方面的準確度。這種新的術前評估方法的為腫瘤進展評估和術前治療決策提供了更加可靠的信息。Abstract: Objective: To determine the role of combinative assessment of 64 multislice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in preoperative rectal cancer staging. Methods : Enrolled consecutive rectal cancer patients undergoing curative surgery were evaluated by MSCT scan. Meanwhile venous blood specimens were taken to measure preoperative SAA concentration. Both MSCT staging and MSCT plus SAA staging were performed to compare with each other. Results : The study population consisted of 121 patients. The accuracy of T staging was 851% for MSCT. The accuracy in evaluating lymph nodes metastases was 760% for MSCT plus SAA compared with 595% for MSCT alone (〖WTBX〗P lt;0001). All the distant metastases were correctly detected by MSCT. The method combining MSCT with SAA led to significant improvement on preoperative TNM staging compared with MSCT alone (785% vs. 636%, 〖WTBX〗P =0011). Conclusion : MSCT plus SAA showed greater accuracy than MSCT alone in rectal cancer staging and lymph node metastases. This novel strategy of preoperative evaluation appears to provide more accurate information on tumor progression and preoperative therapy decisionmaking.
ObjectiveTo analyze the staging methods of colorectal cancer data in the current version of the Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was updated at April 16th, 2020. The columns included stage during surgery, comprehensive stage of clinical, pathologic and imaging (cpi comprehensive stage), TNM stage, pathologic T stage, imaging T stage, nerves involvement, pathologic anus stage, clinical anus stage, imaging anus stage, pathologic mesentery stage, clinical mesentery stage, imaging mesentery stage, pathologic N stage, imaging N stage, positive lymph nodes ratio, cancerous nodules, M stage, cancerous emboli, pathologic vessel stage, clinical vessel stage, imaging vessel stage, cancerous contamination, and high-risk factors. Extracted data were statistically analyzed.ResultsThe total number of data medical records (data rows) that met the criteria was 6 474, the valid data of TNM stage was 4 511 (69.7%), the valid data of stage during surgery was 5 684 (87.8%), and the valid data of cpi comprehensive stage was 4 045 (62.5%). 1 540 data (41.6%) were consistent with stage during surgery and TNM stage, and 2 884 data (76.7%) were consistent with cpi comprehensive stage and TNM stage. According to the data of T, N, and M stage, the proportion of patients with pathologic T4a stage was the highest (40.5%), followed by T3 stage (24.8%); the most T4a stage (31.9%) on the image, followed by T4b stage (28.7%). The pathologic N stage with lymph node metastasis was about 41.9% (N1 and N2), and the imaging N stage lymph node metastasis was about 51.4%. There were a total of 4 745 valid data in the M stage (73.3%). There were 4 313 valid data in the nerves involvement (66.7%), suspected involvement and confirmed involvement, were 691 (16.0%) and 253 (5.9%) respectively. The valid data of anal pathology, clinical, and imaging stage were 4 115 (63.6%), 599 (9.3%), and 598 (9.2%), and only 30 (0.7%), 8 (1.3%), and 13 (2.2%) on muscle involvement respectively. The valid data of pathologic, clinical, and imaging mesentery stage were 732 (11.3%), 589 (9.1%), and 592 (9.1%). There were 4 458 (68.9%) valid data of positive lymph nodes ratio, and 2 908 (44.9%) valid data of cancerous nodules. There were 4 286 valid data of cancerous emboli (66.2%). A total of 244 data (41.1%) of increased blood vessels around tumors in the imaging vessel stage, 274 data (46.4%) of that in clinical vessel stage, and only 1 063 (27.7%) of pathologic vessel stage. There were 3 865 valid data (59.7%) of the cancerous contamination, and the proportion of the third level (746/2 753, 27.1%) in the high-risk factors was the highest.ConclusionThrough detailed analysis of the DACCA database, it is hoped that a more complete and accurate evaluation system of tumor severity can be established, and high-risk factors can provide some ideas for judging prognosis.
Objective To summarize the research progress of preoperative staging diagnosis for gastric cancer. Methods Both the domestic and international literatures involving the preoperative staging diagnosis of gastric cancer in recent years were collected and reviewed. Results Transabdominal ultrosonography, EUS, CT, MRI, PET and diagnostic laparoscopy could provide objective evidences, and enhanced the accuracy of preoperative staging diagnosis for gastric cancer. Conclusion With the development of examination methods, the assessment of preoperative staging diagnosis of gastric cancer has been improved, and operation strategy can be made according to the correct preoperative staging.
