目的 探讨结直肠癌同时合并卵巢转移的临床特点和外科治疗方法。 方法 回顾性分析并总结1985～2005年间我院收治的14例结直肠癌同时合并卵巢转移的临床资料。结果 所有患者均有腹痛、或腹胀、或腹部包块、或血便、或大便习惯改变等症状。月经期患者占57.1%（8/14）。血CEA阳性者3/5例，12例行B超检查，7例行CA125、B超、纤维结肠镜及钡灌肠辅助检查者均为阳性发现。结直肠管状腺癌占71.4%，中低分化腺癌占78.6%。3例行免疫组化检查，其CK7和CK20均为阳性表达。结论 是否合并广泛的腹腔内转移、能否有条件接受广泛的手术切除以及术后的辅助放化疗是决定结直肠癌卵巢转移患者存活时间的关键。
Objective To investigate the surgical treatment effect for patients with gastrointestinal stromal tumor (GIST) of the rectum and its clinical characteristics. Methods The medical records of 22 patients who had undergone surgery for GIST of the rectum between March 2003 and February 2010 in this hospital were analyzed. Results There were 14 males and 8 females with a median age of 51 years (range 27－81 years). There were 12 patients without symptoms, 10 patients with clinical symptoms, included: hematochezia 4 cases, difficult defecation 2 cases, shape of defecate change 2 cases, crissum pain 1 case, times of defecate increase 1 case. Course of disease was 2 weeks-18 months with average 6 months. All patients underwent curative resection: in form of abdominoperineal resection in 3 patients, transanal excision in 8 patients, Mason operation in 8 patients, and transanal endoscopic microsurgery in 3 patients. The median tumor size was 3.1 cm (range 0.4－18.5 cm). The diameter of tumor lt;2.0 cm was 11 cases, 2.1-5.0 cm was 8 cases, 5.1-10.0 cm was 2 cases, gt;10.0 cm was 1 case. Twentyone of 22 cases were positive for CD117, 18 cases positive for CD34, 5 cases positive for αsmooth muscle actin (SMA), and 2 cases positive for Desmin. Local recurrence or hepatic metastasis developed in 2 patients with average 26 months of follow-up (range 1 month to 7 years), and who were then treated with imatinib for more than 1 year. Conclusions The primarily treatment of rectal GIST is surgical. Imatinib therapy is effective against local and systemic recurrent GIST of the rectum.
Objective To explore whether mutations of p53 gene and hMLH1 gene may be an early event of carcinogenesis in rectal cancer. Methods The expressions of p53 and hMLH1 protein in 32 patients with early rectal cancer, 32 patients with rectal adenoma， and 30 patients with normal rectal mucosa were detected by PV-9000 immunohistochemical method between February 2003 and July 2009 in this hospital. Results ① The positive expression rates of p53 protein were 0 (0/30), 59.38% (19/32), and 68.75% (22/32) in the normal rectal mucosa, rectal adenoma, and early rectal cancer, respectively. There was no difference between the rectal adenoma and early rectal cancer (Pgt;0.05), but which were higer than that of the normal rectal mucosa (Plt;0.01). The negative expression rates of hMLH1 protein were 0 (0/30), 12.50% (4/32), and 50.00% (16/32) in the normal rectal mucosa, rectal adenoma, and early rectal cancer, respectively. The negative expression rate of hMLH1 protein in the early rectal cancer was significantly higher than that in the rectal adenoma or the normal rectal mucosa (Plt;0.01). ② The positive expression of p53 concomitant negative expression of hMLH1 in the rectal adenoma and early rectal cancer were 9.38% (3/32) and 37.50% (12/32), respectively, the difference was statistically significant (P=0.008). ③ In the early rectal cancer, the positive expression of p53 and the negative expression of hMLH1 were closely related to the degree of differentiation (Plt;0.05), but which weren’t related to the patient’s gender, age, tumor maximum diameter, depth of invasion or fecal occult blood (Pgt;0.05). ④ The positive expression of p53 was closely related to higher adenoma hyperplasia (P=0.009), while not of negative expression of hMLH1 (Pgt;0.05). Conclusion Simultaneous mutations of p53 gene and hMLH1 gene may be an early event of carcinogenesis in rectal cancer.
Objective To investigate the accuracy of preoperative high-resolution magnetic resonance imaging (MRI) scans to predict tumor stage, lymph node stage, and circumferential resection margin (CRM) involvement. Methods Between September 2006 and May 2009, 42 patients with histologically proven rectal cancer by the colonoscopic biopsy in Peking Union Medical College Hospital were staged preoperatively using MRI. All of the patients underwent total mesorectum excision (TME) operation within 1 week after MRI examination. The specimens were reported according to the 2002 TNM staging system for primary colorectal cancer of the American Joint Committee on Cancer (AJCC). Concordance between radiologic staging of tumor, local lymph node, and CRM involvement and pathologic reporting was assessed by means of the Kappa statistic.Results For all of 42 patients, MRI correctly staged the tumor in 36 patients, understaged in 3 patients and overstaged in 3 patients. Statistically, there was a better correlation between pathologic and radiologic tumor staging (Kappa=0.731, P=0.000). MRI correctly staged lymph node status in 31 patients, understaged in 5 patients and overstaged in 6 patients. Statistically, there was a common correlation between pathologic and radiologic lymph node staging (Kappa=0.410, P=0.009). MRI correctly reported the status of the CRM in 40 patients. Statistically, there was the best correlation between pathologic and radiologic reporting of CRM involvement (Kappa=0.829, P=0.000). Conclusion Preoperative highresolution MRI scans has a good concordance with pathologic tumor stage but common with pathologic lymph node stage. Preoperative highresolution MRI can provide reliable information about CRM and thus help to choose which patient could benefit from the preoperative neoadjuvant therapy.
Objective Heparan sulfate proteoglycans (HSPGs) is an important component of the extracellular matrix. syndecan-1, a member of syndecan family, belongs to HSPGs and plays an important role in cell morphology and intracellular arrangement. The present study was designed to investigate the expression of syndecan-1 in patients with colorectal cancer, to analyse its relationship to cancer progression and clinical prognosis. Methods Paraffin-embeded specimens were collected from 31 patients with colorectal cancers from 2003 to 2004 in Peking Union Medical College Hospital. Syndecan-1 protein expression was measured by immunohistochemistry. Its expression was evaluated with relationship to clinicopathological factors, including tumor infiltration, tumor differentiation, lymph node metastasis, accompanying with colorectal adenoma and 2-year survivals. Results Immunohistochemistry in 31 specimens showed syndecan-1 were detected positive in 1 colorectal cancer tissue (3.2%), while positive in 29 normal tissues (93.5%), with significant difference (P＜0.01). No prognostic differences could be found in the clinic outcome because of the high expression rate of syndecan-1 in normal tissues and low expression rate in cancer tissues. Conclusion Syncecan-1 is expressed in normal colorectal tissues and rarely expressed in cancer tissues.
Objective Heparanase can specifically cleave carbohydrate chains of heparan sulphate proteoglycans, which is an important component of the extracellular matrix. This study was designed to investigate the expression of heparanase in patients with colorectal cancer, and to analyze its relationships with progression of the cancer and clinical prognosis. Methods Samples were collected from 36 patients with colorectal cancers from 2003 to 2004 in Peking Union Medical College Hospital, and were embeded by Paraffin and fresh-frozened. The expression of heparanase mRNA and its protein were measured by RT-PCR and immunohistochemistry. The relationships between these expressions and the clinicopathologic information (tumor invasion, tumor differentiation, lymph node involvement, accompanying with colorectal adenoma and 2-year survival) were also evaluated. Results The expressions of heparanase mRNA in colorectal cancer (19/31， 61.3%) were significantly higher than those in normal colorectal tissues (6.5%). The overexpressions in normal tissues were positively correlated to the incidence of adenoma in patients with colorectal cancer （r=0.352， P=0.024）. The result of immunohistochemistry also showed that heparanase mainly expressed in the vascular endothelium within cancer tissues and the peripheral invased region outside cancer tissues. The 2-year disease-free-survival in patients with negative heparanase expression (88.9%) was higher than that with positive heparanase expression (50.0%), but there was no significant difference （P=0.078）. Conclusion Heparanase overexpressed in colorectal cancer tissues, and thus it may take a role as an indicator for the formation and prognosis of colorectal cancer.
ObjectiveTo compare clinical outcomes between laparoscopic (LAP) and open surgery for non-metastatic colon cancer of T4a stage.MethodsWe retrospectively analyzed clinical data of non-metastatic colon cancer patients of T4a stage with confirmed pathological results who underwent curative resection in Peking Union Medical College Hospital between January 2011 and December 2017. These patients were allocated into LAP group (n=107, underwent laparoscopic radical operation) and open group (n=52, underwent open surgery).ResultsThere were no significant difference in operating time, number of lymph nodes harvested, number of positive lymph nodes, incidence of complications within 30 days, and Clavien-Dindo grading between the LAP group and open group (P>0.05), but intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay in the LAP group were less than (shorter than) those of the open group (P<0.05).ConclusionLaparoscopic approach for non-metastatic colon cancer of T4a stage is safe and feasible, and it has advantages including less intraoperative blood loss, faster recovery, and shorter hospital stay.