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Reappraise role of lymph node status in patterns of recurrence following curative resection of gastric adenocarcinoma

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Chinese Journal of Cancer Research 2021年第3期33卷 331-342页

作者： Yihui Tang jianxian lin Junpeng lin Jiabin Wang Jun Lu Qiyue Chen Longlong Caolj Mi lin Ruhong Tu Changming Huang Ping Li Chaohui Zheng Jianwei Xie Department of Gastric Surgery Fujian Medical University Union HospitalFuzhou 350001China Key Laboratory of Ministry of Education of Gastrointestinal Cancer Fujian Medical UniversityFuzhou 350108China

Objective: To examine the association between lymph node status and recurrence patterns in completely resected gastric ***: We retrospectively assessed 1,694 patients who underwent curative gastrectomy from January 2010 to August 2014. Patients stratified according to lymph node status and recurrence patterns among different subgroups were ***: Of all, 517(30.5%) patients developed recurrent disease, and complete data of recurrence could be obtained in 493(95.4%) patients. For p^(N0) patients, the patterns of recurrence were different according to p T stage: locoregional recurrence was most common in patients with p T1-2 disease(57.1%), distant recurrence was most common in patients with p T3 disease(57.1%), and peritoneal recurrence was most common in patients with p T4 a disease(66.7%). For p^(N+) patients, distant metastasis was most common pattern irrespective of p T stage. The site-specific trend of recurrence showed that locoregional recurrence increased within 5 years in patients with p^(N0)-2 disease but plateaued 3 years after surgery in patients with p N3 disease. Time to recurrence was significantly longer for the p^(N0) patients compared with the p^(N+) patients(median: 25 vs. 16 months, P=0.001).Moreover, post-recurrence survival was significantly better for the p^(N0) patients than for the p^(N+) patients(median:12 vs. 6 months, Plinicopathologic factors, lymph node status is the most important factor associated with recurrence patterns after curative gastrectomy. Lymph node status may be used as an adjunct in clinical decisionmaking about postoperative therapeutic and follow-up strategies.

关键词： Recurrence patterns lymph node status post-recurrence survival recurrence-free survival gastric cancer

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教科书式结局对新辅助化疗后行外科治疗的进展期胃癌患者的预后价值

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中华外科杂志 2024年第5期62卷 379-386页

作者：唐逸辉黄泽宁陈起跃李平谢建伟王家镔林建贤陆俊曹龙龙林密涂儒鸿郑朝辉黄昌明福建医科大学附属协和医院胃外科、普外科福建省微创医学中心福州350001

目的探讨新辅助化疗后行外科治疗的进展期胃癌患者教科书式结局(TO)的影响因素及预后价值。方法本研究为回顾性队列研究。回顾性分析2010年1月至2019年12月福建医科大学附属协和医院胃外科收治的253例新辅助化疗后行胃切除术联合D2淋巴... 详细信息

目的探讨新辅助化疗后行外科治疗的进展期胃癌患者教科书式结局(TO)的影响因素及预后价值。方法本研究为回顾性队列研究。回顾性分析2010年1月至2019年12月福建医科大学附属协和医院胃外科收治的253例新辅助化疗后行胃切除术联合D2淋巴结清扫的进展期胃癌患者的临床病理学资料,男性195例,女性58例,年龄(60.3±10.0)岁(范围:27~75岁)。根据术后是否达到TO分为TO组(168例)和非TO组(85例)。采用多因素Logistic回归分析TO的独立影响因素。采用Cox回归模型分析总体生存和无病生存的独立预后因素。将TO组和非TO组按1∶1行倾向性评分匹配,对匹配后的资料用Kaplan-Meier法行生存分析。结果253例进展期胃癌患者中,达到TO的比例为66.4%(168/253)。多因素Logistic回归结果显示,美国东部肿瘤协作组评分(OR=0.488,95%CI:0.278~0.856,P=0.012)和ypN分期(OR=0.626,95%CI:0.488~0.805,P0.05)。结论TO是新辅助化疗后行外科治疗的进展期胃癌患者术后生存的独立预后因素,并且与术后化疗获益相关,可根据患者是否达到TO制定个体化治疗方案。

关键词：胃肿瘤胃切除术新辅助化疗教科书式结局预后

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Comparison of Hematoxylin-eosin Staining and Methyl Violet Staining for Displaying Ghost Cells

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Eye Science 2013年第3期28卷 140-143页

作者： Wenxin Zhang Yongping Li jianxian lin Shangtao Wan Huanhuan Gao Lanzhi Zhang Jianliang Zheng Ping Zhang State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat-sen University

Purpose:.To compare the merits and limitations of hematoxylin-eosin(HE) and methyl violet staining for displaying ghost cells from vitreous or aqueous ***:.A specimen containing ghost cells was adjusted to five different concentrations:(12×104,.10×104,.8×104, 6×104and 4×104cells / ml) and subjected to smearing and methyl violet and HE staining..The staining results were observed by light ***: The ghost cells were readily observed at a cell density of > 8×104cells / ml with methyl violet staining,.but only a few cells were occasionally seen at lower cell densities..In contrast,.ghost cells were seen at all cell densities with HE ***: Methyl violet staining is more rapid and simpler for the identification of ghost cells, but its staining color more readily fades, the slides cannot be stored, and it is only effective at a cell density of > 8 ×104cells / ml. In contrast,.HE staining is more time-consuming but it can display cell morphology and distinguish cell components more explicitly and slides can be permanently stored. HE staining has advantages over methyl violet staining in detecting the ghost cells when the concentration is < 8×104cells / ml.

关键词：细胞密度 HE染色甲基紫苏木精显示伊红光镜观察电池组件

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A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

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Chinese Medical Journal 2014年第3期127卷 403-407页

作者： lin jianxian Huang Changming Zheng Chaohui Li Ping Xie Jianwei Wang Jiabin Lu Jun Department of Gastric Surgery Fujian Medical University Union Hospital Fuzhou Fujian 350001 China

Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy （LATG） with extended lymphadenectomy in patients with advanced gastric cancer （AGC）.This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy （OTG） for AGC without serosa *** From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa ***,gender,and depth of invasion （pT2 and pT3） were matched by propensity scoring,and 116 patients （58 LATG and 58 OTG） were selected for *** clinicopathologic characteristics,postoperative outcomes,and survival were *** There was no significant difference in clinicopathologic characteristics between the two propensity-matched *** number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups （30.8±10.2 vs.29.0±8.3）.Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group （P ＜0.05,respectively）.Rates of post-operative complications （12.1％ vs.15.5％） and postoperative mortality （0％ vs.1.7％）,as well as cumulative survival rates,were *** LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa ***,randomized trials are needed to confirm the efficacy of LATG in this patient population.

关键词： laparoscopic surgery total gastrectomy advanced gastric cancer D2 lymphadenectomy matched cohort study

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Pathological,Ultrastructural and Immunohistochemical Observations of Adenoma of Retinal Pigment Epithelium

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眼科学报 2001年第3期17卷 168-172页

作者： Ping Zhang, Guanguang Feng, Tao Yue, jianxian lin, Yuzhen Yi, Youjian PangZhongshan Ophthalmic Center, Biochemistry DepartmentSun Yat-sen University of Medical Sciences, Guangzhou 510060, China Zhongshan Ophthalmic Center Sun Yat-sen University of Medical Sciences Guangzhou 510060 China

Purpose: To Study the clinical, pathological, ultrastructural and immunohistchemicalcharacters of adenoma of the retinal pigment epithelium in order to offer evidence todiagnose this ***: Routine paraffin slices HE stain, histochemistry PAS and VG stain,transmission electron microscopy, and immunohistochemistry for S-100 and vimentinwith LSAB method were ***: The tumor cells were oval and cuboidal in shape. Part of the tumor had atubular arrangement. Around the sheets of tumors cells there was a large amount ofuniform red stick-like substances. The above matter represented positive in PAS *** of the above matter was yellow, while less of the matter showed red in VG *** electron microscopy showed that there were tight junctions between tumorcells. Immunohistochemistry showed positive for S-100, negative for ***: The ultrastructural and immunohistochemical characters of the adenoma ofretinal pigment epithelium are consistent with the retinal pigment epithelium.

关键词：眼色素上皮腺瘤病理学超微结构免疫组化

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Keratinocyte Growth Factor-2 on the Proliferation of Corneal Epithelial Stem Cells in Rabbit Alkali Burned Cornea

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眼科学报 2007年第2期23卷 107-116页

作者： lin Liu Yongping Li Shuqi Huang jianxian lin Wenxin Zhang Guangzhou Military General Hospital Guangzhou 510010 China Zhongshan Ophthalmic Center Sun Yat-sen University Guangzhou 510060 China

Purpose: To determine whether the topical application of keratinocyte growth factor-2 (KGF-2) can enhance corneal epithelial healing in rabbit alkali burned cornea. In addition, the distribution and proliferation of corneal epithelial stem cells in KGF-2-treated and control corneas were investigated to explain their mechanisms of effects on the epithelium. Methods: Twenty-four New Zealand eyes were divided into four groups, treated with KGF-2 solution (1, 50, 100 μg/ml) and PBS solution. Eighth millimeter filter paper discs, produced by standard paper punch, were soaked for 15 sec in 0.5N NaOH solution. The alkali-soaked discs were applied to the central cornea, centered on the pupil and held gently in position with forceps for 1 min. The cornea was finally irrigated over 1 min with 100 ml balanced salt solution (BSS). Keratinocyte growth factor-2 was then applied topically three times a day. The phosphate-buffered saline (PBS) group was served as a control. Each corneal epithelial defect was subsequently photographed every 24 hours with a slit lamp and was measured by computer-assisted digitizer. In each group, two rabbits were sacrificed for light microscopic examination after the interval of 7, 14 and 21 days. Meanwhile, the cornea epithelium was examined by immunohistochemistry for P63, AE5, EGFR. Results: Topical application of 10 μg/ml to 100 μg/ml KGF-2 significantly accelerated corneal epithelial wound healing when compared with controls. After 24 hours, epithelial healing rate of the 100 μg/ml KGF-2 group and the PBS treated group was (74±6)% and (40±8)% (P < 0.05). After 48 hours, the rate of the C group was (94±6)%, whereas in the control group it was (73±12)% (P < 0.05). Epithelial defects were often recurrent, which happened only two times in the 100 μg/ml KGF-2-treated group, but many times in the control group. In the corneal epithelial stem cell analysis, the number of the P63 positive cells was higher in the KGF-2-treated corneal epithelium than in

关键词：角化细胞生长因子-2 角膜上皮干细胞角膜碱烧伤治疗细胞培养

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胃癌3D腹腔镜手术的优势与劣势

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中华胃肠外科杂志 2016年第2期19卷 148-150页

作者：黄昌明林建贤福建医科大学附属协和医院胃外科福州350001

3D腹腔镜系统是近年来新兴的腹腔镜技术平台。在胃癌根治手术中，其通过构建景深及三维立体结构，还原真实的手术视野，除有利于初学者较快地度过学习曲线外，更重要的是为手术操作提供了较为精准的空间定位，使组织解剖层次更为清晰，... 详细信息

3D腹腔镜系统是近年来新兴的腹腔镜技术平台。在胃癌根治手术中，其通过构建景深及三维立体结构，还原真实的手术视野，除有利于初学者较快地度过学习曲线外，更重要的是为手术操作提供了较为精准的空间定位，使组织解剖层次更为清晰，利于腹腔镜下胃周血管裸化、淋巴结清扫及消化道重建等操作。但是，术者初期对三维视觉不适应以及3D腹腔镜特殊的设备操作和需要特殊设备进行资料展示等方面是3D腹腔镜系统存在的不足。

关键词：胃肿瘤腹腔镜 3D 外科手术

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进展期近端胃癌脾门淋巴结清扫的启示与思考

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中华消化外科杂志 2020年第1期19卷 50-54页

作者：黄昌明林建贤福建医科大学附属协和医院胃外科福州350001

脾门淋巴结清扫是进展期近端胃癌根治术中胃周淋巴结清扫的难点和焦点。虽然第5版《日本胃癌治疗指南》将脾门淋巴结排除在非大弯侧进展期近端胃癌患者D2淋巴结清扫范围外,但是相关的高级别循证医学证据仍然较少。同时,对于侵犯大弯侧... 详细信息

脾门淋巴结清扫是进展期近端胃癌根治术中胃周淋巴结清扫的难点和焦点。虽然第5版《日本胃癌治疗指南》将脾门淋巴结排除在非大弯侧进展期近端胃癌患者D2淋巴结清扫范围外,但是相关的高级别循证医学证据仍然较少。同时,对于侵犯大弯侧的进展期近端胃癌患者,指南推荐行脾切除术以清扫脾门淋巴结,而在逐渐增多的循证医学证据支持下,保脾脾门淋巴结清扫术越来越多地得到学者的认可。同时,腹腔镜技术的出现为保脾脾门淋巴结清扫术提供一种新的手段,笔者团队在国际上首次报道"黄氏三步法"腹腔镜保脾脾门淋巴结清扫术,不仅降低手术难度,使该技术易于推广,还显示出良好的微创效果。临床实践中脾门区血管后方淋巴结的清扫,也是争议的焦点之一。因此,对于脾门淋巴结清扫这项困难的技术,不仅要求胃肠外科医师进行技术上的探索,对其清扫指征的探索也尤为重要,既要避免不需要清扫患者的扩大手术,但也不能因为技术困难而使高危患者失去根治机会。

关键词：胃肿瘤外科手术脾门淋巴结淋巴结清扫术腹腔镜检查

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胃癌腹腔镜手术的循证医学评价

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中国肿瘤临床 2013年第22期40卷 1357-1360页

作者：黄昌明林建贤福建医科大学附属协和医院胃外科福州市350001

腹腔镜胃癌手术已近20年的历史,其运用范围已日益广泛。但是,目前腹腔镜胃癌手术仍未被大多数临床医师所掌握。相关循证医学证据显示,腹腔镜胃癌手术能够达到与开腹手术相当的肿瘤根治效果,且使其具有较好的微创效果。在远期疗效方面,... 详细信息

腹腔镜胃癌手术已近20年的历史,其运用范围已日益广泛。但是,目前腹腔镜胃癌手术仍未被大多数临床医师所掌握。相关循证医学证据显示,腹腔镜胃癌手术能够达到与开腹手术相当的肿瘤根治效果,且使其具有较好的微创效果。在远期疗效方面,早期胃癌的腹腔镜手术已经获得良好的远期疗效,而在进展期胃癌方面,仍缺乏多中心的前瞻性随机对照研究结果来评价腹腔镜手术的优劣。外科医师只有严格选择合适病例,手术中严格遵循恶性肿瘤手术的根治原则,才能使腹腔镜胃癌根治术不仅具有微创优势,而且可以取得与开腹手术相当的远期疗效。

关键词：腹腔镜手术胃癌胃切除术循证医学

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局部进展期胃癌的综合治疗策略

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中华消化外科杂志 2022年第3期21卷 342-347页

作者：黄昌明林巨里林光锬林建贤福建医科大学附属协和医院胃外科福州350001

胃癌是常见的消化系统恶性肿瘤之一,目前外科手术仍然是治疗进展期胃癌的主要手段,进展期胃癌行D2淋巴结清扫术已逐渐达成共识。在D2淋巴结清扫术的基础上,由经验丰富的外科医师完成腹腔镜远端胃癌根治术的安全性和肿瘤学疗效均不劣于... 详细信息

胃癌是常见的消化系统恶性肿瘤之一,目前外科手术仍然是治疗进展期胃癌的主要手段,进展期胃癌行D2淋巴结清扫术已逐渐达成共识。在D2淋巴结清扫术的基础上,由经验丰富的外科医师完成腹腔镜远端胃癌根治术的安全性和肿瘤学疗效均不劣于开腹手术,且腹腔镜保脾脾门淋巴结清扫术安全可行。辅助化疗和新辅助化疗可以延长胃癌患者术后生存时间,常见化疗方案有单药S-1、XELOX方案或S-1联合多西他赛。DOS方案、SOX方案和FLOT方案是常用的新辅助化疗方案。分子靶向药物或免疫药物尚未被批准用于局部进展期胃癌围手术期一线治疗,但越来越多的研究结果提示联合分子靶向治疗或免疫治疗,可以有效提高新辅助治疗后进展期胃癌的R_(0)切除率或病理学完全缓解率,能否延长患者生存时间等尚无证据支持。针对进展期胃癌最佳的综合治疗方案,尚无统一标准,需要深入研究。

关键词：胃肿瘤手术化疗靶向治疗免疫治疗

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