索拉非尼治疗肝细胞性肝癌肝移植后的复发

背景：肝细胞肝癌肝移植后肿瘤复发转移十分常见,肿瘤进展迅速,缺乏有效治疗方法。 目的：观察索拉非尼联合介入治疗肝细胞性肝癌肝脏移植后复发的疗效。 方法：选择24例肝细胞性肝癌肝移植后肿瘤复发患者,其中单纯接受介入治疗者16例,接受索拉非尼联合介入治疗者8例,通过Log-rank检验比较两组患者移植后6个月生存率、1年生存率、移植后无瘤生存时间。 结果与结论：介入治疗组移植后平均无瘤生存时间为95 d,联合治疗组为100 d,两组间差异无显著性意义(P=0.280 5)。移植后终生随访,介入化疗组16例全部死亡,中位生存时间为211 d,6个月生存率为69%,1年生存率为25%。联合治疗组死亡2例,6个月生存率为100%,1年生存率为100%,两组间差异有显著性意义(P < 0.000 1)。说明对于肝细胞性肝癌肝移植后肿瘤复发患者,采用索拉非尼+介入治疗联合治疗方案可显著提高患者生存期及生存率。     

肝细胞癌肝外转移对患者生存预后的影响

目的：探讨肝细胞癌（ HCC）肝外转移最常见的部位及对患者生存预后的影响。方法收集经PET/CT检查确诊HCC肝外转移的病例132例,对其HCC转移部位进行回顾性分析,同时行单因素、多因素生存分析。结果 HCC 肝外转移最常见的部位是淋巴结（54.5%,72/132）、骨（24.2%,32/132）和肺（21.2%,28/132）；单因素和多因素生存分析均提示淋巴结转移对患者生存预后有显著影响（P值均〈0.05）,而其他转移部位和生理指标对生存预后均无显著影响（P值均〉0.05）。结论淋巴结转移在HCC肝外转移最常见且可显著影响患者生存预后,及早诊断及治疗淋巴结转移病灶将能改善患者生存质量,延长生存时间。     

肺大细胞神经内分泌癌的预后影响因素：一项基于SEER数据库的研究

目的:探讨肺大细胞神经内分泌癌（LCNEC）患者的生存预后及其影响因素。方法:横断面研究。纳入监测、流行病学和最终结果数据库（SEER）2010年1月—2016年12月收录的2 504例肺LCNEC患者,其中男1 357例、女1 147例,<60岁633例、60～80岁1 664例、>80岁207例。采用Kaplan-...     

肝癌靶向载体药物的靶向作用与应用分析

背景：肝癌是常见的恶性肿瘤之一,选择有效的治疗药物及治疗方法具有重要的意义。 目的：评价载体缓释化疗药物对肝癌的靶向治疗作用及效果。 方法：分析临床常用的肝癌化疗药物5-氟尿嘧啶、丝裂霉素以及表阿霉素载体缓释系统对肝脏肿瘤的靶向性特征以及对肿瘤的抑制和杀伤作用。并观察总结海南省农垦总医院肿瘤内科163例中晚期肝癌患者应用化疗药物5-氟尿嘧啶、丝裂霉素、表阿霉素,同时采用导管动脉化疗栓塞辅助治疗的临床效果。 结果与结论：5-氟尿嘧啶、丝裂霉素以及表阿霉素载体缓释系统通过不同的作用机制显示出对肝脏肿瘤的靶向性特征,并且对肝脏肿瘤具有较高的抑制和杀伤作用,减少药物用量,降低毒副作用,提高治疗效果。此外,治疗时辅助应用导管动脉化疗栓塞可以延长患者的生存期,提高肝癌的治疗效果。     

Combined A20 and tripartite motif-containing 44 as poor prognostic factors for breast cancer patients of the Japanese population

We previously reported that a strong immunoreactivity of tripartite motif-containing 44 (TRIM44) predicts the poor prognosis of patients with invasive breast cancer, and proposed that TRIM44 activates nuclear factor-κB (NF-κB) signaling as a causative mechanism. In the present study, we examined the clinicopathological roles of A20, which is known to be an NF-κB responsive gene, with TRIM44, in an updated cohort. Tissue samples of invasive breast cancer were obtained from 140 Japanese female breast cancer patients who underwent surgical treatment. Immunoreactivities of A20 and TRIM44 were analyzed using specific antibodies for each protein. A positive A20 immunoreactivity was significantly associated with a shorter disease-free survival (P = 0.043) and was positively correlated with TRIM44 immunoreactivity (P = 0.039). Combined use of the immunoreactivities for two proteins revealed that double-positive status for both A20 and TRIM44 immunoreactivities was associated with a shorter disease-free survival (P = 0.012) and was an independent factor for poor prognosis. These results indicate that a combined A20 and TRIM44 immunoreactivity predicted the prognosis of patients with invasive breast cancer. Moreover, the positive correlation between A20 and TRIM44 immunoreactivities suggested that the activation of NF-κB signaling by TRIM44 could occur in clinical breast cancer tissues.     

Long-term Treatment Outcomes for Autoimmune Hepatitis in Korea

Immunosuppressive therapy can improve clinical, biochemical and histological features and considerably prolong survival in patients with autoimmune hepatitis. Although ethnicity may affect disease severity and presentation, the long-term outcome of immunosuppression in Korean populations is unknown. This study was aimed to assess the efficacy of immunosuppressive therapy and determine the prognosis of autoimmune hepatitis in Korean populations. We reviewed the medical records of 86 patients diagnosed as having autoimmune hepatitis at the Samsung Medical Center between 1994 and 2008. Seventy-two (83.7%) patients reached remission after a median treatment duration of 3.5 months (range 1 to 44 months). Attempts to withdraw medications were made in 24 cases after the median treatment duration of 36 months (median 6 to 125 months). Thirteen of 24 (54.1%) patients relapsed after treatment withdrawal. Of the 86 patients, 6 (7.2%) experienced disease progression and the overall 5-and 10-yr progression-free survival rates were 91.2% and 85.5%, respectively. In conclusion, immunosuppressive therapy for autoimmune hepatitis results in a favorable rate of remission and excellent progression-free survival, but the relapse rate after treatment withdrawal is high. This suggests that long-term immunosuppressive therapy may be particularly important for treatment of Korean patients.     

循环肿瘤细胞与肿瘤恶性行为间的关系

转移和复发是恶性肿瘤最主要的死因。近年研究发现,外周血循环肿瘤细胞（circulating tumor cells,CTCs）可成为判断肿瘤预后的重要指标。在提倡个体化治疗的当下,CTC检测可帮助指导临床设计更有效的治疗方案,从而延长患者寿命,提高患者生存率。本文综述CTCs与肿瘤复发转移的关系和CTCs分离富集检测技术研究进展。     

Cancer and venous thromboembolism. Clinical implications of strong association

Venous thromboembolism is a common occurrence inpatients with cancer. Among risk factors for thromboembolism are prolonged immobilization, especially during hospital stay, surgery, and chemotherapy with or without adjuvant hormone therapy. Although prophylaxis and treatment of thromboembolism in cancer patients encompass those agents that are commonly utilised in patients free from malignancy, there are many unique issues in cancer patients that often make their use more problematic. Low-molecular weight heparins are the cornerstone of prophylaxis and treatment of venous thromboembolism in cancer patients. Furthermore, they have the potential to prolong patients survival, at least in those with more favourable prognosis. Approximately 10% of patients with idiopathic venous thromboembolism harbour an underlying malignancy that can be detected by an extensive diagnostic work-up. However, whether screening for occult malignancies ultimately improves prognosis and prolongs survival remains to be demonstrated.     

糖尿病与结直肠癌患者预后相关研究进展

目前国内外大量研究证实糖尿病是诱发结直肠癌的独立危险因素,其机制与高血糖尧高胰岛素血症尧胰岛素样生长因 子尧胰岛素抵抗等密切相关遥为延长合并糖尿病的结直肠癌患者的生存期,改善患者的生存质量,关于糖尿病与结直肠癌预后 的研究越来越多遥本文就糖尿病与结直肠癌预后相关性的研究进展做一综述遥     

Prevalence and prognosis of synchronous distant metastatic tonsil squamous cell carcinomas

Background: To analyze the prevalence proportions and prognostic factors of synchronous distant metastases in patients with tonsil squamous cell carcinomas (TSCC).Methods: TSCC patients were extracted from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2014. We examined the association between clinical manifestations and distant metastases using Chi-squared tests. Predictors of 5-year survival were assessed using univariate and multivariate analyses.Results: A total of 6193 patients were analyzed and lung was the most common site of distant metastases. Poorly/undifferentiated differentiation was found to be significantly correlated with lung metastasis (p=0.033) and liver and bone metastases were associated with African American (p=0.000 and p=0.000, respectively). A higher T classification was associated with higher prevalence of lung, liver, bone and brain metastasis (p=0.000, p=0.000, p=0.000 and p=0.007, respectively). The same results were found in N classification in lung, liver, and bone metastasis (p=0.000, p=0.000, and p=0.000, respectively). Worse prognosis was associated with older age, Blacks, lower grade, higher T and N classification, no surgery therapy and more metastatic sites.Conclusion: Lung was the most frequent lesion of synchronous distant metastases and liver and bone metastases were associated with African American. Higher T and N classification were independent prognostic parameters for higher prevalence of lung, bone, liver and brain metastasis. Worse prognosis was associated with older age, African Americans, lower grade, higher T and N classification, no surgery therapy and more metastatic sites.     

Outcome prediction values of soluble human epidermal growth factor receptor-2 extracellular domain in metastatic breast cancer

Background: HER-2 overexpression is an independent predictor for poor prognosis of breast cancer patients. Recently, extracellular domain of HER-2 (ECD) was found detectable in the serum of breast cancer patients. In this prospective study, we wonder whether ECD levels predict the clinical outcome of metastatic breast cancer patients. Methods: ECD were measured in 190 women with metastatic breast cancer. Chi-square test was performed to determine the relationship between ECD status and clinical outcomes. Kaplan-Meier curves were applied for survival analysis. Results: Elevated ECD levels were significantly associated with short-term response to Herceptin treatment. The median PFS was significantly longer in ECD-Low patients. The patients who remained low ECD levels or achieved low ECD levels after treatments have significantly longer PFS than those whose levels remained high or converted from low to high. Conclusions: Overall, our results support the clinical utility of measuring serum HER2 ECD levels in patients with advanced breast cancer. Baseline and serial measurements of serum ECD levels are reliably predictive of clinical outcome of breast cancer patients.     

Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects

Hepatocellular carcinoma (HCC) is usually accompanied by chronic liver damage, which sometimes influences the selection of HCC treatment. The Barcelona Clinic Liver Cancer (BCLC) staging system, which was first introduced in 1999, is the most commonly used worldwide. Although the intermediate-stage (BCLC stage B) includes the largest number and heterogeneous HCC patients, the recommended treatment option is transarterial chemoembolization (TACE) only. However, recent progress in radical treatments such as hepatic resection, liver transplantation, radiation therapy, and percutaneous therapy has made it possible to treat selected patients with BCLC stage B HCC. Radical treatments are expected to prolong survival time. To-date, TACE has also progressed. In addition to conventional TACE, balloon-occluded TACE and drug-eluting beads TACE are available. These new modalities of TACE will improve therapeutic efficacy and reduce adverse events. One of the most serious concerns of TACE is that repeated TACE reduces the treatment effect and induces liver function impairment. The decision on when TACE should be interrupted is complex. Many molecular targeted agents are now available, and immune checkpoint inhibitors will soon be available for HCC patients with Child-Pugh class A worldwide. Under these circumstances, in patients with TACE unsuitability, switching to molecular targeted agents before deterioration of liver function might improve the prognosis compared to repeated TACE. We should pay attention to stop TACE in TACE-unsuitable HCC patients as it can induce the deterioration of liver function.     

替吉奥联合阿帕替尼治疗晚期胰腺癌的疗效分析

目的 探讨替吉奥联合阿帕替尼治疗晚期胰腺癌的临床疗效。方法 选取2016年5月~2018年5月我院收治的100例晚期胰腺癌患者作为研究对象,按照数字随机分为对照组和研究组,每组50例。对照组采用阿帕替尼治疗,研究组采用替吉奥联合阿帕替尼治疗,比较两组PR、PD及化疗后血常规、肝功、不良反应情况。结果 研究组PR、SD分别为46.00%、28.00%,多于对照组的26.00%、6.00%,差异有统计学意义（P＜0.05）;研究组PD占26.00%,少于对照组的68.00%,差异有统计学意义（P＜0.05）。研究组白细胞减少、中性粒细胞减少、血小板减少、贫血、乏力、厌食、氨基转移酶升高、腹泻均低于对照组,差异有统计学意义（P＜0.05）;研究组5个月、10个月、15个月的无进展生存率,均高于对照组,差异有统计学意义（P＜0.05）。结论 替吉奥联合阿帕替尼治疗晚期胰腺癌有利于改善患者的临床症状,降低不良反应发生率,延长患者生命。     

Potential role of TNF alpha blockers in delaying the progression of hepato-renal syndrome

Hepatorenal syndrome occurs in patients with advanced liver cirrhosis and is associated with functional renal impairment and poor prognosis. These patients present a challenge to physicians and management strategies. Although various pharmacological therapies are available, large randomized controlled trials are required to determine which treatment modality is most effective to improve survival rates along with its dose and duration of treatment. The overproduction of tumor necrosis factor-alpha (TNF-alpha) has been postulated to play a role in progression of this disease, being associated with hyperdynamic circulation and inflammatory process. Moreover, increasing the levels of TNF-alpha during the course of hospitalization is suggested to be associated with increased mortality. Hence the role of TNF-alpha inhibitors, such as pentoxifylline, may prove to be become a new clinical pathway. Various randomized clinical trials have demonstrated a significant reduction in mortality in patients receiving pentoxifylline, in comparison to the control group. This survival rate benefit was associated with decrease in the incidence of hepatorenal syndrome in these patients. We propose a double-blinded trial to test the hypothesis, in which patients with advanced liver disease without evidence of hepatorenal syndrome are recruited. The control group receives the standard management while the case group receives standard management along with TNF-alpha blockers. If the cases develop hepatorenal syndrome at a significant duration later in comparison to the control group, our hypothesis will be confirmed. Our methodology is limited due to costs of TNF-alpha inhibitors in a developing country setup, hence it has only been proposed as a hypothesis. If the recommended trial confirms our hypothesis, we might see favorable outcomes and improved survival rates in patients with decompensated liver diseases.     

缓释药物治疗胃癌的不同缓释性能及靶向效应

背景：化疗药物缓释系统能够改善化疗药物对胃癌的治疗效果,是目前药物材料研究的热点。 目的：评价不同缓释药物系统治疗胃癌的缓释性能及靶向作用效果。 方法：通过不同的制备方法获得5-氟尿嘧啶聚乳酸缓释药物、5-氟尿嘧啶壳聚糖缓释药物、纳米活性炭吸附丝裂霉素缓释药物以及几丁糖顺铂缓释药物,并检测上述药物的缓释性能特征,同时明确上述缓释药物对胃癌的靶向作用以及对胃癌的治疗效果。 结果与结论：5-氟尿嘧啶聚乳酸缓释药物、5-氟尿嘧啶壳聚糖缓释药物、纳米活性炭吸附丝裂霉素缓释药物以及几丁糖顺铂缓释药物具有良好的药物缓释性能,可以延长药物与肿瘤组织的作用时间,使化疗药物发挥更强的胃癌细胞抑制和杀伤作用,改善胃癌患者的预后,延长胃癌患者的生存。此外,采用腹腔灌注化疗药物的给药方式,可以进一步提高化疗药物对胃癌组织的杀伤作用。     

Comparison of rifaximin and lactulose for the treatment of hepatic encephalopathy: a prospective randomized study

Rifaximin has been reported to be effective for the treatment of hepatic encephalopathy (HE) in Europe. However, it is unknown whether Rifaximin is effective for the treatment of HE in Koreans, therefore we conducted a open-label prospective randomized study to evaluate the efficacy of rifaximin versus lactulose in Korean patients. Fifty-four patients with liver cirrhosis and hepatic encephalopathy were enrolled. Thirty-two patients were randomized to receive rifaximin and 22 to receive lactulose both over a 7-day periods. Before and at the end of treatment, gradation of blood ammonia, flapping tremor, mental status, number connection test (NCT) were performed and estimation of HE indexes determined. Both rifaximin and lactulose were effective in the majority of patients (84.4% and 95.4%, respectively, p = 0.315). Blood NH3, flapping tremor, mental status, and NCT was significantly improved by rifaximin and lactulose, and the post- treatment levels of these measures were similar for the rifaximin and lactulose-treated groups, as was the HE index (rifaximin group (10.0 --> 4.2, p = 0.000); lactulose group (11.3 --> 5.0, p = 0.000)). One patient treated with rifaximin complained of abdominal pain, which was easily controlled. There was no episode of renal function impairment in either treatment group. Rifaximin proved to be as safe and as effective as lactulose for the treatment of Korean patients with hepatic encephalopathy.     

经口腔前庭腔镜甲状腺切除术联合131Ⅰ治疗化型甲状腺癌的近期效果及分析

目的:分析经口腔前庭腔镜甲状腺切除术（TOETVA）联合放射性碘131（131Ⅰ）治疗分化型甲状腺癌（DTC）的效果。方法:回顾性分析2018年7月至2020年5月南方医科大学珠江医院和中山市东凤人民医院收治的80例DTC患者临床资料,按照治疗方案不同分为对照组（46例,实施TOETVA术联合优甲乐治疗）和研究组（34例,接受TOETVA术联合131Ⅰ治疗）。对比两组疗效、甲状腺指标、血清白细胞分化抗原44变异型6（CD44V6）、可溶性白细胞介素-2受体（sIL-2R）水平与细胞凋亡信号受体（Fas）、细胞周期素E蛋白表达、唾液腺功能、近期进展情况。结果:研究组治疗总有效率（82.35%）比对照组（58.70%）高（P<0.05）;研究组治疗后甲状腺球蛋白抗体、促甲状腺激素、甲状腺球蛋白水平均比对照组低（P<0.05）;研究组治疗后血清CD44V6、sIL-2R水平与细胞周期素E蛋白均比对照组低,血清Fas蛋白表达比对照组高（P<0.05）;研究组治疗前后右侧颌下腺、左侧颌下腺、右侧腮腺、左侧腮腺的排泌分数与对照组相比,差异无统计学意义（P>0.05）;研究组随访2年内无病生存率（91.18%）比对照组（71.74%）高（P<0.05）;研究组随访2年内复发率（2.94%）、转移率（8.82%）与对照组（13.04%、21.74%）相比,差异无统计学意义（P>0.05）。结论:TOETVA术联合131Ⅰ治疗有助于提高DTC临床效果,改善患者甲状腺指标,抑制恶性细胞增殖转移,提升近期局部控制率,且对患者唾液腺功能无明显影响。     

中晚期非小细胞肺癌的支气管动脉介入治疗的临床研究

目的观察健择、顺铂联合支气管动脉介入化疗治疗中晚期非小细胞肺癌的临床疗效。方法将64例中晚期肺癌患者随机分为支气管动脉灌注治疗组（治疗组）和静脉注射治疗组（对照组）,每组32例。观察两组疗效、生存率和生活质量。结果治疗组缓解率65.63%,中位生存期10个月,生存1年以上患者占52.13%;对照组缓解率28.13%,中位生存期6个月,生存1年以上患者占28.13%。治疗组的缓解率、1年生存率较对照组明显提高,差异均有统计学意义（P〈0.05）。治疗组的恶心呕吐症状较对照组明显减少（P〈0.05）。结论支气管动脉灌注治疗肺癌的临床疗效优于静脉滴注。更有利于改善患者的生活质量、延长患者生存时间的作用,减轻化疗药物的毒副作用。     

Clinical significance of NQO1 polymorphism and expression of p53, SOD2, PARP1 in limited-stage small cell lung cancer

Background: Small cell lung cancer (SCLC) is one of highly aggressive cancers with poor prognosis. Unfortunately, there are as yet no molecular targets that can be exploited to prolong survival in patients with SCLC. This study aimed to investigate possible molecular markers associated with prognosis in limited-stage small cell lung cancer (LS-SCLC). Methods: The demographic and clinical data for LS-SCLC patients treated in a tertiary care hospital between January 2008 and December 2012 were retrospectively reviewed. NQO1 polymorphism and the expression of p53, SOD2, PARP1 were examined in biopsy specimens, and the factors affecting prognosis were identified. Results: 79 patients with LS-SCLC having available pathologic tissues were analyzed. 84.8% of them received both chemotherapy and radiotherapy. NQO1 polymorphism was detected in 60.0% (45/79; heterozygous in 26 patients, homozygous in 19 patients). Over-expression of p53, SOD2, PARP1 was seen in 45.6% (36/79), 38.0% (30/79) and 41.8% (33/79) of the patients, respectively. The univariate Cox proportional hazards model revealed that serum lactate dehydrogenase (LDH) levels and PARP1 expression were associated with disease progression. In the multivariate analysis, only PARP1 expression was a significant independent prognostic factor for progression-free survival (hazard ratio: 0.494; 95% CI, 0.267-0.913, P = 0.025). Conclusions: PARP1 expression is correlated with longer progression-free survival in LS-SCLC requiring further studies to clarify the precise role of PARP1 and the relevance of PARP1-targeted therapy.     

Increased expression of thioredoxin-1, vascular endothelial growth factor, and redox factor-1 is associated with poor prognosis in patients with liver metastasis from colorectal cancer

We examined whether the expression of thioredoxin-1 (Trx-1) was associated with patient prognosis after liver resection for metastatic colorectal cancer. Eighty-four patients underwent resection of liver metastases from colorectal cancer, leaving no macroscopic evidence of residual tumor. Immunohistochemical study was performed to evaluate the relation among Trx-1, vascular endothelial growth factor (VEGF), and redox factor-1 (Ref-1) expression and the clinicopathologic characteristics and patient survival. Thirty-seven patients (44.0%) with Trx-1-positive metastases had shorter survival after primary liver resection (P = .0003) than the 47 patients (56.0%) with Trx-1-negative metastases. The percentage VEGF-positive and Ref-1-positive metastases was significantly higher in patients with Trx-1 expression (P = .0009 and .0002, respectively). Multivariate analysis revealed that Trx-1 expression was an independent prognostic factor. Expression of VEGF and Ref-1 is associated with Trx-1 overexpression, which is related to a poor prognosis in patients with liver metastases from colorectal cancer.