急诊TACE介入治疗肝癌破裂出血的临床疗效及安全性分析

目的 探讨急诊肝动脉化疗栓塞术(TACE)介入治疗肝癌破裂出血的临床疗效及安全性.方法 选择肝癌破裂出血患者38例,均行TACE介入治疗.分析急诊TACE介入治疗效果,随访180 d,观察患者TACE术后生存率,并对影响患者生存的相关因素进行分析.结果 随访180 d,中位生存时间为(59.83±3.61)d;经30 ...     

TACE及手术切除治疗肝癌破裂出血疗效观察

目的:探讨经导管肝动脉化疗栓塞术(TACE)及手术切除治疗肝癌破裂出血的临床价值。方法:对我院30例肝癌破裂出血患者的临床资料进行回顾性分析,其中经TACE治疗21例、手术切除9例以及TACE后再手术切除10例。结果:经TACE治疗21例,其中1例患者因肝功能欠佳,治疗后两个月死于肝功能衰竭。10例患者1月后进行II期手术。单纯TACE治疗患者术后1年存活率为27.3%(3/11),10例经TACE治疗后II期手术患者1年存活率为70.0%(7/10),9例行Ⅰ期手术切除的患者中,死亡1例,发生腹腔种植转移者5例,术后1年存活率为44.4%(4/9)。TACE治疗后行II期手术患者治疗明显高于单纯TACE治疗患者(P<0.01)及I期手术切除患者(P<0.05)。结论:TACE治疗肝癌破裂出血安全、迅速,TACE治疗后行手术切除可显著降低肿瘤腹腔种植转移率,提高患者生存率。     

肝动脉化疗栓塞与肝动脉化疗栓塞联合无水乙醇注射治疗原发性肝癌疗效比较

目的:比较肝动脉化疗栓塞(TACE)与肝动脉化疗栓塞联合无水乙醇注射(PEI)治疗原发性肝癌的治疗效果.方法:52例患者接受TACE治疗,58例患者接受TACE联合PEI治疗,比较两组患者1、2、3年的存活率.结果:TACE联合PEI治疗组2、3年的存活率分别为34.48%,15.51%.显著高于TACE组2、3年的存活率15.38%,1.9%.结论:肝动脉化疗栓塞联合无水乙醇注射治疗较单用肝动脉化疗栓塞治疗能延长原发性肝癌患者存活期.     

肝癌破裂出血临床特点和诊治分析

目的 探讨肝癌破裂出血的临床特点、诊断和治疗方法及其疗效,为临床治疗提供参考.方法 回顾性分析2003-01-01-2010-07-31东莞市人民医院外科收治的77例肝癌破裂出血患者临床资料,其中行急诊肝切除术28例(另有6例为介入止血后肝切除,1例保守治疗止血后肝切除),姑息性手术11例,经导管动脉内化疗栓塞术或栓塞术(transcatheter arterial chemoembolization or embolization,TACE or TAE)治疗23例,内科保守治疗15例.分别对各组患者的近期止血效果和生存时间进行统计和随访.结果 28例急诊肝切除患者中,共14例采用肝不规则切除(右肝11例,左肝3例),并发症和死亡率较低;2例急诊肝切除后死亡,其余26例抢救成功,再出血和肝衰竭发生率相对较低;1年生存率为78.8％,平均生存时间为(437.2±101.4)d;右半肝切除术后发生肝衰竭和死亡率较高.姑息性手术组11例患者中,7例患者止血成功,4例再次出血;1年生存率为18.2％,平均生存时间为(79.8±48.6)d.介入组23例患者中,21例成功止血,4例因肝功能衰竭死亡;其中6例患者介入止血后施行根治性肝切除康复出院;1年生存率为60.0％,平均生存时间为(289.5±92.7)d.内科保守治疗组15例患者中,仅有6例患者止血成功,死亡率为66.0％;1年生存率为15.4％,平均生存时间为(68.8±37.1)d.结论 肝癌破裂出血常以突发性腹痛为首发症状,不规则性肝切除成功率高,治疗效果较好,是首选的治疗措施.对无法手术根治患者可采用TACE介入治疗,可有效延长生存期.姑息性手术治疗和单纯内科保守治疗效果差.     

术前辅助性肝动脉化疗栓塞对可切除巨块型肝癌术后生存的影响

目的:探讨术前辅助性肝动脉化疗栓塞(TACE)治疗对可切除巨块型肝癌患者长期生存的影响.方法:回顾性分析接受手术切除的176例巨块型肝癌病例资料,按照术前是否曾行辅助性TACE治疗分为TACE组(n-51)和non-TACE组(n=125),根据是否伴有门静脉分支癌栓和子灶等癌残留高危因素分层,比较各组的总体生存率.结果:TACE组与non-TACE组1、3和5年总体生存率分别为65.60%、43.00%、30.70%和52.90%、30.60%、25.10%,两组差异无统计学意义,P=0.214;但对于伴有子灶或门静脉分支癌栓等癌残留高危因素的巨块型肝癌,TACE组与non-TACE组1和3年总体生存率分别为 58.00%、21.70%与 35.90%、9.10%.差异有统计学意义.P=0.027.结论:可切除巨块型肝癌的术前辅助性TACE治疗可选择性应用,对于伴有门静脉分支癌栓和子灶等癌残留高危因素的巨块型肝癌,术前辅助性TACE治疗有助于延长患者生存时间.     

肝癌术后肝动脉化疗栓塞治疗患者肿瘤复发的影响因素分析

目的 探讨影响肝癌术后经导管肝动脉化疗栓塞治疗(TACE)患者肿瘤复发的危险因素.方法 选择并收集200例肝癌患者的年龄、性别等一般人口学特征和临床特征资料并对患者进行随访追踪,采用Logistic逐步回归分析法分析肿瘤复发的影响因素.结果 在200例患者中130例有肿瘤复发,占65.0％.Logistic逐步回归分析结果显示,血管癌栓(OR=3.796;95％CI:1.871～7.702)、侵透肝被膜(OR=3.340;95％CI:1.067～10.451)、肝硬化(OR=2.790;95％CI:1.771～4.396)、包膜完整性(OR=2.048;95％CI:1.273～3.298)和最大癌结节直径(OR=1.739;95％CI:1.014～2.980)是肝癌术后TACE治疗患者肿瘤复发的危险因素.结论 肝癌术后TACE治疗患者的肿瘤复发率较高,术前有无血管癌栓、侵透肝被膜和肝硬化,包膜是否完整,以及肿瘤的直径等均会影响肿瘤复发,临床需要加强患者术后复诊和康复治疗.     

TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌的疗效分析

目的 探讨TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌的疗效.方法 按照入院顺序抽签后随机将97例原发性肝癌患者分为实验组和对照组,对照组给予TACE治疗,实验组给予TACE联合恩替卡韦治疗,对比2组近期和远期疗效.结果 实验组治疗后ALT、HBV DNA水平均明显低于治疗前和对照组,有统计学差异(P＜0.05);对照组治疗前后,ALT、HBV DNA水平变化,无统计学差异(P＞0.05).实验组HBeAg转阴率和转换率明显高于对照组,差异有统计学意义(P＜0.05).实验组治疗后ORR、DCR明显高于对照组(P＜0.05);实验组患者中位总生存时间(OS)和中位无进展生存时间(PFS)均明显高于对照组,有统计学差异(P＜0.05).结论 TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌效果较好,患者ALT、HBV DNA水平改善较好,HBeAg转阴率和转换率较高,ORR、DCR较高,患者中位总生存时间和中位无进展生存时间均较高,临床应用价值较高.     

海藻酸钠微球经导管动脉化疗栓塞术治疗原发性肝癌的疗效分析

目的 探讨海藻酸钠微球经导管动脉化疗栓塞术(TACE)治疗原发性肝癌的疗效.方法 将80例原发性肝癌患者依据TACE治疗时应用的栓塞剂不同分为KMG组(40例)和LP组(40例),KMG组予以海藻酸钠微球TACE治疗,LP组予以碘化油TACE治疗,两组均接受两次TACE治疗,比较两组患者的临床疗效、血清肿瘤标志物[热休克蛋白90α(HSP90α)及甲胎蛋白(AFP)]、不良反应及生存情况.结果 KMG组患者的临床有效率明显高于LP组,差异有统计学意义(P﹤0.01).治疗后,两组患者HSP90α、AFP水平均下降(P﹤0.05),且KMG组患者HSP90α、AFP水平均明显低于LP组(P﹤0.01).两组患者不良反应发生率比较,差异无统计学意义(P﹥0.05).KMG组患者3年及5年生存率均高于LP组,差异均有统计学意义(P﹤0.05).结论 海藻酸钠微球作为血管栓塞剂应用于原发性肝癌TACE治疗中,能够提高临床疗效,延长生存期,且具有较高安全性.     

雷替曲塞联合奥沙利铂经导管动脉化疗栓塞治疗原发性肝癌的疗效研究

目的 探讨雷替曲塞联合奥沙利铂经导管动脉化疗栓塞(TACE)治疗原发性肝癌的短期疗效及安全性.方法 收集75例原发性肝癌患者的临床资料,根据治疗方法的不同将患者分为研究组(n=39)和对照组(n=36),研究组患者接受雷替曲塞联合奥沙利铂栓塞化疗,对照组患者接受吡柔比星联合奥沙利铂栓塞化疗.比较两组患者的近期疗效、生存情况、甲胎蛋白(AFP)改变情况、不良反应发生率及血常规和肝肾功能指标.结果 两组患者的疾病控制率、生存情况和AFP下降率比较,差异均无统计学意义(P﹥0.05).术后3天研究组患者发热、肝区疼痛及恶心呕吐的发生率均明显低于对照组,差异均有统计学意义(P﹤0.01).治疗后研究组患者的总胆红素(TB)、直接胆红素(DB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平均明显高于治疗前(P﹤0.01),血浆白蛋白水平低于治疗前(P﹤0.05);治疗后对照组患者的TB、DB、ALT、AST、白细胞计数(WBC)水平均高于治疗前(P﹤0.05),血浆白蛋白水平明显低于治疗前(P﹤0.01).治疗后研究组患者的血浆白蛋白水平高于对照组,差异有统计学意义(P﹤0.05);ALT、AST、γ-谷氨酰转移酶(γ-GT)、WBC水平均明显低于对照组,差异均有统计学意义(P﹤0.01).结论 雷替曲塞联合奥沙利铂TACE治疗原发性肝癌的不良反应较少,其近期疗效与吡柔比星联合奥沙利铂栓塞效果相当,远期疗效有待临床进一步研究.     

炎症预后指数对经导管肝动脉化疗栓塞术治疗肝癌疗效的评估价值

目的:探讨以血清中白蛋白(ALB)、淋巴细胞计数、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比率(NLR)为基础的炎症预后指数(IPI)在经导管肝动脉化疗栓塞术（TACE）治疗肝癌中的疗效以及预后评估价值。方法:回顾分析2014年01月至2016年12月在我院接受肝动脉化疗栓塞术治疗的286例肝癌患者的临床资料,计算患者IPI。采用受试者工作特征（ROC）曲线计算IPI截断值,并采用单因素和多因素COX回归分析探讨影响患者术后生存情况的独立影响因素。结果:随访期间24例患者失访,以IPI=14.56为临界值,将随访有效的262例肝癌患者分为高IPI组（n=154）和低IPI组(n=108);临床病理资料分析结果显示,病灶数量、肿瘤最大径、是否存在门脉癌栓、AFP水平、TNM分级对肝癌患者的IPI表达水平具有显著影响（P＜0.05）;随访期间共死亡68例,中位生存时间为9个月;其中高IPI组死亡53例,中位生存时间为6（1~28）个月;低IPI组死亡15例,中位生存时间为13（4~36）个月,两组患者中位生存时间差异具有统计学意义（P=0.015);多因素COX回归分析结果显示肿瘤IPI>14.56（OR=5.689,95%CI 1.589~13.254）是影响肝癌患者预后的独立危险因素。结论:NLR、CRP、ALB、IPI均是影响肝癌患者TACE术后预后的独立危险因素,以NLR、CRP、ALB为基础的IPI对于预测肝癌患者手术疗效和预后生存情况具有重要价值。     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60–3.53) and 1.64 (95% CI 1.02–2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63–1.13) for CM and 1.03 (95% CI 0.95–1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.