胃神经内分泌肿瘤预后相关因素的临床分析（附71例）

目的:分析71例胃神经内分泌肿瘤（G-NEN）的临床特征及预后相关因素。方法:回顾性分析2009年7月至2018年10月西京医院收治的71例G-NEN患者的临床病理资料及随访资料，分析其临床病理学特征及预后相关因素。结果:单因素生存分析结果显示:5年生存率与年龄、肿瘤分级、TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）；3年生存率与肿瘤分级、TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）；1年生存率与TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）。多因素 Cox风险生存模型统计结果表明TNM分期和复发转移是影响胃神经内分泌癌预后的独立因素（P<0.05），性别、年龄、肿瘤直径、肿瘤分类、肿瘤分级、化疗与否、手术方式等与其预后无关（P>0.05）。复发转移在性别、年龄、肿瘤直径、肿瘤分级、肿瘤分类、脉管/神经侵犯、淋巴结转移数目、淋巴结转移、手术方式、辅助化疗上均不存在显著差异（P>0.05）；是否复发转移在TNM分期上存在显著差异（P<0.05）。结论:年龄、肿瘤分级、肿瘤分期、是否复发转移是影响胃神经内分泌癌患者术后生存时间的因素，肿瘤分期、是否复发转移是影响患者预后的独立危险因素。     

144例结直肠癌肝转移原发灶切除术后临床病理特征和预后分析

目的:分析144例结直肠癌肝转移原发灶切除术后患者的临床病理特征和预后。方法:回顾性分析病理证实的144例结直肠癌肝转移原发灶切除术后患者的临床病理特征和预后,Kaplan-Meier法分析生存率,Log-rank检验比较组间生存差异。结果:144例结直肠癌肝转移组及其中77例结直肠癌同时性肝转移亚组的中位生存期分别为28个月和21个月,所有病例分析显示原发肿瘤分化程度、肝转移发生时间、肝转移灶数目及治疗方法与预后显著相关(P＜0.05);同时性肝转移亚组分析显示原发肿瘤分化程度、性别、TNM分期与预后显著相关(P＜0.05);两组病例分析显示年龄对患者总生存期的影响无统计学差异(P＞0.05)。结论:原发肿瘤低分化、同时性肝转移、多发肝转移及单纯化疗是结直肠癌肝转移原发灶术后患者独立预后不良因素。原发肿瘤低分化、男性及Ⅱ-Ⅲ期是结直肠癌同时性肝转移原发灶术后患者独立预后不良因素。年龄对结直肠癌肝转移原发灶切除术后患者总生存期的影响无统计学意义。     

术前中性粒细胞与淋巴细胞比值联合癌胚抗原检测对直肠癌患者预后的评估价值

目的探讨术前中性粒细胞与淋巴细胞比值(NLR)联合癌胚抗原(CEA)对直肠癌预后的评估价值。方法选取268例直肠癌患者,依据术后5年生存情况,分为生存组和死亡组,比较两组患者的临床特征,影响直肠癌患者预后的独立影响因素采用Cox回归分析,采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评估NLR及CEA单独及联合检测对直肠癌预后的评估价值。结果随访结束,268例直肠癌患者中,生存156例,病死112例,直肠癌患者术后5年生存率为58.21%。将生存患者和病死患者分别作为生存组和死亡组,生存组和死亡组直肠癌患者性别、年龄比较,差异均无统计学意义(P﹥0.05);生存组和死亡组直肠癌患者TNM分期、分化程度、肿瘤直径、神经侵犯情况、浸润深度、远处转移情况、淋巴结转移情况、CEA水平及NLR比较,差异均有统计学意义(P﹤0.05)。Cox回归分析结果显示,TNM分期、肿瘤直径、远处转移、CEA水平和NLR是直肠癌患者预后不良的独立危险因素(P﹤0.05)。CEA、NLR及二者联合预测直肠癌预后的AUC分别为0.991、0.923、0.997,CEA和NLR联合检测对直肠癌患者的预后评估具有较高的准确性,二者联合检测的AUC高于单独预测的AUC(P﹤0.05)。结论术前NLR联合CEA检测对直肠癌预后具有较高的预估价值,二者联合能够为评估直肠患者预后提供重要的参考信息。     

结直肠癌肺转移患者的临床特征及预后生存分析

目的探讨结直肠癌肺转移患者的临床特征及预后生存分析。方法选取2008年1月至2014年1月间福建医科大学附属第一医院收治的146例结直肠癌肺转移患者的临床资料及随访资料,分析患者的临床特征及影响结直肠癌肺转移患者预后的相关因素。结果患者中位随访时间为35.1个月,中位生存时间为27.1个月,1年、3年和5年生存率分别为75.3%、30.8%和12.4%。病理组织分级、TNM肿瘤分期、肺转移灶大小、肺转移灶数目、是否合并肝转移和治疗方式不同的结直肠癌肺转移患者,预后生存时间差异均有统计学意义(均P<0.05)。低分化结直肠癌、高TNM分期、合并肝转移及单纯化疗是影响结直肠癌肺转移患者预后生存的独立危险因素,差异有统计学意义(P<0.001)。结论结直肠癌肺转移患者预后较差,低分化、高TNM分期、合并肝转移及单纯化疗是影响患者预后生存的危险因素,积极进行综合治疗可提高预后疗效。     

直肠癌组织中mTOR和VEGF的表达与侵袭转移及预后的关系

目的 探讨直肠癌组织中哺乳动物雷帕霉素靶蛋白（mTOR）和血管内皮生长因子（VEGF）的表达,并分析其与侵袭转移和预后的关系。方法 采用免疫组化SP法检测mTOR和VEGF在60例直肠癌、30例直肠腺瘤及10例正常直肠黏膜组织中的表达,并对直肠癌中两者与临床病理特征、预后及两者间的相关性进行分析。结果 mTOR在直肠癌中的阳性表达率为60.0％（36／60）,高于直肠腺瘤和直肠正常黏膜组织的36.7％（11／30）和10.0％（1／10）,差异均有统计学意义（P＜0.05）;其表达与直肠癌患者的术前CEA水平、分化程度、TNM分期、淋巴结转移和远处转移有关（P＜0.05）,而与年龄、性别、肿瘤部位和肿瘤形态无关（P＞0.05）。VEGF在直肠癌中的阳性表达率为70.0％（42／60）,显著高于直肠腺瘤和直肠正常黏膜组织的46.7％（14／30）和20.0％（2／10）,差异均有统计学意义（P＜0.05）;其表达与直肠癌患者的TNM分期、淋巴结转移和远处转移有关（P＜0.05）,而与年龄、性别、肿瘤部位、肿瘤形态、术前CEA水平和分化程度无关（P＞0.05）。两者在直肠癌组织中的表达呈正相关（r=0.393,P=0.002）。60例直肠癌患者的中位生存期为39.2个月,1、2、3年生存率分别为89.4%、76.6%和55.3%。单因素生存分析显示,术前CEA水平、TNM分期、淋巴结转移、远处转移与直肠癌预后有关（P＜0.05）,而年龄、性别、肿瘤部位、分化程度、肿瘤形态、VEGF、mTOR与直肠癌预后无关（P＞0.05）。结论 直肠癌组织中 mTOR、VEGF均呈高表达,且呈正相关,二者在直肠癌侵袭转移中可能发挥重要作用。     

论著术前PLR、LMR与胃癌患者预后的相关性研究

目的 探讨术前血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)在预测胃癌患者生存预后中的意义。方法 选取2011年1月至2017年12月海南省人民医院收治的112例胃癌患者,回顾性分析其临床资料,通过受试者工作特征曲线(ROC曲线)选取PLR、LMR预测胃癌预后的截点,据此将112例患者分为低PLR组(PLR<15273)67例、高PLR组(PLR≥15273)45例,低LMR组(LMR<299)22例、高LMR组(LMR≥299)90例;比较不同PLR分组、LMR分组患者的临床资料,采用单因素和Cox回归分析影响预后的高危因素。结果 低PLR组和高PLR组在肿瘤直径、分化程度及TNM分期方面差异有统计学意义,在年龄、性别、淋巴结转移方面差异无统计学意义。低LMR组和高LMR组在性别、淋巴结转移方面差异有统计学意义,在年龄、肿瘤直径、分化程度、TNM分期方面差异无统计学意义。单因素和多因素Cox回归分析结果均显示,术前PLR高值、术前LMR低值与肿瘤TNM分期高均为影响胃癌术后无病生存率的危险因素。结论 术前PLR、LMR与胃癌患者预后有相关性,术前PLR高值、LMR低值是影响胃癌预后的独立危险因素。     

结直肠癌患者外科治疗的预后分析

目的探讨T2NOM0期结直肠癌患者外科治疗的生存状况。方法选取2008年1月至2016年12月间连云港市赣榆瑞慈医院收治的82例接受外科治疗且有完整随访资料的T2NOM0期结直肠癌患者,计算患者生存率,采用Log-rank法进行单因素和Cox模型进行多因素分析影响结直肠癌患者生存状况的相关因素。结果患者6个月、1年、2年和3年生存率分别为100.0%(82/82)、95.1%(78/82)、87.8%(72/82)和82.9%(68/82)。单因素分析,年龄、性别、肿瘤部位、浸润深度、脉管浸润及肿瘤分化程度是结直肠癌患者生存状况的影响因素,差异均有统计学意义(均P<0.05)。多因素分析,年龄、肿瘤分化程度与脉管浸润是患者生存状况的独立影响因素,差异均有统计学意义(均P<0.05)。结论结直肠癌患者治疗后的生存状况与多方面因素有关,年龄、肿瘤分化程度及脉管浸润是患者生存状况的独立影响因素,在诊断及预后时需综合多方面考虑。     

miRNA-203表达水平对结直肠癌患者预后的临床价值

目的:探讨miRNA-203表达水平对结直肠癌患者预后的预测价值。方法:回顾性选择2010年1月至2013年12月来我院接受手术切除治疗的结直肠癌患者120例,所有患者均经病理确认。根据结直肠癌组织中miRNA-203表达水平将患者分为miRNA-203低表达组（n=42）和miRNA-203高表达组（n=78）。分析结直肠癌组织中miRNA-203表达水平与临床病理特征的关系,应用单因素、多因素非条件Cox回归分析影响结直肠癌患者预后的危险因素,并采用Kaplan-Meier法绘制累积生存曲线。结果:结直肠癌患者组织中miRNA-203表达量与年龄、性别、吸烟史、嗜酒史、组织类型、肿瘤位置、肿瘤直径无关（P>0.05）,与分化程度、TNM分期、淋巴结转移、脉管浸润有关（P<0.05）。单因素、多因素Cox回归分析结果显示,分化程度为高分化、TNM分期为IV期、组织中miRNA-203低表达是影响结直肠癌患者无进展生存率和总生存率的危险性因素（P<0.05）。Kaplan-Meier法生存曲线结果显示,miRNA-203高表达组结直肠癌患者无进展生存率和总生存率显著高于低表达组（P<0.05）。结论:miRNA-203表达水平可作为预测结直肠癌患者预后的指标。     

术前PLR、LMR与胃癌患者预后的相关性研究

目的探讨术前血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)在预测胃癌患者生存预后中的意义。方法选取2011年1月至2017年12月海南省人民医院收治的112例胃癌患者,回顾性分析其临床资料,通过受试者工作特征曲线(ROC曲线)选取PLR、LMR预测胃癌预后的截点,据此将112例患者分为低PLR组(PLR152.73)67例、高PLR组(PLR≥152.73)45例,低LMR组(LMR2.99)22例、高LMR组(LMR≥2.99)90例;比较不同PLR分组、LMR分组患者的临床资料,采用单因素和Cox回归分析影响预后的高危因素。结果低PLR组和高PLR组在肿瘤直径、分化程度及TNM分期方面差异有统计学意义,在年龄、性别、淋巴结转移方面差异无统计学意义。低LMR组和高LMR组在性别、淋巴结转移方面差异有统计学意义,在年龄、肿瘤直径、分化程度、TNM分期方面差异无统计学意义。单因素和多因素Cox回归分析结果均显示,术前PLR高值、术前LMR低值与肿瘤TNM分期高均为影响胃癌术后无病生存率的危险因素。结论术前PLR、LMR与胃癌患者预后有相关性,术前PLR高值、LMR低值是影响胃癌预后的独立危险因素。     

615例中老年胃癌患者的临床特征及预后影响因素分析

目的 分析615例中老年胃癌患者的临床特征及预后影响因素.方法 依据患者年龄将615例胃癌患者分为中年组(n=403,年龄55～64岁)和老年组(n=212,年龄65～79岁).收集两组患者分化程度、TNM分期和肿瘤部位等临床特征,随访3年比较两组患者的总生存(OS)率.影响胃癌患者OS的因素采用Cox风险比例回归模型分析.结果 两组患者分化程度、T分期、N分期、TNM分期、预后营养指数(PNI)、手术时间及术中出血量比较,差异均无统计学意义(P﹥0.05).两组患者肿瘤部位和肿瘤直径比较,差异均有统计学意义(P﹤0.05).随访3年,中年组患者的3年OS率为72.70％(293/403),明显高于老年组患者的61.32％(130/212),差异有统计学意义(P﹤0.01).多因素Cox风险比例回归模型分析结果显示,老年患者、低分化、T分期为T4期、N分期为N2～N3期、TNM分期Ⅲ期、PNI﹤40是胃癌患者OS的独立危险因素(P﹤0.05).结论 老年胃癌患者的临床特征与中年患者不同,老年胃癌患者的预后明显差于中年患者.     

Tumorigenicity of T lymphoma/T lymphoma hybrids and T lymphoma/normal cell hybrids

Stable hybrids formed between clones of established murine T-cell lymphoma lines, and between lymphoma clones and normal spleen or thymus cells were examined for their tumorigenic properties by intravenous (i.v.) and intradermal (i.d.) inoculation into syngeneic AKR mice. Fusion parents consisted of T lymphoma clones of high and low tumorigenicity derived from the SL 12 cell line. In addition, normal spleen cells and thymocytes were fused with poorly tumorigenic T-lymphoma clones. Hybrids tested by i.v. inoculation of 10(6) cells to syngeneic hosts showed that fusion between the lymphoma cells resulted in hybrids which displayed the phenotype of the highly tumorigenic parent. Also, it was shown that fusion of poorly tumorigenic lymphoma cells with normal spleen cells resulted in hybrids with enhanced tumorigenicity. Fusion of poorly tumorigenic lymphoma cells with normal thymocytes resulted in hybrids with the highest tumorigenic potential. The pattern of spread for the tumor/tumor hybrid was that of the highly tumorigenic parent. Tumor spread patterns for the spleen/tumor hybrids were different from those of the thymocyte/tumor hybrids. Intradermal inoculation of 10(5) cells from tumor/spleen or tumor/thymocyte hybrids revealed differences in latent periods between parental and hybrid cells, the tumor/thymocyte hybrids having the shortest latent period. Surface marker studies and T-cell antigen receptor mRNA determinations in the tumor cell/normal cell hybrids indicated that the normal parent was a cell of immature phenotype. Therefore, high tumorigenicity is a dominant characteristic, and poorly tumorigenic but "immortal" T lymphoma cells can derive characteristics which increase their in vivo growth capacity from the putative immature normal cells with which they selectively fuse.     

Engineered T Cells: CAR T Cell Therapy and Beyond

Current Oncology Reports - This article reviews the current data and future directions of engineered T cell therapies in non-Hodgkin lymphomas. Currently, four chimeric antigen receptor (CAR) T...     

Results of implantation for T1 and T2 bladder tumours

In the period from January 1972 through December 1983 a total of 123 patients was treated for a bladder malignancy by preoperative external irradiation followed by interstitial therapy. Criteria for selection of patients are solitary lesion, tumour smaller than 5 cm in diameter, state T1 and T2. The majority of patients was in state T2 (89 patients). Persisting local control was achieved in 29 out of 34 T1 cases and in 69 out of 85 T2 cases. The actuarial 10 years survival was 72% for T1 and 34% for T2, with a total disease-free percentage at 10 years of 77% for T1 and 56% for T2. Although in many patients delayed wound healing was noticed, no serious late reactions were seen in skin, bladder or intestine. The causes of death are distant metastases in 13 patients and intercurrent diseases in another 21 patients.     

Proton spinlocking and T1 rho-weighted MR imaging at 1.5 T

During spinlocking, the magnetization is aligned along an oscillating field (RF) and relaxes with time constant T1 rho, the spin-lattice relaxation time in the rotating frame. Using a clinical whole-body MR scanner, methods of spinlocking preparation and signal acquisition were combined to evaluate the potential of T1 rho-weighted MR imaging (T1 rho w-MRI) at B0 = 1.5 T. Examinations of the brain of healthy volunteers yielded images with pronounced contrast and T1 rho-variation of the tissue. However, the contrast resembled that of T2-weighted MRI, which is explained by the restricted spinlocking-field strength (BSL < or = 6 microT) on the tomograph. The result (mono-exponential fit) of serial T1 rho w-MRI data from examinations of 8 volunteers was on average 105 +/- 4 ms in the gray matter and 86 +/- 4 ms in the white matter (for BSL = 3 microT). The values are comparable to T2 of both tissues. MRT with spinlocking is less susceptible to local magnetic field inhomogeneities than conventional MRI.     

T1和T2期直肠癌淋巴结转移特点及预后

目的 探讨T1和T2期直肠癌淋巴结的转移特点及预后。方法 回顾性分析241例T1和T2期直肠癌的淋巴结转移特点,用X^2检验分析其相关因素,并对预后进行单因素及多因素分析。结果T1和T2期直肠癌行Mile＇s术132例,保肛术109例,淋巴结转移率为22．0％（53／241）,X^2。检验显示,肿瘤分化程度与淋巴结转移有关。5年生存率为91．5％。单因素分析显示,肿瘤组织学类型、浸润深度、分化程度、淋巴结转移、放疗与预后相关。多因素分析显示,肿瘤浸润深度为T1和T2期直肠癌患者预后的主要影响因素。结论 T1和T2期直肠癌均可发生淋巴结转移,肿瘤分化与淋巴结转移相关,根治性切除术预后较好,应作为首选的治疗方法。     

T Cell-Depleted and T Cell-Replete HLA-Haploidentical Stem Cell Transplantation for Non-malignant Disorders

Purpose of Review

Hematopoietic stem cell transplantation (HSCT) is a treatment option for children with malignant and non-malignant disorders as well as an expanding number of inherited disorders. However, only a limited portion of patients in the need of an allograft have an HLA-compatible, either related or unrelated, donor. Haploidentical HSCT is now considered a valid treatment option, especially in view of the recent insights in terms of graft manipulation. This review will offer an overview of clinical results obtained through the use of haploidentical HSCT in non-malignant diseases. We will analyze major advantages and drawbacks of both T cell depleted and unmanipulated HSCT, discussing future challenges for further improving patients’ outcome.

Recent Findings

T cell depletion (TCD) aims to reduce the morbidity and mortality associated with graft-versus-host disease (GvHD). However, the delayed immune recovery and the risk of graft failure still remain potential problems. In the last years, the use of post-transplant cyclophosphamide has been shown to be an alternative effective strategy to prevent GvHD in recipients of haploidentical HSCT.

Summary

Recent data suggest that both T cell depleted and T cell-replete haplo-HSCT are suitable options to treat children with several types of non-malignant disorders lacking an HLA-identical donor.

     

Notch and T cell malignancy

Notch signaling is required for normal T cell development. However, Notch expression must be precisely regulated as constitutive Notch signaling leads to T cell lymphomas. Recent evidence has provided insights into potential mechanisms of Notch-mediated lymphomagenesis and its relationship to T cell development. The evidence suggests that Notch likely interacts with several important cellular pathways and can cooperate with other oncogenes during lymphomagenesis. In particular, Notch appears to modulate pre-TCR signaling, inhibit the E2A pathway, and in murine leukemia models, frequently cooperates with Myc, E2A-PBX and dominant negative Ikaros dysregulation. This review will present current knowledge in these areas and explore theories on Notch-mediated T cell lymphomagenesis.     

调节性T细胞与肿瘤

调节性T细胞是具有免疫抑制功能的T细胞亚群,在维持机体免疫平衡和自身免疫耐受中起重晏作用,最新研究表明,FOXP3+ CD25+ CD4+调节性T细胞在各种肿瘤患者的外周血与肿瘤组织内大量表达,并且与肿瘤发生、发展及预后有明显的关系.