小细胞肺癌肿瘤组织VEGF表达及其与预后的关系

[目的]探讨小细胞肺癌(SCLC)肿瘤组织中血管内皮生长因子(VEGF)的表达水平及其与预后的相关性。[方法]收集1998~2010年行手术治疗的35例SCLC患者,采用免疫组化法检测肿瘤组织中VEGF蛋白的表达水平,并分析其与预后的相关性。[结果]全组患者VEGF阳性表达率为45.7%,且均为弱阳性表达;在成功随访的22例患者中VEGF阳性表达与不表达患者的中位生存期差异无统计学意义(13个月vs 20个月,P=0.784)。[结论]近半数SCLC患者肿瘤组织中存在VEGF弱表达,VEGF表达与预后无明显相关性,抗血管生成的治疗策略在SCLC中有待进一步研究。     

小细胞肺癌组织中VEGF和MVD的表达及意义

目的探讨小细胞肺癌(smallcelllungcancer,SCLC)组织中血管内皮生长因子(vascu-larendothelialgrowthfactor,VEGF)、微血管密度(microvesseldensity,MVD)的表达及其临床意义。方法应用SP法检测48例SCLC标本中的VEGF、MVD的含量,及其与临床生物学特性相关性。同时检测20例正常组织作对照分析。结果48例SCLC中VEGF阳性表达率为81%(39/48),MVD平均为52.82±15.34;VEGF阳性组MVD为54.71±11.12,阴性组为43.63±13.57,两组间差异有统计学意义,P=0.013。肿瘤直径≥3cm、区域淋巴结转移与MVD含量密切相关,P值分别为0.024和0.018;其中VEGF阳性率也高,但差异无统计学意义,P值分别为0.159和0.228。20例正常肺组织中VEGF阳性表达率为15%(3/20),MVD平均为18.23±6.92,均明显低于SCLC,P=0.000。结论SCLC组织中VEGF、MVD有高表达,可作为判断SCLC的生长、转移及预后的指标。     

胃癌组织中血管内皮生长因子的表达及其意义

目的:探讨VEGF在胃癌组织中的表达与预后以及预测辅助化疗疗效的关系。方法:采用S-P免疫组化法检测64例胃癌组织和34例癌旁组织中VEGF的表达水平。对术后辅助性化疗45例患者,分析化疗疗效与VEGF表达的关系。结果:64例胃癌组织中VEGF表达阳性率62·5%,与癌旁组织相比有显着性差异(P<0·05);VEGF阳性表达与胃癌患者的性别、肿瘤部位和病理分化程度无关(P>0·05);与临床分期、淋巴结转移、肿瘤大小和浸润深度关系密切(P<0·05);与患者生存之间有显着性差异,阳性表达者比阴性表达者5年生存率低(P<0·05);接受术后辅助化疗的45例患者,VEGF阳性表达者5年生存率低于阴性表达者(P<0.05);VEGF阳性表达与年龄呈正相关,>50岁以上年龄组的VEGF阳性表达率较≤50岁年龄组高(P<0·05)。结论:VEGF在胃癌组织中呈高表达;VEGF表达与胃癌侵袭转移能力和预后密切相关;VEGF高表达与化疗疗效差和胃癌耐药有关。     

DLL3表达与晚期小细胞肺癌含铂化疗疗效及预后的相关性CSCD

目的探讨Delta-like protein 3(DLL3)与晚期小细胞肺癌(SCLC)顺铂/依托泊苷(EP)方案化疗敏感度及预后的关系。方法选取64例明确诊断为Ⅲ/Ⅳ期的SCLC患者,采用免疫组织化学法检测DLL3在SCLC石蜡包埋组织中的表达情况;χ~2检验分析DLL3表达与化疗疗效的关系,Kaplan-Meier和Cox多因素分析DLL3表达及其他因素对晚期SCLC患者无进展生存期(PFS)和总生存期(OS)的影响。结果在84.1%(54/64)的SCLC组织中可检测到DLL3表达,其表达与患者性别、年龄、吸烟史、分期无相关性(P>0.05)。DLL3高表达组的EP方案化疗有效率及疾病控制率均低于DLL3低表达组(P<0.05);DLL3低表达组的无进展生存期长于DLL3高表达组,差异有统计学意义(P<0.05)。Cox多因素分析结果显示DLL3表达、肿瘤分期、肿瘤直径是晚期SCLC患者PFS的独立预后因素,肿瘤分期是OS的独立预后因素。结论DLL3表达与晚期SCLC EP方案化疗反应率及PFS相关,可能成为预测化疗敏感度的生物标志物。DLL3表达对于晚期SCLC患者的远期预后无预测价值。     

TIP30和VEGF-C在小细胞肺癌中的表达及临床意义

目的 分析TIP30和血管内皮生长因子-C(VEGF-C)在局限期小细胞肺癌(SCLC)中的表达和临床意义。方法 免疫组化法检测68例SCLC原发灶中TIP30和VEGF-C的表达。结果 68例SCLC组织中TIP30和VEGF-C阳性表达率分别为51.5%(35/68)、54.4%(37/68)。VEGF-C表达与淋巴结转移和肿瘤大小相关(P＜0.05),与患者的年龄、性别和吸烟之间差异无统计学意义(P＞0.05)。TIP30表达与患者的年龄、性别、吸烟、淋巴结转移和肿瘤大小之间的差异无统计学意义(P＞0.05)。VEGF-C与TIP30表达呈负相关。TIP30表达阳性SCLC患者的DFS和OS较长。相反,VEGF-C表达阳性SCLC患者的DFS和OS较短。Cox多因素分析提示TIP30和VEGF-C表达是SCLC独立不良预后因素(P＜0.01)。结论 VEGF-C表达与淋巴结转移相关,TIP30阴性和VEGF-C阳性表达的SCLC患者预后差。     

乳腺癌组织中P38、VEGF表达与其淋巴结转移及预后的关系

目的 探讨乳腺癌组织中P38、VEGF表达与其淋巴结转移及预后的关系.方法 选取经病理证实为乳腺癌患者88例为研究对象.采用SP法检测P38、VEGF蛋白在乳腺癌组织中的表达,应用COX回归模型,探讨P38、VEGF表达与乳腺癌预后的关系.结果 88例患者中P38阳性表达67例,阴性21例;VEGF阳性56例 阴性32例.所有患者均随访到2016年1月31日,以死亡或肿瘤转移、复发为终点事件,出现终点事件的患者17例;P38、VEGF在Ⅲ期乳腺癌组织中表达水平明显高于Ⅰ、Ⅱ期,而与患者年龄、肿瘤大小无明显相关性.复发及转移患者中P38、VEGF阳性率明显高于无转移和复发者,差异显著,具有统计学意义,P<0.05;多因素分析提示:肿瘤分期(P=0.01)、P38阳性(P=0.001)、VEGF阳性(P=0.02)是乳腺癌患者转移或复发的独立危险因素.结论 P38、VEGF阳性表达患者的转移及复发率高,P38、VEGF阳性是患者转移及复发的独立风险因素.     

小细胞肺癌c-Kit基因蛋白的表达及其与预后的关系

目的:探讨c-Kit基因蛋白在小细胞肺癌(SCLC)中的表达及其与临床病理、预后的关系.方法:采用免疫组化方法,检测63例手术切除SCLC中c-Kit蛋白的表达,并分析其与患者的生存率及其它相关临床资料的关系.结果:63例c-Kit蛋白的阳性表达率为56%(35/63).c-Kit蛋白的表达与SCLC患者性别、年龄、肿瘤分期以及生存率无明显相关.结论:SCLC的发生发展与c-Kit基因蛋白表达密切相关;与SCLC患者预后尚无确切的相关性.     

p21^WAF1和VEGF在非小细胞肺癌中的表达及临床相关性研究

目的 研究p21WAFI和血管内皮生长因子的表达和肿瘤内微血管密度测定在非小细胞肺癌中的意义。方法用免疫组化方法对45例非小细胞肺癌患者经纤支镜活检、经皮肺活检取得的标本检测p21WAFI和VEGF的表达,并用CD31抗体标记癌组织血管内皮细胞,计算MVD。结果 p21WAFI和VEGF阳性表达率分别为68.9％和77.8％;二者的表达和MVD均与性别、病理类型无关(P>0.05),与临床分期、癌组织MVD呈正相关(P<0.05);p21WAFI阳性、VEGF阴性组的中位生存期(14个月)与p21WAFI阴性、VEGF阳性组的中位生存期(11个月)相比,差异无显著性(P>0.05);p21WAFI阳性、VEGF阳性组的中位生存期(10个月)与p21WAFI阴性、VEGF阴性组的中位生存期(15个月)相比,差异无显著性(P>0.05)。结论p21WAFI和VEGF在非小细胞肺癌的发生和发展中起着重要作用,可反映非小细胞肺癌的恶性程度和进展情况。作为预后指标,p21WAFI作用的发挥是通过上调VEGF的表达水平来实现的,VEGF的表达对肿瘤血管形成、转移起重要作用。     

MMP-2、VEGF、CD105和Ki-67在小细胞肺癌中的表达及预后相关性研究

目的 探讨基质金属蛋白酶-2（MMP-2）、血管内皮生长因子（VEGF）、CD105和Ki 67在小细胞肺癌（SCLC）中的表达及其与临床病理特征和预后的关系。方法 收集42例SCLC和8例正常肺组织标本,采用免疫组化SP法检测MMP-2、VEGF、CD105和Ki 67在SCLC和正常肺组织中的表达,并分析其与SCLC临床病理特征和预后的关系。结果 42例SCLC组织中MMP-2、VEGF、CD105和Ki-67的阳性表达率分别为50.0％、66.7％、81.0％和64.3％,在8例正常肺组织中分别为12.5％、12.5％、0和0,差异均有统计学意义（P＜0.05）。MMP-2、VEGF、CD105的表达均与肿瘤直径、淋巴结转移、远处转移和临床分期有关,Ki-67表达与淋巴结转移有关（P＜0.05）。MMP-2、VEGF表达均与CD105和Ki-67有相关性（P＜0.05）,且MMP-2和VEGF表达呈正相关（r=0.447,P＜0.05）。单因素分析显示,肿瘤直径、淋巴结转移、远处转移、临床分期、MMP-2、VEGF、CD105和Ki 67均与总生存有关。结论 MMP-2、VEGF、CD105和Ki-67均为SCLC预后不良指标,MMP-2和VEGF可以协同促进肿瘤的新生血管形成和细胞增殖。     

血管内皮生长因子在人脑胶质瘤中的表达及意义

目的研究人脑胶质瘤中血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)的表达及临床病理意义.方法应用SABC免疫组化技术检测67例人脑胶质瘤、8例正常脑组织中VEGF表达.结果VEGF仅在肿瘤组织中表达,阳性表达率为83.6%,而在正常脑组织中无表达.VEGF与胶质瘤恶性程度(P<0.01)及肿瘤复发(P<0.01)相关.结论胶质瘤细胞能分泌VEGF,VEGF表达与肿瘤复发及预后有关.     

洛铂联合多西他赛行肿瘤细胞减灭术加腹腔热灌注化疗治疗腹膜癌的临床观察

目的 分析洛铂联合多西他赛行肿瘤细胞减灭术（cytoreductive surgery, CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）治疗腹膜癌（peritoneal carcinoma, PC）的围手术期安全性及疗效。 方法 PC患者行CRS+HIPEC治疗,药物为洛铂50 mg/m2、多西他赛60 mg/m²,加入12 000 ml 0.9%氯化钠溶液加热至（43±0.5）℃持续灌注60 min。记录术后6天体温和心率变化、围手术期不良事件、血常规及血生化指标、术后患者恢复情况及生存结果。结果 90例PC患者行95次CRS+HIPEC,手术时间180~450 min (中位数485 min）;术后6天最高体温、心率分别为36.4℃~38.6℃（中位数37.5℃）、76~124 bpm（中位数100 bpm）,严重不良事件16例,包括围手术期死亡2例。中位生存期20.8月（95%CI: 13.1~25.8月）,1、3、5年生存率分别为75.6%、45.6%、43.3%。 结论 洛铂联合多西他赛进行CRS+HIPEC治疗PC安全性可接受,有助于延长患者生存期。     

Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR

EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient.     

参麦注射液对阿霉素所致大鼠心肌损伤保护作用的实验研究

目的　观察参麦注射液 (SMI)对阿霉素 (ADM )诱导大鼠心肌损伤的保护作用和抗氧化作用。方法　选用ADM诱导大鼠心肌损伤模型。SD大鼠 60只 ,随机分为 3个组 ,每组 2 0只 ,分别为正常组、治疗组、对照组。正常组 :实验第 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。治疗组 :实验第 1～ 9天注射参麦注射液 ,每天 3ml/kg ,1次 /天 ,第 4天注射阿霉素 ,隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。对照组实验 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。第 4天注射阿霉素 ,以后隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。到期测定血丙二醛 (MDA )含量和超氧化物歧化酶(SOD )活性 ,并进行心肌病理检查。结果　对照组MDA水平明显高于治疗组 ,对照组SOD水平则显著低于治疗组 ,即加用SMI可提高SOD活性 ,降低MDA含量。SMI能明显减轻大鼠心肌损伤 ,对照组与治疗组比较 ,治疗组心肌损伤明显减轻 ,治疗组与正常组比较无显著性差异。参麦注射液有抗氧化作用 ,与对照组比较 ,血SOD水平升高 ,MDA水平降低 ,心肌病理计分下降。结论参麦注射液有抗氧化作用和对阿霉素所引起的心脏毒性具有保护作用 ,为临床寻找有效的阿霉素所致心肌损伤保护药物提供良好的客观依据 ,值得临床推广应用     

Denosumab in patients with cancer and skeletal metastases: A systematic review and meta-analysis

Background

We conducted a systematic review of the literature to determine the efficacy and safety of denosumab in reducing skeletal-related events (SRE) in patients with bone metastases.

Methods

A literature search using MEDLINE, EMBASE, Web of Science and The Cochrane Collaboration Library identified relevant controlled clinical trials up-to-March 14, 2012. Two independent reviewers assessed studies for inclusion, according to predetermined criteria, and extracted relevant data. The primary outcomes of interest were SRE, time to first on-study SRE, and overall survival. Secondary outcomes included pain, quality of life, bone turnover markers (BTM), and adverse events.

Results

Six controlled trials including 6142 patients were analyzed. Compared to zoledronic acid, denosumab had lower incidence of SRE with a risk ratio (RR) of 0.84 (95% confidence intervals (CI) 0.80–0.88), delayed the onset of first on-study SRE (RR 0.83; 95% CI 0.75–0.90) and time to worsening of pain (RR 0.84; 95% CI 0.77–0.91). No difference was observed in overall survival with pooled hazard ratio of 0.98 (95% CI 0.90–1.0). For total adverse events, denosumab was similar to zoledronic acid (RR 0.97; 95% CI 0.89–1.0). No significant differences were observed in the frequency of osteonecrosis of the jaw (RR 1.4; 95% CI 0.92–2.1). Patients on denosumab had a greater risk of developing hypocalcemia (RR 1.9; 95% CI 1.6–2.3).

Conclusions

Denosumab was more effective than zoledronic acid in reducing the incidence of SRE, and delayed the time to SRE. No differences were found between denosumab and zoledronic acid in reducing overall mortality, or in the frequency of overall adverse events.     

体内诱导艾氏腹水瘤细胞的耐药性研究

肿瘤细胞耐药性的存在是临床化疗失败的主要原因之一。本实验在小鼠体内用阿霉素（ADR）诱导艾氏腹水瘤细胞（EHR）的耐药性，探讨细胞产生耐药性的机理。HPLC法测定细胞内药物浓度．结果表明耐药细胞─—EHR/ADR细胞内ADR积聚低于EHR细胞，而对ADR外排快于EHR细胞；异博定（VER）增加EHR／ADR细胞对ADR的摄取并阻滞其外排．而对EHR影响不大，揭示EHR／ADR细胞具有MDR特性。     

Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis

The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.     

邻近腋窝的上皮样血管内皮瘤1例报道

We described a case of a 71-year-old woman with an epithelioid hemangioendothelioma (EHE) in her left axilla,a rare location which hasn't been reported yet. The patient suffered from numbness, pain and decreased muscle strength of her left upper extremity. Sonography revealed a hypoechoic mass surrounded the axillary artery and brachial artery. No obvious capsule was demonstrated. CT showed a soft-tissue mass with some calcifications and peripheral ring-like en-hancement. The MRI indicated a mass with mainly intermediate signal intensity on Tl-weighted imagine and intermediate signal intensity on T2-weighted imagine. The diagnosis was confirmed by histopathologic examination after surgery. There are some correlations of these imaging features with its histopathologic characters.     

GF方案与TP方案一线治疗晚期非小细胞肺癌的临床对照研究

Objective  

The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin (GP) and paclitaxel plus cisplatin (TP) 1st-line chemotherapies for advanced non-small cell lung cancer (NSCLC) and observe their side effects.     

鼻咽癌患者放射性骨坏死引起的正电子显像假阳性结果1例及文献复习

目的:探讨鼻咽癌(NPC)患者放射性骨坏死(osteoradionecrosis,ORN)引起正电子假阳性结果的原因及避免因此引发诊断错误的方法。方法:回顾性分析1例放疗后的鼻咽癌患者,行鼻咽部MRI及正电子显像后,再行组织病理学检查,对三种结果进行分析、比较。结果:MRI及正电子显像均诊断患者颅底区域肿瘤复发,组织病理学结果则显示鼻咽部病灶为放射性骨坏死。因此正电子扫描结果为假阳性结果。结论:鼻咽癌患者放疗后所致的放射性骨坏死容易引起正电子显像假阳性结果并可能引发不必要的治疗,因此NPC患者的正电子图像,对于可能的局限性肿瘤复发诊断,应该非常慎重。     

Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration.