转移性肝癌外科治疗及预后因素分析

目的 为探讨转移肝癌肝切除术疗效及影响预后因素,对７８例转移性肝癌切除术进行性分析。方法 我院从１９８２年１月至１９９４年１月对７８便肝转移癌的病人,在原发癌根治术的基础上行肝切除术。其中４８例原发癌结肠癌,３０例为非结直肠癌,随访生存期并分析影响预后诸因素累进要转移性肝癌切除术后总的１、３、５的眩分别为７６．９１％、３９．６％、２５．６４％。肝转移癌数目超过２个的病人５年生存率为０％,而转移灶少     

BLADDER CANCER IN PATIENTS WITH MULTIPLE SCLEROSIS TREATED WITH CYCLOPHOSPHAMIDE

Purpose

We define the risk of bladder cancer in multiple sclerosis related to the use of indwelling catheters and cyclophosphamide administered as an immunomodulating agent.

Materials and Methods

We retrospectively reviewed the records of 2,351 patients with multiple sclerosis referred to the National Center for Multiple Sclerosis.

Results

Of the 2,351 patients 2 women and 5 men (0.29%) had bladder cancer. Of the 850 chronically catheterized patients the incidence was 0.7%. One patient with cancer performed intermittent catheterization for a rate of 0.23% in this group. In a subgroup of 70 patients treated with cyclophosphamide 5 chronically catheterized patients (5.7%) had bladder cancer. Hematuria was the most common presenting symptom. These data were compared with those in the literature on bladder cancer in spinal cord injury.

Conclusions

These data suggest a possible synergistic role of cyclophosphamide and chronic catheterization in the induction of secondary bladder cancer. Regular cystoscopy is warranted in these patients to allow early detection of bladder tumors. Nitric oxide metabolism may be an important factor in the carcinogenesis of this type of bladder cancer.     

THE MONITORING OF SERUM FACTORS IN PATIENTS WITH CANCER

Numerous changes occur in the sera of patients bearing malignant neoplasms. These changes may take the form of appearance of oncofetal proteins that are normally not detectable in non-cancer-bearing patients, or an alteration in the normally present serum constituents such as the serum proteins. Monitoring of these serum factors may be of considerable value in assessing the progress of cancer patients following treatment of their primary tumour. This paper reviews progress in this area to date and documents our early results with six non-specific serum factors (total protein, total protein hexose, total protein hexosamine, ceruloplasmin, alpha-1-antitrypsin, and haptoglobin), in 64 patients bearing a variety of malignant neoplasms in various stages of the disease. Present methods of postoperative assessment of cancer patients are inadequate for detecting early recurrence. Preliminary results indicate that the nonspecific serum factors that we are studying may be of considerable value for monitoring of cancer patients, and may also possibly serve as a diagnostic screen in high-risk groups.     

IMMUNE REACTIONS IN PATIENTS WITH BLADDER AND PROSTATIC CANCER1

Although there are many reports of cellular immune reactions in bladder and prostatic carcinoma patients, few have demonstrated the presence of humoral reactivity. The use of microtechniques, especially the enzyme-linked immunosorbent assay (ELISA), has made sequential studies possible on patients with early or small tumours. Using this assay, the presence of serum antibodies has been demonstrated in both bladder and prostate patients, the specificities of these reactions being checked against a battery of different tumours and normal tissues. In many of the patients, with low or transient antibody levels, the presence of circulating immune complexes was shown by the Raji cell assay and analysed by double counter-current immunoelectrophoresis (DCIE). The content of these complexes appeared to be either antibody and tumour antigen or antibody and antiimmunoglobulin. In a small series of cryosurgically treated prostatic carcinoma patients, the course of these antibodies was monitored over several weeks, and the fluctuations in antibody levels were related to the presence of these different types of complexes.     

原发性肝癌TACE后并发急性肾功能衰竭临床分析

目的探讨肝癌介入治疗后引起急性。肾功能衰竭（ARF）的原因、临床表现特点、预防及治疗。方法对6例肝癌患者因介入治疗所致的ARF的临床表现、实验室检查、治疗及转归进行回顾性分析、讨论。结果6例肝癌均为原发性肝癌,介入治疗后出现ARF的时问为术后5天以内。经以血液透析为主的临床综合治疗后,5例患者肾功能均能恢复正常,1例患者因并发脑梗塞临床死亡。结论肝癌介入治疗引起ARF的比例虽然小,但危害大,应引起重视。积极有效的临床观察与早期干预治疗可减少介入治疗后ARF的发生率,术后出现肉眼血尿及实验室尿常规改变,及早给予干预治疗,可提高病人的预后。一旦确诊ARF临床发生,及时进行血液透析是治疗的关键。     

THE ASSESSEMENT OF PROTEIN-CALORIE MALNUTRITION IN PATIENTS WITH GASTROINTESTINAL CANCER

Daily protein and calorie intake, three plasma protein estimations, two upper limb anthropometric measurements, and estimated weight loss were all determined in 31 patients attending a surgical oncology outpatient department. The patients, who had had prior resection of a gastrointestinal cancer, could be divided Into three groups depending on (I) the absence of clinically detectable tumour; (ii) the presence of clinically detectable tumour with survival over the ensuing four-month period. and (iii) clinically detectable tumour without survival over the ensuing four-month period. The variables least able to discriminate between these groups, and to Interrelate to the other variable in a cross-correlation matrix, were the dietary intake data and the estimated weight loss, it is concluded that protein-calorie mainutrition can be adequately assessed In patients with advanced cancer from studies of the plasma albumin, prealbumin, transferrin, arm fat area, and arm muscle area.     

CORRELATES OF DISSATISFACTION WITH TREATMENT IN PATIENTS WITH PROSTATE CANCER DIAGNOSED THROUGH SCREENING

PURPOSE: We evaluated correlates of patient reported dissatisfaction with treatment of prostate cancer detected by screening. MATERIALS AND METHODS: We performed a cross-sectional retrospective study to evaluate the correlates of dissatisfaction with treatment in 1,651 patients in whom prostate cancer was detected through serial screening. We included demographic and clinical characteristics in the independent and control variables, and we validated measurements of quality of life outcomes. RESULTS: Overall 11% of patients were dissatisfied with the treatment received. Differences in the rates of dissatisfaction with treatment were not statistically significant across treatment groups (11% for retropubic radical prostatectomy, 21% for perineal radical prostatectomy, 14% for radiotherapy, 8% for observation, 8% for hormonal treatment and 4% for cryoablation, p = 0.1). Patient age, race, followup interval, marital status, education and co-morbid conditions were not significant correlates of dissatisfaction with treatment (for all characteristics p> or =0.05). Urinary function and bothersomeness were associated with dissatisfaction with treatment (p<0.0001), whereas sexual function and bothersomeness were not (p>0.05). Multivariate analysis revealed that urinary function and bothersomeness were also the only significant correlates of dissatisfaction with treatment. CONCLUSIONS: Of patients in whom prostate cancer was detected by screening 11% were dissatisfied with treatment. Urinary function and bothersomeness were the only important correlates of dissatisfaction.     

手术前血清癌胚抗原与胃癌预后的关系

本文对病理组织学诊断为腺癌的９６例胃癌病人进行手术血清癌胚抗原（ＣＥＡ）测定，井与若干预后因素及生存率作们关分析和比较。结果显示：①胃癌患者血清ＣＥＡ增高时，肝转移率增高，但淋巴结转移率无明显增多；②ＣＥＡ水平虽与肿瘤分期不呈等级正相关，但Ⅰ、Ⅱ期与Ⅲ、Ⅳ期对照，ＣＥＡ水平差别有显著性（Ｐ＜０．０５）；③粘液腺癌病人ＣＥＡ阳性率较管状腺癌及印戒细胞癌病人高，但与肿瘤分化程度无明确关系；①当ＣＥＡ＞２０ｕｇ／Ｌ时，癌肿能作根治性手术切除的可能性减少，生存率明显降低。本研究结果提示，术前血清ＣＥＡ水平对判断胃癌预后有实用意义，术前检测ＣＥＡ对胃癌的治疗选择和制订手术方案有一定的参考价值。     

结肠癌患者术后肠内营养治疗

目的：探讨采用肠内营养对结肠癌患者术后进行营养治疗。方法：７１例住院结肠癌患者，平均年龄（５２．５３±１３．０４）岁，随机分为肠内营养治疗组（ＥＮ）和静脉营养治疗组（ＰＮ）。每天基础热能按１２５ＫＪ（３０ｋｃａｌ）／ｋｇ体重，蛋白质１.２５ｇ／ｋｇ（０．２氮／ｋｇ），热氮比值为非蛋白热能１５０ ｋｃａｌ：１ｇ氮。结果：ＥＮ组未见有恶心、呕吐、腹胀、腹泻等胃肠反应。全部患者的外部切口均Ⅰ期愈合。术前ＥＮ组４７.０６％，ＰＮ组４８．４７％的患者存在营养不良。体重、握力、ＭＡＣ、ＭＡＭＣ、ＴＳＦ、淋巴细胞总数、Ｈｂ、ＴＰ、Ａ、ＢＵＮ、ＣＲ、Ｎａ、Ｋ、Ｃｌ、血糖、Ｔｃｈ、ＴＧ等指标均在正常范围内。两组均为负氮平衡，术后第３天与第９天相比，均有显著性差异（Ｐ＜０.０５）。ＥＮ组血清谷氨酰胺和谷氨酸高于ＰＮ组，有显著性差异（Ｐ＜０.０５），其余氨基酸无差异。ＰＮ组尿Ｌ／Ｍ值升高，与ＥＮ组相比，有显著性差异（Ｐ＜０.０５）。结论：结肠癌患者术后用肠内营养治疗有明显的效果和并能维护肠屏障功能。     

COSMETIC OUTCOME OF BREAST-CONSERVING THERAPY IN CHINESE PATIENTS WITH EARLY BREAST CANCER

Background : Breast-conserving surgery combined with radiotherapy has emerged as an alternative to mastectomy for women with early breast cancer, and cosmetic outcome has correlated closely with the psychosocial and physical well-being of the patient. Cosmetic outcome assessment after breast-conserving therapy in Chinese patients has so far not been conducted among the clinicians, the patients or their spouses. Methods : The cosmetic results from breast-conserving therapy were evaluated in a group of 33 patients who had been selected as suitable for undergoing local excision, axillary dissection and postoperative radiation therapy for early stage breast cancer. The success of the procedures was assessed by the patients, the clinicians and the patient'spouse, and their ratings were compared with each other. Results : Eighty per cent of the patients and their spouse were satisfied with the cosmetic outcome. Using McNemar'test, when the groups were evaluated on a case-by-case basis, there was a good level of concordance between the patients and their spouses, and that of the patients and the clinicians. Conclusions : Evaluation of the cosmetic and psychosocial sequelae of breast cancer patients is essential when new approaches to treatment are introduced; our data suggest that cosmetically successful breast conservation is feasible in a selected group of Chinese women with early breast cancer.     

术前外周血AFP表达水平与肝癌肝移植患者生存率的关系

目的探讨原发性肝癌肝移植患者术前外周血AFP表达水平与生存率的关系。方法回顾性分析我科2001年12月~2006年12月间234例肝癌肝移植患者的临床资料,按术前外周血AFP表达水平分为3组:A组:AFP<20μg/L,B组:AFP<400μg/L,C组:AFP≥400μg/L,用SPSS11.0软件进行统计分析,Kaplan-Meier法计算累积/无瘤生存率,Long-ran法检验组间差异,Cox模型进行预后多因素分析。结果全组随访1~56个月,随访期间死亡85例(36.3%),复发70例(29.9%)。患者6个月、1、2、3、4年累积生存率分别为88.5%、76.3%、61.3%、53.6%、47.6%;6个月、1、2、3年无瘤生存率分别为80.1%、70.6%、60.4%、52.3%。A、B两组患者6个月、1、2、3、4年累积/无瘤存活率均明显高于C组(P<0.05),而两组之间差异无显著性(P>0.05);Cox回归多因素分析显示:术前AFP水平、肿瘤类型、大血管侵犯和肿瘤分化程度是影响预后的独立因素。结论术前外周血AFP表达水平是肿瘤复发和影响患者生存的危险因素,可作为预后的判断因子。     

LOW P27 EXPRESSION PREDICTS POOR DISEASE-FREE SURVIVAL IN PATIENTS WITH PROSTATE CANCER

Purpose

p27 is an inhibitor of the cell cycle with potential tumor suppressor function. Decreased levels of p27 protein expression have been correlated with poor prognosis in patients with breast and colorectal carcinomas. Although as many as a third of patients with clinically localized prostate cancer will have relapse after radical prostatectomy, predicting who will have recurrence remains enigmatic. We examined the ability of p27 protein levels to predict outcome in patients with clinically localized disease who underwent radical prostatectomy.

Materials and Methods

p27 protein expression was evaluated in 86 patients with clinical stage T1-2 prostate cancer who were treated with radical prostatectomy. Archived paraffin embedded specimens were sectioned and immunostained with p27 antibody, and scored by 2 independent observers in a blinded fashion. The absence or presence of p27 protein was then correlated with biochemical relapse in univariate and multivariate analyses.

Results

In a multivariate analysis that included age, preoperative prostate specific antigen, Gleason score and pathological stage p27 was a strong independent predictor of disease-free survival (p = 0.0184, risk ratio 3.04), second only to pathological stage (p = 0.0001, risk ratio 6.73). Even more strikingly, multivariate analysis demonstrated that p27 was the strongest predictor of biochemical recurrence (p = 0.0081, risk ratio 4.99) among factors studied in patients with pathological T2a-T3b disease.

Conclusions

Absent or low levels of p27 protein expression appear to be an adverse prognostic factor in patients with clinically organ confined disease treated by radical prostatectomy. This marker appears to be especially useful in those patients in whom surgery is believed to be potentially curative, that is patients with pathological T2-T3b disease. Patients with low or absent p27 protein expression may be candidates for novel adjuvant therapies.     

44例中下段直肠癌经腹肛拖出切除术的疗效分析

目的：探讨直肠癌经腹肛拖出切除术后排便功能恢复的程度和生存率。方法：对接受此项手术的44例病人临床病理和随访资料进行分析,并与其它保肛手术效果对比。结果：肿瘤下缘距离齿状线的平均长度为4．1cm,术后吻合口瘘发生率4．5％,72．7％的病人认为肛门功能恢复达到正常。平均随访47个月,盆底和直肠肿瘤复发率11．8％。结论：虽经腹肛拖出切除术后肛门排便功能恢复正常率低于低位前切除术（Dixon术）,但复发率低,比前切除术更适宜于中下段直肠癌的保肛治疗。