卵巢透明细胞癌临床治疗效果研究

背景与目的:卵巢透明细胞癌相比于其他卵巢上皮性癌,其预后较差,本文对本院卵巢透明细胞癌患者生存率作分析比较,探讨CAP[表柔比星(E-ADM)、顺铂(DDP)加环磷酰胺(CTX)]方案加用丝裂霉素(MMC)后的治疗效果。方法:对本院于1999年1月1日至2002年12月31日接受治疗的卵巢透明细胞癌共33例(A组),同时随机取37例卵巢其他上皮性癌的患者作对照(B组)。Ⅰ期患者行全子宫 双附件 大网膜切除 阑尾切除 淋巴结分期术),2例患者需要生育的卵巢癌患者行患侧附件切除 对侧卵巢活检 大网膜切除 阑尾切除术术。Ⅱ期以上的患者行肿瘤减灭术(tumor reductive surgery,TRS)尽可能使残余灶<1cm,2组患者均在术后化疗均采用CAP方案(静脉应用),但A组患者CAP方案中加用了丝裂霉素。A组患者与仅用CAP方案的透明细胞癌患者(C组)Ⅰ/Ⅱ期15例及Ⅲ/Ⅳ期9例相比较。结果:术前A组与B组Ⅰ/Ⅱ血清CA125差异有显著性,卵巢透明细胞癌血清CA125水平值较低,Ⅲ/Ⅳ期血清CA125差异无显著性。在3次及6次化疗后与化疗前Ⅰ/Ⅱ期A组及B组血清CA125差异有显著性,而Ⅲ/Ⅳ期血清CA125下降水平差异无显著性。A组卵巢透明细胞癌患者中有11例有子宫内膜异位症(33.33%),有7例患者出现深静脉血栓(21.21%),有深静脉血栓的患者与生存率无直接关系(P=0.26)。Ⅰ/Ⅱ期患者的平均生存时间分别为:A组38.3±2.4个月,B组38.3±2.7个月,Ⅰ/Ⅱ期患者A组与B组用Log Rank检验相比较4年生存率差异无显著性(P=0.471),Ⅲ/Ⅳ期患者的平均生存时间分别为:A组20±3个月,B组34±4个月,Ⅲ/Ⅳ期患者A组与B组相比较用Log Rank检验4年生存率差异有显著性(P<0.05)。C组患者Ⅰ/Ⅱ期15例,平均生存时间为:30±3个月,与A组用MMC的透明细胞癌患者Ⅰ/Ⅱ期23例比较生存率差异有显著性(P<0.05)。C组患者Ⅲ/Ⅳ期9例,均死亡。平均生存时间为18±3个月。与A组用MMC的透明细胞癌患者Ⅲ/Ⅳ期10例比较生存率差异无显著性(P=0.430)。结论:卵巢透明细胞癌术前及化疗后血清CA125水平值较低,用CAP加丝裂霉素的规则化疗治疗透明细胞癌对Ⅰ/Ⅱ期患者有一定的治疗效果,对Ⅲ/Ⅳ期患者治疗效果不佳。卵巢透明细胞癌疾病的复发率及死亡率仍然较高。     

大肠腺癌组织MDR1表达与肠系膜淋巴结转移关系的研究

目的　探索大肠腺癌组织多药耐药基因 (MDR1)表达与大肠腺癌分化程度及肠系膜淋巴结转移之间的关系。方法　以光敏生物素标记MDR1cDNA探针 ,链亲和素胶体金为检测系统做原位杂交 (ISH SAG)检测大肠癌MDR1mRNA表达 ,同时用LSAB法对P 糖蛋白进行免疫组织化学检测。结果　大肠腺癌MDR1mRNA表达阳性的肠系膜淋巴结转移率与MDR1表达阴性的肠系膜淋巴结转移率两者有显著性差异 (P <0 0 5) ,大肠癌MDR1表达阳性率与分化程度无显著性差异(P >0 0 5)。结论　MDR1表达高低与大肠腺癌肠系膜淋巴结转移呈正相关 ,MDR1阳性表达与细胞分化程度比较无统计学意义。MDR1表达的检测对判定化疗疗效及预后有一定的意义。     

大肠腺癌组织MDR1表达与肠系膜淋巴结转移关系的研究

 目的　探索大肠腺癌组织多药耐药基因(MDR1)表达与大肠腺癌分化程度及肠系膜淋巴结转移之间的关系。方法　以光敏生物素标记MDR1 cDNA探针,链亲和素胶体金为检测系统做原位杂交(ISH-SAG）检测大肠癌MDR1 mRNA表达,同时用LSAB法对P-糖蛋白进行免疫组织化学检测。结果　大肠腺癌MDR1 mRNA表达阳性的肠系膜淋巴结转移率与MDR1表达阴性的肠系膜淋巴结转移率两者有显著性差异(P<0.05),大肠癌MDR1表达阳性率与分化程度无显著性差异(P>0.05)。结论　MDR1表达高低与大肠腺癌肠系膜淋巴结转移呈正相关,MDR1阳性表达与细胞分化程度比较无统计学意义。MDR1表达的检测对判定化疗疗效及预后有一定的意义。     

类癌及结肠癌、肺癌中神经内分泌细胞免疫组织化学研究

应用铬粒素 A、NSE、S-100蛋白及 Leu7单克隆抗体免疫组织化学方法,对24例结肠癌和肺癌、8例类癌、4例小细胞肺癌进行研究,结果表明除类癌外,结肠腺癌和肺癌中也存在神经内分泌细胞,阳性率为铬粒素 A 20.8%(5/24 3,NSE 33%(8/24),S-100蛋白33%(8/24),Len7 12.5%(3/24)。探讨了神经内分泌源性肿瘤与结肠癌、肺癌之间的关系和组织发生学。初步提出了类癌可能起源于壁内内分泌细胞,但须进一步研究和证实。     

What is the value of the computer for the physician?

Computer technology is advancing at an increasingly rapid rate. Although the computer's former role in the health care field was primarily limited to the financial and marketing departments of health care facilities, the computer is moving beyond the managerial departments and into the realm of the practicing physician. Much of this change in the use of computers in this field is due to the pressures of cost containment, DRG requirements, the availability of microcomputers, and the desire for improved health care. In the areas of clinical care, medical research, and medical education, the computer is rapidly becoming an indispensable tool through its technological adaptation. The computer is an obvious adjunct to the problem of improving cost efficiency without compromising the efforts toward better health care.     

The role of the matricellular protein SPARC in the dynamic interaction between the tumor and the host

Tumor growth is essentially the result of an evolving cross-talk between malignant and surrounding stromal cells (fibroblasts, endothelial cells and inflammatory cells). This heterogeneous mass of extracellular matrix and intermingled cells interact through cell-cell and cell-matrix contacts. Malignant cells also secrete soluble proteins that reach neighbor stromal cells, forcing them to provide the soil on which they will grow and metastasize. Different studies including expression array analysis identified the matricellular protein SPARC as a marker of poor prognosis in different cancer types. Further evidence demonstrated that high SPARC levels are often associated with the most aggressive and highly metastatic tumors. Here we describe the most recent evidence that links SPARC with human cancer progression, the controversy regarding its role in certain human cancers and the physiological processes in which SPARC is involved: epithelial-mesenchymal transition, immune surveillance and angiogenesis. Its relevance as a potential target in cancer therapy is also discussed.     

The role of the matricellular protein SPARC in the dynamic interaction between the tumor and the host

Tumor growth is essentially the result of an evolving cross-talk between malignant and surrounding stromal cells (fibroblasts, endothelial cells and inflammatory cells). This heterogeneous mass of extracellular matrix and intermingled cells interact through cell–cell and cell–matrix contacts. Malignant cells also secrete soluble proteins that reach neighbor stromal cells, forcing them to provide the soil on which they will grow and metastasize. Different studies including expression array analysis identified the matricellular protein SPARC as a marker of poor prognosis in different cancer types. Further evidence demonstrated that high SPARC levels are often associated with the most aggressive and highly metastatic tumors. Here we describe the most recent evidence that links SPARC with human cancer progression, the controversy regarding its role in certain human cancers and the physiological processes in which SPARC is involved: epithelial–mesenchymal transition, immune surveillance and angiogenesis. Its relevance as a potential target in cancer therapy is also discussed.     

Radiotherapy in Glioblastoma: the Past,the Present and the Future

The aim of this review is to explore the changing utility of radiotherapy in the treatment of patients with glioblastoma over the past 60 years. Together with surgery, radiotherapy has always been the cornerstone of treatment of glioblastoma, but techniques have significantly advanced over this time. The exploration of early two-dimensional techniques, investigation of dose escalation, concomitant chemotherapy and modern techniques, including intensity-modulated radiotherapy, image-guided radiotherapy, and volumetric-modulated arc therapy will be covered. In addition, current controversies including decreasing margin size, re-irradiation, treatment of elderly patients, and novel imaging tracers will be discussed. Future directions including immunotherapy and tumour treating fields are examined. Radiotherapy-based treatments cannot rely solely on advances in chemotherapy or immunotherapy to improve the overall survival of patients with glioblastoma. Radiation oncology needs to continue to develop and improve the delivery, target definition, and dose of radiotherapy to these patients to improve their survival and the toxicity associated with treatment.     

Pathfinders in oncology from the beginning of the 19th century to the inauguration of the first cancer hospital in the United States

The fields of medicine and oncology made substantial progress between 1800 and 1885. The first half of this period was dominated by the spectacular progress in physiology, cytology, histology, histopathology, and diagnostic microscopy. In the second half of the period, advancements in surgical techniques, anesthesia, asepsis, and laboratory medicine, including bacteriology, chemistry, and biochemistry, led to the development of medical specialties, including surgical pathology and surgical oncology. Although wars, revolutions, and socioeconomic upheavals interrupted the daily life of the populace, distinguished artists, scientists, and physicians continued, against all odds, to advance their field of interest. Among the many eminent individuals, there were 7 renowned physicians (4 pathologists and 3 surgeons) who revolutionized medical and oncology thinking in ways that are still felt today. They were polyglots with formidable erudition, beloved teachers, and mentors, and are remembered eponymically for their contributions to oncology to this day. As a passing note, the 3 surgeons also were skillful microscopists. Cancer 2018;124:230‐41. © 2017 American Cancer Society.     

Radiotherapy in the management of epidemic Kaposi's sarcoma of the oral cavity, the eyelid and the genitals

From January 1987 to December 1992, 420 patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma (EKS) were treated with radiotherapy at the oncology department in the Henri Mondor Hospital. Of these, 146 (34.7%) exhibited tumours at 186 sites; 35 were oral, 102 eyelid or conjunctival (ophthalmic), and 49 penile or scrotal (genital) sites. Most patients had received prior chemotherapy. Radiation therapy consisted of 4 MV or 45 kV X-rays, depending on tumor size and location. Doses ranged from 10 to 30 Gy, according to tumor response and toxicity. In oral lesions mucosal reactions were often observed after relatively low doses of radiotherapy. In 27 patients receiving 15 Gy, severe reactions were observed in 6 (22%), moderate reactions in 4 (15%) and mild reactions in 17 (63%). By contrast, irradiation of eyelid or conjunctival lesions and genital lesions was well-tolerated. Treatment was generally successful in achieving good symptom palliation. Eyelid and conjunctival Kaposi's sarcoma seemed to be more radiosensitive when compared with cutaneous sites: a high objective remission rate (96%, 98/102) was observed at doses ranging from 10 to 20 Gy. Penile and scrotal lesions showed a good response to low dose radiation (complete response was scored in 34/49 patients (69.4%)). A meticulous evaluation of tolerance was necessary. Toxicity of oropharyngeal irradiation at relatively low doses is an argument for a restrictive use of this procedure in oral lesions.     

胸部放疗增加表阿霉素心脏毒性的临床分析

目的　本文旨在分析胸部放射治疗是否增加表阿霉素的心脏毒性。方法　回顾性分析 128例接受表阿霉素化疗和配合或不配合胸部放射治疗的乳腺癌患者,对其治疗前后的心电图检查结果进行统计学分析。结果　表阿霉素化疗配合胸部放射治疗的乳腺癌患者的心脏毒性明显高于单纯化疗组 (P<0.001);而放化疗组中表阿霉素累积剂量超过 200mg/m2时,心脏毒性明显增加。结论　表阿霉素的心脏毒性与表阿霉素的累积剂量及胸部放射治疗有关。     

Social inequalities in the incidence and case fatality of cancers of the lung,the stomach,the bowels,and the breast

Objective  In order to examine health inequalities in terms of incidences and case fatalities in a German health insurance population. Lung cancer, stomach cancer, intestinal carcinoma, and breast cancer were considered. Social differentiation was depicted by income and occupational position in order to examine which one is more strongly associated with incidence and case fatality. Methods  Analyses were performed using data from a statutory health insurance (n = 170,848). Incomes were divided into quintiles, and subjects were grouped according to occupational status. Results  For lung cancer incidence a gradient between the highest and the lowest 20% of the income distribution emerged. The relative risk of the lowest category was RR = 7.03, for occupational position the figure was RR = 6.98. For stomach cancer the relative risks were RR = 5.33 for income and RR = 7.11 for occupational position. For intestinal carcinoma only income was significantly related with incidence (RR = 4.37 for the lowest 20% of the income distribution), and for breast cancer incidence no social inequalities were found. For case fatality increased relative risks emerged for lung cancer, but only for income. Conclusions  Income and occupational position were associated with cancer incidence with the exception of breast cancer. Apart from lung cancer, case fatalities were unrelated to measures of social differentiation.     

Tobacco Smoking in the Asian Pacific - the Scope of the Problem

Smoking is a major cause of death in the west and increasingly also in the Asian Pacific area, some of the countries of ‍which have the highest smoking rates in the world. While lung cancer incidence may demonstrate a better ‍general correlation with numbers of cigarettes smoked rather than percentages of smokers, clearly the emphasis ‍should be on quittingas well as not starting smoking. For this purpose the cooperation of the general physician ‍is essential. Helping persuade these individuals to themselves refrain from their own habit as role models for ‍their societies, increasing their counselling ands support of patients, and generating a comprehensive ‍understanding of the most effective approaches to prevention by taking into account the myriad of interacting ‍factors, is one of the most important tasks of the APJCP in 2000 and the new centur y. ‍     

应用SELDI-TOF-MS技术筛选肺腺癌患者血清诊断标志物

目的 探讨肺腺癌患者及正常人血清中蛋白质质谱的不同,筛选出肺腺癌血清诊断标志物.方法 用WCX2蛋白芯片结合表面增强激光解吸电离飞行时间质谱(SELDI-TOF-MS)技术,检测24例肺腺癌和10例正常人血清蛋白质谱,筛选出差异表达蛋白质.结果 本实验共检测到86个有效的蛋白质波峰,其中m/z位于分子质量2000～10 000的波峰有78个.筛选出m/z分子质量为8129.55,2022.18,3271.91,3933.44,3504.49,3811.71的6个血清肿瘤标志物.结论 SELDI-TOF-MS技术是寻找肺腺癌血清诊断标志物的有效工具.利用蛋白组学和生物信息学及相关技术,将有利于建立新的疾病诊断模式--蛋白质指纹图谱.