单向式完全胸腔镜下肺癌根治术治疗早期非小细胞肺癌的疗效评价

目的 探讨单向式完全胸腔镜(c-VATS)下肺癌根治术治疗早期非小细胞肺癌(NSCLC)的远期疗效.方法 根据手术方式的不同将98例NSCLC患者分为开胸组和微创组,每组49例.开胸组患者采用传统开胸肺癌根治术治疗,微创组患者使用c-VATS下肺癌根治术治疗.比较两组患者的围手术期指标、血清炎性反应指标、并发症发生率、肺功能指标,统计两组患者无进展生存期(PFS)与总生存期(OS).结果 微创组患者切口长度、手术用时、术中出血量、胸腔积液引流量、术后拔管时间、术后24 h视觉模拟评分法(VAS)评分、住院时间均优于开胸组,差异均有统计学意义(P﹤0.05);两组患者淋巴结清扫数目比较,差异无统计学意义(P﹥0.05).术后3天,两组患者血清C反应蛋白(CRP)、降钙素原(PCT)水平均高于本组术前,但微创组患者血清CRP、PCT水平均低于开胸组,差异均有统计学意义(P﹤0.05).微创组患者术后并发症总发生率低于开胸组,差异有统计学意义(P﹤0.05).术后6个月,两组患者第一秒用力呼气量(FEV1)、用力肺活量(FVC)均低于本组术前,但微创组患者FEV1、FVC均高于开胸组,差异均有统计学意义(P﹤0.05);两组患者FEV1/FVC比较,差异无统计学意义(P﹥0.05).术后随访,两组患者PFS、OS比较,差异均无统计学意义(P﹥0.05).结论 c-VATS下肺癌根治术治疗早期NSCLC远期疗效可达到传统开胸术效果,且具有手术损伤小、术后易恢复、安全性高等优势.     

IMRT与VMAT治疗小细胞肺癌合并上腔静脉压迫综合征患者的急性不良反应比较

目的比较调强适形放疗(IMRT)和容积旋转调强放疗(VMAT)治疗小细胞肺癌合并上腔静脉压迫综合征(SVCS)的急性不良反应及耐受性。方法根据治疗方法不同将48例小细胞肺癌合并SVCS患者分为IMRT组(n=23)和VMAT组(n=25),两组患者均行两阶段治疗,比较两组患者的急性不良反应发生情况。结果48例小细胞肺癌合并SVCS患者中,未出现因急性不良反应而中断放疗的患者,且主要发生1～3级急性不良反应,其中食欲下降、白细胞减少、放射性皮炎、乏力、放射性肺损伤、恶心、贫血、食管黏膜损伤等较为常见。VMAT组患者1～3级食管黏膜损伤发生率低于IMRT组(P﹤0.05);VMAT组和IMRT组患者的其他1～3级不良反应发生情况比较,差异均无统计学意义(P﹥0.05)。结论小细胞肺癌合并SVCS患者采用IMRT和VMAT治疗的总体耐受性均较好,IMRT和VMAT均可作为常规放疗手段在小细胞肺癌合并SVCS的患者中应用。     

鼻咽癌序贯加量调强放疗中个体化聚甲基丙烯酸甲酯支架对口腔正常黏膜的保护作用研究

目的 观察鼻咽癌序贯加量调强放疗(IMRT)中个体化聚甲基丙烯酸甲酯(PMMA)支架的使用效果及对口腔正常黏膜的保护作用.方法 将60例鼻咽癌患者按治疗方式不同分为对照组和观察组,每组30例.两组均采用序贯加量IMRT,其中对照组患者在IMRT中佩戴简易口塞,观察组患者在IMRT中佩戴个体化PMMA支架.观察两组的疗效和不良反应,比较均匀性指数(HI)、适形指数(CI)、黏膜损伤情况、疼痛评分、味觉评分.结果 两组患者治疗有效率、CI、HI水平比较,差异均无统计学意义(P﹥0.05).在治疗期间,观察组患者软腭、咽后壁、舌尖、舌根黏膜受损情况明显轻于对照组,差异均有统计学意义(P﹤0.01).治疗过程中观察组患者疼痛评分明显低于对照组,治疗后4周观察组患者味觉评分明显高于对照组,差异均有统计学意义(P﹤0.01).两组患者血细胞毒性、恶心呕吐、肝功能损伤和唾液腺损伤发生率比较,差异均无统计学意义(P﹥0.05).结论 鼻咽癌序贯加量IMRT中个体化PMMA支架的应用有较好的效果,对患者口腔黏膜损伤小,且对减轻疼痛和保护味觉有良好的作用,具有临床应用价值.     

白蛋白结合型紫杉醇新辅助化疗对宫颈癌患者术后疗效影响的研究

目的 探究白蛋白结合型紫杉醇新辅助化疗对宫颈癌患者术后疗效的影响.方法 选取宫颈癌患者104例,根据治疗方法不同将患者分为治疗组与对照组,每组各52例.对照组患者接受顺铂联合紫杉醇新辅助化疗治疗;治疗组患者接受顺铂联合白蛋白结合型紫杉醇新辅助化疗治疗.结果 治疗前,两组患者的瘤体最大直径比较,差异无统计学意义(P﹥0.05);治疗后,治疗组患者的瘤体最大直径明显小于对照组(P﹤0.01).治疗组患者的术中出血量明显少于对照组(P﹤0.01),单次给药时间、手术时间明显短于对照组(P﹤0.01).治疗过程中,治疗组患者的荨麻疹及低血压发生率均低于对照组(P﹤0.05);两组患者周围感觉神经病变及肾功能异常发生率比较,差异无统计学意义(P﹥0.05).治疗组患者化疗总有效率高于对照组(P﹤0.05);治疗组患者的术后1年复发率低于对照组(P﹤0.05).结论 白蛋白结合型紫杉醇相对普通紫杉醇具有不良反应轻,疗效明显,患者耐受性好等优势.     

局部晚期宫颈癌患者贫血的相关危险因素及其对预后的影响

目的:分析局部晚期宫颈癌患者发生贫血的相关危险因素及贫血对预后的影响。方法:回顾性分析62例行根治性同步放化疗的局部晚期宫颈癌患者临床资料,统计治疗前后癌性贫血的发生率,分析贫血与年龄、临床分期、ECOG评分的关系,采用Kaplan-Meier法计算OS和PFS,采用Log-rank法检验并进行单因素分析,以及Cox风险回归模型进行多因素预后分析。结果:局部晚期宫颈癌患者出现贫血的发生率为58.1%;治疗后贫血的发生率明显高于治疗前（80.6% vs 58.1%）,差异具有统计学意义（P＜0.05）;单因素分析结果显示贫血与临床分期和ECOG评分显著相关（P＜0.05）,与年龄、病理类型无明显相关（P＞0.05）;Log-rank法显示,临床分期、ECOG评分和贫血是影响患者PFS和OS的危险因素（P＜0.05）;Cox多因素分析结果显示,临床分期和放化疗前后贫血状态是影响5年OS和5年PFS的独立预后因素（P＜0.05）。结论:贫血在局部晚期宫颈癌患者中的发生率高,而临床分期越早、ECOG评分越低,发生贫血的风险越小,改善贫血状态可能获得更大生存获益。     

调强适形放疗同步化疗联合热疗治疗原发性上皮性卵巢癌的疗效分析

目的 探讨调强适形放疗(IMRT)同步化疗联合热疗对原发性上皮性卵巢癌(EOC)的治疗效果.方法 回顾性分析90例原发性EOC患者的临床资料,根据治疗方式分为观察组和对照组,每组45例,对照组给予IMRT同步化疗进行治疗,观察组在此基础上给予热疗.治疗3个月后,观察两组患者的治疗效果,比较两组患者治疗前后肿瘤标志物水平、生活质量和不良反应发生情况的差异.结果 观察组患者疗效优于对照组(P﹤0.05).治疗前两组患者肿瘤标志物水平差异无统计学意义(P﹥0.05);治疗后观察组患者的癌胚抗原(CEA)、糖类抗原15-3(CA15-3)和糖类抗原125(CA125)水平均明显低于对照组(P﹤0.01).治疗前两组患者生活质量评分差异无统计学意义(P﹥0.05);治疗后观察组患者生活质量评分明显高于对照组(P﹤0.01).两组患者恶心、呕吐,肝肾功能受损,骨髓抑制及血栓性静脉炎发生情况差异无统计学意义(P﹥0.05).结论 IMRT同步化疗联合热疗对原发性EOC有较好的治疗效果,可提高患者的生活质量.     

胃食管吻合及浆肌层内翻缝合包埋处理对食管癌患者术后并发症的影响研究

目的 探讨胃食管吻合及浆肌层内翻缝合包埋处理对食管癌患者术后并发症的影响.方法 选取接受治疗且手术前确诊为食管癌,并行食管癌切除和胃食管吻合手术的患者177例,其中65例患者行单纯胃食管吻合术,设为对照组;112例患者在胃食管吻合术基础上进行吻合口浆肌层的内翻缝合包埋,设为观察组;比较两组患者手术后切口感染、吻合口瘘、肺部感染、喉返神经受损和乳糜胸发生情况,手术后1个月食管X线钡餐检测测量吻合口狭窄、吻合口直径和反流反酸、吞咽困难的评分状况.结果 术后观察组患者吻合口直径小于对照组,吻合口狭窄发生情况多于对照组,差异均有统计学意义(P﹤0.05);两组患者术后并发症发生情况及围手术期内死亡情况比较,差异均无统计学意义(P﹥0.05);对照组患者术后吞咽困难评分优于观察组,差异有统计学意义(P﹤0.05),两组患者反流反酸评分比较,差异无统计学意义(P﹥0.05).结论 吻合口浆肌层内翻缝合包埋对防止出现吻合口瘘没有临床意义,无法使患者术后吻合口瘘发生率降低,同时使术后出现吻合口狭窄的概率增大.     

紫杉醇脂质体联合铂类新辅助化疗对Ⅱa~Ⅳ期宫颈癌患者的近期疗效观察

目的 观察紫杉醇脂质体联合顺铂新辅助化疗治疗Ⅱa~Ⅳ期宫颈癌的临床疗效和安全性.方法 回顾性分析120例Ⅱa~Ⅳ期宫颈癌患者的临床资料,根据化疗方案不同将患者分为观察组(n=67)和对照组(n=53),观察组接受紫杉醇脂质体联合顺铂新辅助化疗治疗,对照组接受紫杉醇联合顺铂化疗治疗,两组均持续化疗2个疗程,期间均给予对症支持治疗.观察两组患者的近期疗效及不良反应发生情况,并对治疗前后两组患者的Karnofsky(KPS)功能状态评分进行比较.结果 观察组和对照组患者的临床有效率分别为82.1%、77.4%,差异无统计学意义(P﹥0.05).治疗后,两组患者的KPS评分均较本组治疗前明显提高(P﹤0.001);而观察组患者治疗后的KPS评分明显高于对照组治疗后(P﹤0.001).观察组患者的肌肉酸痛、过敏反应总发生率均低于对照组(P﹤0.05);但两组骨髓抑制、胃肠道反应及脱发的总发生率比较,差异无统计学意义(P﹥0.05).结论 紫杉醇脂质体联合顺铂新辅助化疗对Ⅱa~Ⅳ期宫颈癌具有良好的疗效,相比于紫杉醇联合顺铂化疗,其耐受性更好,不良反应更轻.     

全腹腔镜与腹腔镜辅助全胃切除术对胃上部癌患者的治疗效果对比

目的 分析全腹腔镜与腹腔镜辅助全胃切除术对胃上部癌患者的治疗效果.方法 选择胃上部癌患者94例,根据治疗方式不同将患者分为对照组(n=47)和研究组(n=47),对照组行腹腔镜辅助全胃切除术,研究组行全腹腔镜全胃切除术,比较两组患者的术后凝血功能指标、视觉模拟评分(VAS)、手术情况、术后恢复及并发症情况.结果 术后两组患者的凝血功能指标(APTT、Fg、D-D)均升高,但两组比较差异无统计学意义(P﹥0.05);研究组患者VAS评分低于对照组,差异有统计学意义(P﹤0.05);研究组术中切口长度短于对照组,差异有统计学意义(P﹤0.01);两组的手术时间、术中出血量、淋巴结清扫数目比较,差异无统计学意义(P﹥0.05);研究组患者术后下床活动时间、肛门排气时间、进食流质时间、住院时间均短于对照组,差异有统计学意义(P﹤0.01);两组患者的并发症发生情况比较,差异无统计学意义(P﹥0.05).结论 全腹腔镜全胃切除术对胃上部癌患者的治疗效果优于腹腔镜辅助全胃切除术,值得临床推广应用.     

同期化疗辅助全脑放疗联合三维适形调强局部加量治疗乳腺癌脑转移的临床研究

目的 探讨同期化疗辅助全脑放疗联合三维适形调强局部加量治疗乳腺癌脑转移的临床疗效.方法 回顾性分析92例乳腺癌脑转移患者的临床资料,依据治疗方法的不同将患者分为对照组(n=48)和试验组(n=44).对照组患者采用全脑放疗联合三维适形调强局部加量治疗,试验组患者在上述放疗的基础上给予同期辅助化疗.评估两组患者的临床疗效、不良反应发生情况及生存质量.结果 两组患者均顺利完成治疗.试验组患者的总有效率为31.8％(14/44),高于对照组的12.5％(6/48),差异有统计学意义(P﹤0.05);试验组和对照组患者的疾病控制率分别为86.4％(38/44)和75.0％(36/48),差异无统计学意义(P﹥0.05).试验组患者的中位无进展生存时间(PFS)为4.6个月(95％CI:3.694～5.506),中位总生存时间(OS)为8.3个月(95％CI:6.739～9.861);对照组患者的中位PFS为3.3个月(95％CI:1.893～4.707),中位OS为6.0个月(95％CI:5.103～6.897).试验组患者的中位PFS和中位OS均长于对照组,差异均有统计学意义(P﹤0.05).两组患者均出现不同程度的不良反应,主要的3～4级不良反应为胃肠道反应、血小板减少和头痛,但患者均可耐受,均未中止治疗.试验组患者胃肠道反应的发生率为50.00％(22/44),明显高于对照组的16.67％(8/48),差异有统计学意义(P﹤0.01);其余不良反应的发生率比较,差异均无统计学意义(P﹥0.05).治疗后两组患者的KPS评分均提高,且试验组患者的KPS评分明显高于对照组,差异均有统计学意义(P﹤0.01).结论 对乳腺癌脑转移患者进行同期化疗辅助全脑放疗联合三维适形调强局部加量治疗可获得较好的临床疗效,且不良反应可耐受.     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

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.     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers

Alcoholic beverages are causally related to cancer of the oral cavity, pharynx, larynx and esophagus. Ethanol is oxidized to acetaldehyde and then to acetate by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), both of which have genetic polymorphisms. A review of case-control studies of the effects of ALDH2, ADH2 and ADH3 genotypes shows consistently positive associations between inactive heterozygous ALDH2 and the less-active ADH2 genotypes and the risk for esophageal cancer in East Asian heavy drinkers and this enzyme-related vulnerability may extend to light-to-moderate drinkers. Some studies suggest similar associations with the risk for head and neck cancer in moderate-to-heavy-drinking Japanese. An established carcinogen in experimental animals, acetaldehyde can interact with human DNA. ALDH2-associated cancer susceptibility fits into a scenario in which acetaldehyde plays a critical role in the development of human cancer. Alcohol flushing and drinking behavior may partly explain this carcinogenic effect in carriers of less-active ADH2 genotypes. Whether the ADH3 genotype influences head and neck cancer risk in Western nations is controversial. Professional and public education about risky conditions connected to the ALDH2 and ADH2 genotypes and environmental factors is important in a new strategic approach to the prevention of alcohol-related cancers in East Asians. The use of simple tests to identify inactive ALDH2 on the basis of alcohol flushing responses could benefit many people, by helping them to identify their own cancer risks. Such testing could also help clinicians diagnose esophageal cancer earlier, through the use of endoscopic screening in the high-risk population.     

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.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.