基于经直肠超声造影参数的Logistic回归模型评估局部进展期直肠癌新辅助放化疗疗效的临床价值

目的 探讨基于经直肠超声造影参数的Logistic回归模型评估局部进展期直肠癌(LARC)新辅助放化疗(NCRT)疗效的临床价值。方法 选取于我院接受NCRT后并行全直肠系膜切除术的LARC患者96例,根据病理肿瘤退缩分级(p TRG)将其分为反应良好组(p TRG 0、1级)34例和反应不佳组(p TRG 2、3级)62例。比较两组治疗前、后肿瘤长径、厚径、肿瘤内主要动脉的收缩期峰值血流速度(PSV)和阻力指数(RI)、超声造影不均匀增强程度分级(CEUS-IG_治疗前和CEUS-IG_治疗后),以及治疗后长径变化率、厚径变化率、PSV变化率、RI变化率、CEUS-IG降级占比的差异;应用Logistic回归分析预测LARC患者NCRT反应良好的独立影响因素,并建立Logistic回归模型;绘制受试者工作特征(ROC)曲线分析该模型及单一参数预测LARC患者NCRT反应良好的诊断效能。结果两组CEUS-IG_治疗后、肿瘤长径变化率、PSV变化率、CEUS-IG降级占比比较差异均有统计学意义(均P<0.05);其余参数比...     

miR-146a-3p在胃癌患者血清中的表达及临床意义

目的 探讨miR-146a-3p在胃癌患者血清中的表达及临床意义.方法 选取该院2015年3月至2017年9月收治的64例胃癌患者作为胃癌组,另选取同期该院体检健康者28例作为健康组.采用实时荧光定量聚合酶链反应(qRT-PCR)检测血清中miR-146a-3p水平,采用酶联免疫吸附试验(ELISA)法检测血清中糖类抗原72-4(CA72-4)水平.对患者进行电话随访,根据3年内患者预后情况,将患者分为存活组(n=14)和死亡组(n=50).比较胃癌组和健康组血清miR-146a-3p、CA72-4水平;比较不同特征胃癌患者血清miR-146a-3p、CA72-4水平;绘制受试者工作特征(ROC)曲线评估血清miR-146a-3p、CA72-4对胃癌患者预后的预测价值.结果 胃癌组血清miR-146a-3p水平低于健康组,CA72-4水平高于健康组,差异有统计学意义(P<0.05);不同TNM分期、淋巴结转移情况、局部浸润深度、肿瘤最大径、分化程度胃癌患者的miR-146a-3p、CA72-4水平比较,差异有统计学意义(P<0.05).Pearson相关分析结果显示,胃癌组血清miR-146a-3p水平与CA72-4水平呈负相关(r=—0.474,P<0.001);死亡组血清miR-146a-3p水平低于存活组,血清CA72-4水平高于存活组,差异有统计学意义(P<0.05);miR-146a-3p、CA72-4预测胃癌患者预后的ROC曲线下面积(AUC)分别为0.864(0.764～0.963)、0.769(0.652～0.885);miR-146a-3p的AUC大于CA72-4,差异有统计学意义(P<0.05).结论 miR-146a-3p水平在胃癌患者血清中下调,可作为评估胃癌患者预后的标志物,特异度和灵敏度较高.     

胃癌组织中miR-133a-3p、miR-4317的表达及临床意义

目的检测胃癌组织中微小RNA(miR)-133a-3p和miR-4317表达情况,并探究二者的临床意义。方法收集60例胃癌患者的癌组织及其相对应的癌旁组织,采用实时荧光定量反转录PCR(RT-qPCR)技术检测组织样品中miR-133a-3p和miR-4317表达水平,同时分析miR-133a-3p和miR-4317表达与患者临床特征之间的关系,采用Kaplan-Meier生存曲线分析miR-133a-3p和miR-4317表达与患者预后的关系。结果RTqPCR试验结果显示,胃癌组织中miR-133a-3p、miR-4317相对表达量均低于癌旁正常组织,差异有统计学意义(P<0.05)。胃癌组织中miR-133a-3p表达水平与肿瘤TNM分期、淋巴结转移有关(P<0.05);miR-4317表达水平与淋巴结转移、远处转移及肿瘤TNM分期有关(P<0.05)。Kaplan-Meier生存曲线显示,miR-133a-3p高表达胃癌患者的5年生存率高于低表达者,术后生存时间长于低表达者(P<0.05);miR-4317低表达胃癌患者的5年生存率低于高表达者,术后生存时间短于高表达者(P<0.05)。结论胃癌组织中miR-133a-3p和miR-4317均表现为低表达,二者有可能作为胃癌预测和预后判定的潜在标志物,为胃癌患者的预测和预后判定提供一定的参考价值。     

经直肠三维超声在局部晚期直肠癌新辅助放化疗后病理完全缓解评估中的应用价值

目的：探讨经直肠三维超声（3D-ERUS）在局部晚期直肠癌新辅助放化疗后病理完全缓解评估中的应用价值。 方法：回顾分析我院局部晚期直肠癌患者98例,所有患者均行标准新辅助放化疗方案后行全直肠系膜切除术,在首次入院一周内和术前放化疗后一周内分别行3D-ERUS,记录相关超声参数,将其分为病理完全缓解组（pCR组）和非缓解组（non-pCR组）,比较两组中3D-ERUS参数的差异,采用 Spearman 相关系数法分析各参数与 TRG分级的相关性;采用 ROC 曲线计算各参数对疗效评估的截断值并评价其诊断效能。 结果： NCRT后病变累及长径（r=0.336）、累及最厚径（r=0.403）、累及肠圈（r=0.339）与TRG分级呈正相关（均P＜0.05）,累及长径变化率（r=-0.407）、最厚径变化率（r=-0.435）、肠圈变化率（r=-0.408）、血流分级变化率（r=-0.235）与TRG分级呈负相关（均P＜0.05）。ROC曲线显示3D-ERUS预测pCR的诊断性能,其中累及长径变化率的截断值为29％,敏感性为70.0％,特异性为76.9％,累及最厚变化率的截断值为44％,敏感性为80.0％,特异性为76.9％,累及肠圈变化率的截断值为33％,敏感性为70.0％,特异性为79.5％,累及血流分级变化率的截断值为0％,敏感性为70.0％,特异性为57.7％,NCRT后累及长径的截断值为39mm,敏感性为95.0％,特异性为39.7％,NCRT后累及最厚径的截断值为10mm,敏感性为100.0％,特异性为47.7％,NCRT后累及肠圈的截断值为25％,敏感性为70.0％,特异性为70.5％。 结论：3D-ERUS在局部晚期直肠癌新辅助放化疗后pCR评估中具有重要价值,其所测量的NCRT后累及长径、累及最厚径、累及肠圈,累及长径变化率、最厚径变化率、肠圈变化率、血流分级变化率具有较高的准确性。     

CT在胃癌pN分期中的价值研究进展

<正>肿瘤分期的目的是评价疾病进展程度、选择治疗方案、判定预后,使不同治疗方案、不同医疗中心的疗效具有横向可比性,从而有利于肿瘤的治疗。因此,确立科学、客观的胃癌分期体系具有重要意义。目前,胃癌分期的两个主要系统是国际抗癌联盟(UICC)的TNM系统和日本胃癌协会(JGCA)的胃癌日本分期法。p N分期在TNM分期系统中是以转移淋巴结个数的量化指标为依据,主要用于评估预后,不能为     

影响局部进展期直肠癌新辅助放化疗疗效的临床因素分析

目的探讨影响局部进展期直肠癌(locally advanced rectal cancer,LARC)患者新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)的疗效及预后的临床因素。方法回顾性分析辽宁省肿瘤医院335例接受nCRT后并进行根治性手术的LARC患者的临床资料。通过单因素及多因素分析,找出可能影响LARC患者nCRT的疗效及预后的临床因素。结果多因素Logistic回归分析表明,影响LARC患者nCRT疗效的独立临床因素有nCRT前肿瘤侵犯肠管周径(OR=2.350,95%CI:1.438~3.842,P=0.01)、cT分期(OR=2.101,95%CI:1.024~4.314,P=0.043)及cN分期(OR=5.836,95%CI:3.305~10.306,P<0.01)。竞争风险模型分析表明,影响LARC患者预后的独立因素有肿瘤退缩分级(tumor regression grading,TRG)的评级(HR=3.236,95%CI:1.714~6.110,P<0.01)、cT分期(HR=1.852,95%CI:1.061~3.230,P=0.030)、cN分期(HR=2.008,95%CI:1.083~0.372,P=0.027)、nCRT前癌胚抗原(carcinoembryonic antigen,CEA)水平(HR=7.038,95%CI:3.894~12.720,P<0.01)及血清糖类抗原199(Carbohydrate antigen 199,CA199)水平(HR=3.849,95%CI:2.016~7.350,P<0.01)。结论nCRT前肿瘤侵犯肠管周径、cT分期及cN分期是影响LARC患者nCRT疗效的独立临床因素,nCRT之前肿瘤侵犯肠管周径越大,cT分期及cN分期越高,LARC患者的nCRT疗效越差。TRG分级、cT分期、cN分期、nCRT前CEA和CA199水平是影响LARC患者预后的独立因素,接受nCRT的LARC患者TRG分级越高,cT分期及cN分期越高,nCRT前CEA及CA199水平越高,其预后可能越差。     

新辅助动脉栓塞化疗在局部晚期宫颈癌治疗中的价值

目的：评价新辅助动脉栓塞化疗在局部晚期宫颈癌患者治疗中的作用。方法：将75例局部晚期宫颈癌患者随机分为两组，各例均行宫颈癌根治术，研究组35例于术前两周行髂内动脉栓塞化疗。结果：研究组患者化疗后肿瘤直径明显小于治疗前（P=0．000），化疗后肿瘤细胞的病理分级明显下降（P=0．004），肿瘤细胞的S期增高比率明显下降（P=0．001），凋亡峰明显增多（P=0．016），脉管浸润及淋巴结转移率明显低于对照组（P：0．007，P=0．036），2年复发率低于对照组（P=0．017）。结论：新辅助动脉栓塞化疗可有效缩小肿瘤，降低肿瘤细胞的恶性程度和肿瘤的脉管浸润和淋巴结转移率，诱导肿瘤细胞凋亡，降低S期增高比率，减少术后复发。     

胃癌患者血清Chemerin水平的测定及临床意义

目的观察胃癌患者血清Chemerin的水平变化,并探讨其与胃癌临床病理特征的关系。方法共纳入胃癌组121例及健康对照组86例。用酶联免疫吸附试验（ELISA）测量每组患者的血清Chemerin水平。结果胃癌组患者血清Chemerin水平明显高于健康对照组[（1 879.51±262.65）与（1 135.28±152.72）ng/L],差异有统计学意义（P〈0.01）。血清Chemerin水平随着胃癌TNM分级的增加而升高并与TNM分级呈显著正相关（r=0.258,P〈0.05）。结论胃癌患者血清Chemerin水平显著升高且升高程度与肿瘤的TNM分级相关,Chemerin可能成为诊断胃癌发病及预测胃癌进展程度的重要血清学标记物。     

影响进展期胃癌根治术后早期复发的相关因素分析

【目的】分析影响进展期胃癌根治术后早期复发的相关因素,为临床干预工作提供依据。【方法】选取2008年3月至2011年4月本院收治的195例进展期胃癌患者作为研究对象,所有患者均接受胃癌根治术治疗,根据患者术后1年内复发与否将上述患者分为早期复发组（n=103）与对照组（n=92）。先后采用χ2检验、非条件Logistic回归分析确定影响进展期胃癌根治术后早期复发的独立相关因素。【结果】①单因素分析发现,两组患者的肿瘤直径、Borrmann分型、Lauren分型、T分期、N分期、TNM分期、新辅助化疗、术后化疗等指标相比差异有统计学意义（P〈0．05）,两组患者的性别、年龄、体质指数、肿瘤位置、分化程度、手术方式、腹腔镜手术等指标相比差异无统计学意义（P〉0．05）。②非条件Logistic回归发现,N分期、TNM分期是影响进展期胃癌根治术后早期复发的独立危险因素,而新辅助化疗是独立保护因素。【结论】进展期胃癌的N分期、TNM分期是其术后早期复发的独立危险因素,采取而新辅助化疗可降低进展期胃癌根治术后早期复发率。     

免疫化疗作为胃癌根治性切除术后辅助治疗的效果

免疫化疗作为胃癌根治性切除术后辅助治疗的效果研究对象为经组织学诊断的年龄在７５岁以下的胃癌病人，适宜于胃切除，并且纯蛋白衍化物（ＰＰＤ）皮试阳性，原发性肿瘤分级为２或３级。施行手术后的病人随机分为两个治疗组；标准组１２９例应用丝裂霉素和氟脲嘧啶进行标...     

After neoadjuvant chemotherapy platelet/lymphocyte ratios negatively correlate with prognosis in gastric cancer patients

Introduction

Circulating predictors prognostic factors of neoadjuvant chemotherapy, which identify the patients who are potential possibly to benefit from it are limited at present. In this research, we aimed to compare the prognostic significance of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with locally advance gastric carcinoma who were treated with neoadjuvant chemotherapy (NAC) followed by D2 gastrectomy.

Materials and methods

From 2007 to 2015, 91 patients with locally advanced gastric cancer treated with NAC followed by D2 gastrectomy included in this retrospective cohort study. The correlation of clinical data, including tumor regression, response evaluation, tumor location, pathological type, systemic therapy, tumor size (cm), neural invasion, lymphatic‐vascular invasion, ypTNM stage, and survival prognosis were analyzed.

Results

Platelet/lymphocyte ratio and neutrophil/lymphocyte ratio in gastric cancer patients were higher than in matched normal volunteers. PLR levels higher after neoadjuvant chemotherapy are associated with worse OS. Multivariate Cox proportional analysis showed that pre‐neoadjuvant chemotherapy PLR was an independent prognostic factor.

Conclusions

Pre‐neoadjuvant chemotherapy PLR may be a feasible biomarker for survival prognosis in patients with locally advanced gastric cancer. PLR and NLR were reduced after neoadjuvant chemotherapy. After neoadjuvant chemotherapy, PLR level was negatively correlated with survival prognosis.

     

Value of diffusion-weighted MRI and apparent diffusion coefficient measurements for predicting the response of locally advanced rectal cancer to neoadjuvant chemoradiotherapy

Purpose

The aim of our study was to assess the performance value of magnetic resonance imaging (MRI) in the restaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT) and in the identification of good vs. poor responders to neoadjuvant therapy.

Materials and Methods

A total of 34 patients with locally advanced rectal cancer underwent MRI prior to and after CRT. T stage and tumor regression grade (TRG) on post-CRT MRI was compared with the pathological staging ypT and TRG. Tumor volume and the apparent diffusion coefficient (ADC) were measured using diffusion-weighted imaging (DWI) before and after neoadjuvant CRT; the percentage of tumor volume reduction and the change of ADC (ΔADC) was also calculated. ADC parameters and the percentage of tumor volume reduction were correlated to histopathological results. The diagnostic performance of ADC and volume reduction to assess tumor response was evaluated by calculating the area under the ROC curve and the optimal cut-off values.

Results

A significant correlation between the T stage and the TRG defined in DW-MRI after CRT and the ypT and the TRG observed on the surgical specimens was found (p = 0.001; p < 0.001). The mean post-CRT ADC and ΔADC in responder patients was significantly higher compared to non-responder ones (p = 0.001; p = 0.01). Furthermore, the mean post-CRT ADC values were significantly higher in tumors with T-downstage (p = 0.01).

Conclusion

DW-MRI may have a significant role in the restaging and in the evaluation of post-CRT response of locally advanced rectal cancer. Quantitative analysis of DWI through ADC map may result in a promising noninvasive tool to evaluate the response to therapy.

     

Neoadjuvant therapy: an emerging concept in oncology

Neoadjuvant therapy, an adjunctive therapy given before the main therapy, has become an integral part of modem multidisciplinary cancer management. Organized by the primary organ involved by cancer, this review summarizes the outcomes of neoadjuvant therapy for common malignant solid tumors, based on large, randomized, controlled trials. In locally advanced rectal, laryngeal, and breast cancer, neoadjuvant therapy enables organ preservation; however, it does not improve overall survival when compared with definitive treatment followed by adjuvant therapy. In locally advanced bladder and cervical cancer, patients who undergo neoadjuvant therapy before radical surgery appear to have better survival than those receiving definitive therapy alone; however, it is unclear if the neoadjuvant approach will be superior to definitive therapy followed by adjuvant therapy. To date, the survival benefits of neoadjuvant therapy for resectable non-small cell lung, esophageal, gastric, and prostate cancer remains under investigation.     

Response to neoadjuvant therapy in locally advanced rectal cancer: assessment with diffusion-weighted MR imaging and 18FDG PET/CT

The aim of this study was to evaluate the correlation between the changes of SUV_max and of apparent diffusion coefficient (ADC) before and after neoadjuvant therapy, to enable us predict the therapy response, in patients with locally advanced rectal cancer (LARC). A total of 30 patients with LARC who underwent CRT were recruited for our study. All the patients underwent a whole body 18F-FDG-PET/CT scan and a pelvic MR examination including DW imaging for staging (PET/CT1 and RM1), and after the chemoradiation therapy (PET/CT2, and RM2). Histopathologic analysis of rectal specimen, according to tumor regression grade (Mandard??s criteria) was used as the standard reference. MR and PET-CT images were analyzed, and measurements of ADC values and SUV_max were taken. Diagnostic performance for selection of complete responders (TRG1?C2) and overall diagnostic accuracy for each item were calculated. After neoadjuvant therapy, all patients were submitted to surgery. According to Mandard??s criteria, 21 tumors showed complete (TRG1) or subtotal regression (TRG2) and were classified as responders; nine tumors were classified as non responders (TRG3, 4, and 5). In all the patients, mean value of SUV_max in PET/CT1 was higher than those in PET/CT2 (P?<?0.001), whereas mean ADC value was lower in RM1 than RM2 (P?<?0.001), with a significant percentage decrease of values after the treatment (P?<?0.005).The best predictors cut-off values for TRG response were SUV_max of 4.4 and ADC of 1.28?×?10³?mm²/s with sensitivity, specificity accuracy, negative predictive value, and positive predictive values of 77.3%, 88.9%, 80.7%, 61.5%, and 94.4%, respectively. We conclude from the overall data of this study that the absolute values of SUV_max and ADC of rectal lesion after CRT were the best parameters to define the response to treatment, by differentiating fibrosis from viable tumor tissue.     

Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer

Purpose

Our study aimed to evaluate the diagnostic performance of rectal magnetic resonance imaging (MRI) for local restaging in patients with non-metastatic locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) using surgical histopathology of total mesorectal excision as the reference standard.

Methods

Ninety-five patients with LARC who underwent rectal MRI after CRT between January 2014 and December 2016 were included. Accuracy, sensitivity, specificity, positive, and negative predictive value for local staging regarding T-stage, N-stage, circumferential resection margin, and MRI tumor regression grade (ymriTRG) were calculated, and inter-test agreements were assessed.

Results

22/95 (23.2%) patients had radiological complete response (rCR), whereas 20/95 (21.1%) had pathological complete response (pCR). Among the patients with pCR, 11/20 (55%) had rCR. Fair agreement was demonstrated between ymriTRG and pathological TRG (ypTRG) (κ = 0.255). The sensitivity and specificity for detection of pCR were 61.1% (95% CI 35.7–82.7) and 89.6% (95% CI 80.6–95.4). For the detection of ypTRG grades 1 and 2, the corresponding values were 67.2% (95% CI 54.3–78.4) and 51.6 (95% CI 33.1–69.8). The accuracy of ymriTRG was 24.2% (95% CI 15.6–32.8). Inter-test agreement in TRG between MRI and pathology was overall fair (κ = 0.255) and slight (κ = 0.179), if TRG 1 + 2.

Conclusion

Qualitative assessment on MRI for diagnosing pCR showed moderate sensitivity and high specificity, whereas the diagnosis of TRG had moderate sensitivity and low specificity with slight to fair inter-test agreement when compared with pathological specimens.

     

奥沙利铂联合卡培他滨在局部进展期直肠癌术前同步放化疗中的应用

目的对奥沙利铂联合卡培他滨的术前同步化疗方案在高危局部进展期直肠癌中的安全性和有效性进行分析评价。 方法对2018年3月至2019年2月，病理诊断明确，分期为T3~4或N+M0（距肛缘≤10 cm），于北京大学肿瘤医院行术前放疗的高危局部进展期直肠腺癌患者进行回顾性分析。纳入分析的患者至少具有以下高危因素之一：极低位，临床T分期为T4b，治疗前盆腔MRI提示直肠系膜筋膜受累或肠壁外静脉浸润阳性，侧方淋巴结受累。术前放疗采用同步加量调强放疗技术，处方剂量：95%计划肿瘤靶体积50.6 Gy/95%计划靶体积41.8 Gy，22f，30 d，每天1次。同步化疗为奥沙利铂联合卡培他滨双周方案，具体：每2周静脉滴注奥沙利铂85 mg/m²＋放疗日每日2次口服卡培他滨825 mg/m²。主要观察指标为肿瘤完全缓解（病理完全缓解＋临床完全缓解）率，次要观察指标包括：放化疗不良反应及术后并发症发生率，手术R0切除率、保肛率，肿瘤消退率、降期率，复发转移率等。 结果共63例患者纳入分析，63例（100%）完成全部放疗剂量，50例（79.37%）完成全部3周期化疗。未观察到4级放化疗急性不良反应，5例（7.94%）发生3级不良反应。46例患者接受根治性手术，R0切除率为100%，手术保肛率为73.91%（36/46）。肿瘤完全缓解率为34.92%（22/63）。T、N降期率分别为82.61%（38/46）、95.65%（44/46）；肿瘤消退分级0、1、2级分别为30.43%（14/46）、45.65%（21/46）、23.91%（11/46）。6例出现术后并发症，均经保守治疗好转。中位随访时间7.2个月，随访过程中未出现患者死亡及局部复发，4例（6.35%，4/63）出现远处转移。 结论对于高危局部进展期直肠癌患者，奥沙利铂联合卡培他滨的双药同步放化疗方案具有良好的近期疗效和可接受的不良反应，可能是更佳的新辅助治疗选择。     

Change in glucose metabolism measured by 18F-FDG PET/CT as a predictor of histopathologic response to neoadjuvant treatment in rectal cancer

Purpose  

In order to analyze the changes of glucose metabolism by maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT in patients with rectal cancer submitted to neoadjuvant radiochemotherapy (nRCT) and to correlate SUV changes with tumor regression grade (TRG).     

紫杉醇联合顺铂新辅助化疗治疗局部晚期宫颈癌的疗效观察

目的观察紫杉醇联合顺铂新辅助化疗治疗局部晚期宫颈癌的临床疗效。方法 77例局部晚期宫颈癌患者随机分为两组,观察组(n=37例)采用紫杉醇联合顺铂新辅助化疗联合手术治疗,对照组(n=40例)采用单纯手术治疗。比较两组临床疗效、淋巴结阳性率、阴道切缘阳性率、宫旁累及率和脉管浸润率等情况。结果两组患者在FIGO分期、肿瘤直径、病理分级及病理学类型等方面比较无显著差异(P0.05);观察组术前化疗总有效率为73.0%,两组手术时间及失血量比较无显著差异(P0.05),观察组阴道切缘阳性率、淋巴结阳性率、宫旁累及率及脉管浸润率明显低于对照组(P0.05)。结论紫杉醇联合顺铂术前新辅助化疗可降低局部晚期宫颈癌患者术后阴道切缘阳性率、淋巴结阳性率、宫旁累及率及脉管浸润率,值得临床推广应用。