2016年上海市恶性肿瘤发病和死亡情况与2002—2016年的变化趋势分析

背景与目的：上海市疾病预防控制中心每年更新上海市恶性肿瘤发病和死亡及其趋势的统计资料。分析2016年上海市恶性肿瘤发病和死亡的基本情况及其2002—2016年的变化趋势。方法：采用上海市疾病预防控制中心建立的人群基础肿瘤登记管理系统和死因登记系统收集的2002—2016年恶性肿瘤发病和死亡资料,按诊断或死亡年份、性别和年龄组分层分析,计算数量、构成比、粗率、年龄别率、年龄标准化率（标化率）等指标,同时计算不同分组的主要癌症类型的数量、构成比和率值。按性别划分的所有恶性肿瘤和各主要癌症类型的发病和死亡标化率采用Joinpoint回归模型计算年度变化百分比（annual percent change,APC）分析变化趋势。应用Segi’s 1960年世界标准人口计算发病和死亡的标化率。结果：2016年上海市恶性肿瘤新发病例和死亡人数分别为74 422例和37 010人,粗发病率为513.94/10万,标化发病率为231.58/10万,女性的标化发病率高于男性。粗死亡率为255.58/10万,标化死亡率为90.01/10万,男性的标化死亡率高于女性。年龄别发病和死亡的数量和率值随着年龄的增长而增加,年龄别发病的数量和率值分别在60~64岁组和80~84岁组达到高峰,年龄别死亡的数量和率值分别在80~84岁组和85岁及以上组达到高峰。按发病例数排序,前10位常见癌症类型的部位依次为肺、结直肠、甲状腺、胃、乳腺、肝脏、前列腺、胰腺、脑和中枢神经系统、膀胱。按死亡人数排序,前10位依次为肺、结直肠、胃、肝、胰腺、乳腺、胆囊、食管、前列腺和淋巴系统。按性别划分的发病和死亡的前10位常见癌症类型与按常见组合年龄段划分的前5位常见癌症类型差异较大。总体上,男性的标化发病率在2002—2009年维持稳定状态,在2009—2016年以年均1.16%的增速上升,女性的标化发病率在2002—2009年维持稳定状态,在2009—2016年以年均4.48%的增速上升。2002—2016年,男性的标化死亡率以年均1.35%的减速下降,女性的标化死亡率以年均1.31%的减速下降。不同性别和癌症类型的变化趋势各不相同。结论：尽管男性和女性的标化发病率略有上升,但是对应的标化死亡率正在下降。按性别或年龄分层的总体和常见癌症类型的现况和趋势反映了上海户籍人口在癌症危险因素、筛查技术应用和诊疗水平等方面的变化。以人群为基础的癌症发病和死亡资料可用于减少癌症负担。     

An Atypical Rare Case of Extracranial Craniopharyngioma

We present a case of a purely extracranial, infrasellar craniopharyngioma that initially presented as a mass in nose and nasopharynx. Craniopharyngiomas are usually located within the sella. Purely infrasellar craniopharyngiomas have only rarely been reported in the literature. A 55-year-old man presented with 8-month history of progressive headache and epistaxis. Rhinoscopy revealed polypoidal mass in both the nasal cavities and nasopharynx. Pre-operative biopsy suggested Craniopharyngioma. A battery of tests necessary for the diagnosis of Craniopharyngioma was done which excluded other possibilities. Surgical resection was done and histopathology thereafter was confirmatory of Craniopharyngioma. Adjuvant radiotherapy was given to the patient. The patient is doing well. The Rathke’s pouch arises from the roof of the primitive mouth and grows toward the brain at the fourth week of gestation. Normally, it loses its attachment with the stomadeum completely by the eighth week of gestation. The craniopharyngeal canal (CPC) extends from the floor of the sella to the vomer and may rarely give rise to ectopic craniopharyngiomas. This case shows that such ectopic tumors may arise anywhere along the CPC. We are documenting this case as an atypical rare case of craniopharyngioma probably originating from tooth primordia.     

头颈区黏膜淋巴瘤的WHO分类更新及诊断方法

2017年1月与9月，《WHO头颈肿瘤分类》（第4版）与《WHO造血淋巴组织肿瘤分类》（修订第4版）两本蓝皮书相继面世，笔者也有幸受邀参与了《WHO头颈肿瘤分类》（第4版）一书中淋巴造血组织肿瘤有关章节的编写工作，分别对这两个新分类中关于头颈区黏膜淋巴组织增生性疾病的内容更新、头颈区黏膜淋巴瘤的诊断方法以及该区域常见淋巴瘤类型的诊断与鉴别诊断要点作一简介。     

水蛭素对肝细胞癌HepG2细胞抑制作用机制探讨

目的 研究水蛭素对肝细胞癌（hepatocellular carcinoma,HCC,简称肝癌）HepG2细胞抑制作用及其抗肝癌的分子机制。方法 将含不同浓度（1 U/mL、2 U/mL、4 U/mL和8 U/mL）水蛭素的培养液作用于肝癌HepG2细胞,采用MTT法检测水蛭素对肝癌HepG2细胞增殖的影响,流式细胞仪检测水蛭素对肝癌HepG2细胞凋亡的影响,Transwell法检测水蛭素对肝癌HepG2细胞迁移、侵袭的影响,荧光定量PCR检测血管内皮生长因子（vascular endothelial growth factor,VEGF）基因的mRNA表达水平,Western blot检测VEGF基因的蛋白表达水平。结果 与空白对照组比较,肝癌HepG2细胞增殖抑制率随水蛭素浓度（1 U/mL、2　U/mL、4 U/mL和8 U/mL）增加及作用时间（24　h、48　h、72　h）延长而增加,呈剂量-时间依赖效应（P<0.05）。不同浓度（2 U/mL、4 U/mL和8 U/mL）水蛭素作用48 h后,肝癌HepG2细胞凋亡率分别为（28.37±1.16）%、（40.27±0.97）%、（76.17±1.5）%,细胞侵袭个数分别为（204±9）个、（163±6）个、（94±4）个,细胞迁移个数分别为（86±5）个、（54±7）个、（20±5）个,细胞凋亡率、侵袭及迁移个数随水蛭素浓度增加而增加,呈浓度依赖性（P<0.05）。VEGF mRNA、蛋白的表达量随水蛭素浓度增加而明显下调（P<0.05）。结论 水蛭素能抑制肝癌HepG2细胞增殖、凋亡、迁移及侵袭,其机制可能是通过下调VEGF表达。     

细胞因子在肿瘤相关性贫血中的作用机制研究进展

肿瘤相关性贫血是肿瘤发生发展过程中最常见的并发症,肿瘤患者的贫血类型呈多样性,因影响红细胞生成或消耗的因素众多,如：慢性失血、溶血、铁代谢紊乱、肾功能不全、造血功能障碍（骨髓抑制）、炎性反应因子数量的增加、肿瘤患者恶性消耗、促红细胞生成素相对不足等均可导致贫血。目前肿瘤相关性贫血的具体发生机制尚未完全清楚,但炎性反应因子在肿瘤相关性贫血发生发展过程中起着决定性作用,其中hePcidin、IL-6、TNF-α及EPO等细胞因子扮演着重要角色。改善肿瘤患者的贫血状态,可以改善患者症状,提高患者生活质量,改善患者认知能力,增强患者社会能力,成为临床医师越来越关注的焦点。     

肿瘤患者“营养认知-食欲-功能”量表的编制及信效度分析

目的开发综合营养认知、食欲及机体功能等评价进行营养风险筛查的量表，并进行信效度验证。 方法 在文献回顾、患者访谈及项目组讨论的基础上确定量表维度、形成条目池，经过德尔斐专家咨询形成原始量表。选取首都医科大学附属北京世纪坛医院104例肿瘤患者进行调查，检验量表的信效度。 结果 最终形成的肿瘤患者营养认知-食欲-功能（nutrition belief-appetite-function， BAF）评估量表包括营养认知、食欲和功能指标3个维度，共13个条目。项目分析时发现各条目和总分的相关系数均＞0.3，各条目的决断值均达到预设标准，故不考虑删除条目。本量表的分半信度为0.750，各维度的分半信度为0.590～0.847；量表的Cronbachs α系数为0.806，各维度的Cronbachs α系数为0.631～0.866，营养认知和功能维度的系数未达到理想状态；量表的重测信度为0.784，各维度的重测信度为0.588～0.721。量表效度分析方面，各维度与总量表间得分的相关系数为0.539～0.890，均有显著性；结构性因子分析提取2个公因子，累计方差贡献率为56.36%，删除2个条目后得到营养认知和食欲及功能相关的两个维度；量表总分及各维度得分均与NRS 2002的显著正相关。 结论 编制的肿瘤患者BAF评估量表具有较好的信效度，可有效评估肿瘤患者的营养风险。     

安罗替尼联合紫杉醇和顺铂一线治疗晚期食管鳞癌的疗效分析

目的 探讨安罗替尼联合紫杉醇和顺铂一线治疗晚期食管鳞癌的疗效及不良反应。方法 回顾性分析经病理确诊的晚期食管鳞状细胞癌病例50例,其中24例采用安罗替尼联合紫杉醇和顺铂方案治疗（研究组）,26例采用紫杉醇联合顺铂方案治疗（对照组）,观察两组疗效和不良反应,并进行随访。结果 研究组和对照组的客观有效率分别为83.33%和53.84%（P<0.05）;疾病控制率分别为100%和96.15%（P>0.05）;中位无进展生存期分别为10.6月和9.13月（P<0.05）;中位生存期分别为13.4月和 11.8月（P<0.05）。研究组常见不良事件为：手足综合征（12.5%）、高血压（12.5%）、鼻出血（8.33%）和蛋白尿（4.16%）,较对照组明显增多,但均为Ⅰ~Ⅱ级,均可控制,未影响治疗的连续性。结论 安罗替尼联合紫杉醇和顺铂一线治疗晚期食管鳞癌疗效好,不良反应可耐受。     

二甲双胍抗肿瘤机制的研究进展

二甲双胍通过减少肝脏葡萄糖的合成及肠道葡萄糖的吸收达到降低糖尿病患者空腹及餐后血糖的目的，主要用于 肥胖型2型糖尿病。而近年来的研究发现，二甲双胍还可抑制肿瘤细胞的增殖、迁移和侵袭、抑制肿瘤血管生成、干扰肿瘤细 胞周期并诱导细胞凋亡、诱导细胞分化等发挥抗肿瘤作用。它主要通过单磷酸腺苷蛋白激酶（AMPK）依赖性和非AMPK依赖 性机制，其中二甲双胍激活AMPK的途径又分为直接途径和间接途径两种。两种机制可单独发挥作用也可交叉发挥作用，通 过影响肿瘤细胞和免疫细胞的信号转导通路和能量代谢，参与改善乏氧和免疫抑制的肿瘤免疫微环境，以及通过调节肠道菌 群改善机体代谢和免疫功能，发挥抗肿瘤作用，抑制肿瘤发生、发展，以达到治疗肿瘤的目的。目前已有若干临床试验采取不 同的治疗方式与二甲双胍联用，并取得了一定的成绩。现就二甲双胍对肿瘤细胞、肿瘤微环境、肠道菌群的影响及其抗肿瘤的 相关临床试验四个方面展开综述。     

沉默环状RNA hsa_circ_0000591表达对肝癌细胞增殖及迁移的影响

目的探讨环状RNA hsa_circ_0000591在肝细胞癌(hepatocellular carcinoma,HCC)组织以及肝癌细胞系中的表达,及其对肝癌细胞增殖和迁移的影响。方法收集2014—2018年广西医科大学附属肿瘤医院手术切除的84例HCC组织及其相应癌旁正常组织标本,采用qRT-PCR检测hsa_circ_0000591的表达,并分析其与预后的关系。将hsa_circ_0000591沉默慢病毒及阴性对照慢病毒感染肝癌Hep3B细胞,记为siRNA组和NC组。采用CCK-8实验、平板克隆形成实验检测细胞增殖能力;划痕实验检测细胞迁移能力;Transwell实验检测细胞侵袭和迁移能力。结果qRT-PCR检测结果显示,hsa_circ_0000591在HCC组织中的表达高于癌旁组织(P<0.001),在肝癌细胞系Li-7、HepG2、Hep3B、Huh7及人体正常肝细胞系HL-7702中的表达差异有统计学意义(P<0.05),其中在Hep3B细胞中的表达量高于其余肝癌细胞系及正常肝细胞系HL-7702(均P<0.05)。与NC组比较,沉默hsa_circ_0000591后肝癌Hep3B细胞中的hsa_circ_0000591表达下调(P<0.05),细胞增殖、迁移和侵袭能力降低(P<0.05)。结论hsa_circ_0000591在肝癌中表达上调,沉默hsa_circ_0000591可抑制肝癌细胞增殖和迁移,hsa_circ_0000591可能是肝癌潜在的分子靶点。     

鼻咽癌的综合治疗进展

世界范围内鼻咽癌发病率不到1/105，但在我国高发地区其发病率可高达50/105，我国高发地区主要集中在南方，以广东最多。一直以来，晚期鼻咽癌仍以化疗为主，但缺乏高效、低毒的靶向药物及新的治疗手段。选择合理有效的治疗手段对提高鼻咽癌患者生存率及减少治疗不良反应、提高生活质量具有重要意义。本文就近年鼻咽癌的综合治疗研究进展作简要综述。     

Potential usage of proteasome inhibitor bortezomib (Velcade, PS-341) in the treatment of metastatic melanoma: basic and clinical aspects

Protein degradation by proteasome is essential to the regulation of important cellular functions including cell cycle progression, proliferation, differentiation and apoptosis. Abnormal proteasomal degradation of key regulatory proteins perturbs the normal dynamics of these cellular processes culminating in uncontrolled cell cycle progression and decreased apoptosis leading to the characteristic cancer cell phenotype. Proteasome inhibitors are a novel group of therapeutic agents designed to oppose the increased proteasomal degradation observed in various cancers while restoring key cellular functions such as apoptosis, cell cycle progression, and the inhibition of angiogenesis. Several proteasome inhibitors have been evaluated in pre- and clinical studies for their potential usage in clinical oncology. Bortezomib (Velcade, PS-341) is the first Food and Drug Administration-approved proteasome inhibitor for the treatment of multiple myeloma and mantle cell lymphoma. Bortezomib's ability to preferentially induce toxicity and cell death in tumor cells while rendering healthy cells unaffected makes it a powerful therapeutic agent and has extended its use in other types of malignancies. The ability of bortezomib and other proteasome inhibitors to synergize with conventional therapies in killing tumors in various in vitro and in vivo models makes this class of drugs a powerful tool in overcoming acquired and inherent resistance observed in many cancers. This is achieved through modulation of aberrant cellular survival signal transduction pathways and their downstream anti-apoptotic gene products. This review will discuss the anti-neoplastic effects of various proteasome inhibitors in a variety of cancers with a special emphasis on bortezomib, its mechanism of action and role in cancer therapy. We further discuss the potential use of bortezomib in the treatment of metastatic melanoma.     

The treatment of Wilms' tumour: results of the United Kingdom Children's cancer study group (UKCCSG) second Wilms' tumour study

The aims of the UKW2 study were: (1) to further refine treatment for stage I and II favourable histology (FH) patients; (2) to consolidate the UKW1 results for stage III FH patients; (3) to improve the outlook for patients with inoperable primary tumours and those patients with stage IV and unfavourable histology disease. Treatment consisted of primary nephrectomy, wherever possible, followed by chemotherapy and radiotherapy, as dictated by stage and histology. Treatment was refined successfully for stage I and II FH patients. The 4-year event-free survival for these two groups was 94% and 91%, respectively. Stage III FH patients had a 4-year event free survival of 84%. The outlook for patients with clear cell sarcoma of the kidney is as good as for patients with favourable histology, whilst that for patients with anaplastic or rhabdoid variants remains poor. The outlook for the majority of children with Wilms' tumour is now excellent.     

慢性淋巴细胞白血病免疫治疗研究进展

慢性淋巴细胞白血病（CLL）是一种异质性的成熟B细胞克隆性疾病,好发于老年人。免疫疗法,如嵌合抗原受体T细胞疗法、双/三特异性抗体、免疫检查点疗法等,为CLL的治疗提供了更多选择,新旧疗法的多种联合应用也展现出良好的疗效及安全性。文章就现有CLL的免疫疗法及联合应用进行综述。     

Salubrinal抑制射线诱导NF-κB活化增加口腔癌细胞凋亡

目的 探讨Salubrinal调控射线诱导口腔癌细胞凋亡的作用机制。方法 构建放射抗拒口腔癌细胞KBR (4 Gy/次,7~10d 1次共4次);克隆形成实验检测Salubrinal预处理后口腔癌细胞放射敏感性;蛋白印迹法检测射线及Salubrinal调控口腔癌细胞NF-κB-HIF-1α信号通路及凋亡标志蛋白cleaved PARP的表达;Annexin V、PI染色、流式细胞仪检测凋亡分数。结果 克隆形成实验示Salubrinal增加口腔癌细胞放射敏感性,KB及KBR细胞放射增敏比分别为1.19和1.24。蛋白印迹法结果示射线诱导口腔癌细胞NF-κB-HIF-1α细胞活化具有时间依赖性,而Salubrinal抑制射线诱导其异常活化。Salubrinal增加射线诱导口腔癌细胞凋亡标志蛋白cleaved PARP表达及凋亡指数,而NF-κB激活剂TNF-α逆转了这一作用,提示Salubrinal通过抑制NF-κB活化增加射线调控口腔癌细胞凋亡。进一步应用NF-κB抑制剂Bay11-7082同样增加射线诱导口腔癌细胞凋亡,KB及KBR细胞系Bay11-7082+IR组cleaved PARP的表达为2.67±0.26、1.91±0.17,IR组为2.1±0.16、1.44±0.15(P<0.05)。结论 Salubrinal抑制射线诱导NF-κB活化增加射线诱导口腔癌细胞凋亡进而调控口腔癌细胞放射敏感性。     

Transmembrane voltage potential of somatic cells controls oncogene-mediated tumorigenesis at long-range

The microenvironment is increasingly recognized as a crucial aspect of cancer. In contrast and complement to the field''s focus on biochemical factors and extracellular matrix, we characterize a novel aspect of host:tumor interaction – endogenous bioelectric signals among non-excitable somatic cells. Extending prior work focused on the bioelectric state of cancer cells themselves, we show for the first time that the resting potentials of distant cells are critical for oncogene-dependent tumorigenesis. In the Xenopus laevis tadpole model, we used human oncogenes such as mutant KRAS to drive formation of tumor-like structures that exhibited overproliferation, increased nuclear size, hypoxia, acidity, and leukocyte attraction. Remarkably, misexpression of hyperpolarizing ion channels at distant sites within the tadpole significantly reduced the incidence of these tumors. The suppression of tumorigenesis could also be achieved by hyperpolarization using native CLIC1 chloride channels, suggesting a treatment modality not requiring gene therapy. Using a dominant negative approach, we implicate HDAC1 as the mechanism by which resting potential changes affect downstream cell behaviors. Based on published data on the voltage-mediated changes of butyrate flux through the SLC5A8 transporter, we present a model linking resting potentials of host cells to the ability of oncogenes to initiate tumorigenesis. Antibiotic data suggest that the relevant butyrate is generated by a native bacterial species, identifying a novel link between the microbiome and cancer that is mediated by alterations in bioelectric signaling.     

A case-control study of endogenous hormones and cervical cancer

Both parity and oral contraceptive use are associated with elevated circulating levels of sex hormones, at least transiently, and with increased risk of cervical cancer in human papillomavirus (HPV)-infected women. We directly evaluated whether elevations in the physiologic levels of these hormones predispose to the development of cervical neoplasia. We identified 67 premenopausal and 43 postmenopausal women with cervical intraepithelial neoplasia 2, 3, or cervical cancer (>/=CIN2) diagnosed during enrollment of a population-based cohort of 10 077 women. Four controls, two chosen randomly and two chosen from women testing positive for cancer-associated HPV, were matched to each case on menopausal status, age, days since last menses (pre), or years since menopause (post). Sex hormone-binding globulin, oestradiol, oestrone, oestrone-sulphate, dehydroepiandrosterone sulphate, and progesterone were measured in enrollment plasma. There was no consistent association between the sex hormones and risk of >/=CIN2. Excluding cases with invasive disease had a minimal impact on results. Though this case-control study was based on a well-defined population, it was limited by reliance on a single measure of hormone levels taken at the time of diagnosis. Nonetheless, our results do not support the hypothesis that plasma levels of sex hormones have an important bearing on the risk of cervical neoplasia in HPV-infected women.     

NF-κB诱捕ODN促进宫颈癌HeLa细胞凋亡的实验研究

目的 探讨NF-κB在正常宫颈组织、宫颈上皮内瘤变组织以及宫颈癌组织中的表达情况以及NF-κB诱捕ODN对宫颈癌HeLa细胞增殖、凋亡的影响。方法 选取2013年2月至2014年2月南京医科大学第二附属医院妇产科收治的42例宫颈癌患者,以及同期诊治的宫颈上皮内瘤样病变患者22例、正常宫颈组织12例,进行免疫组织化学检测NF-κB信号激活情况;在体外培养的宫颈癌HeLa细胞株中,分别转染NF-κB特异诱捕ODN和错义ODN,使用MTT和流式细胞技术检测细胞增殖、凋亡情况。结果宫颈癌组织中NF-κB的表达明显增加;使用NF-κB诱捕ODN阻断NF-κB信号激活能够显著抑制宫颈癌HeLa细胞增殖,并增强顺铂诱导的细胞凋亡。结论 NF-κB诱捕ODN可以通过阻断NF-κB信号活化,从而抑制细胞增殖并增强顺铂诱导的细胞凋亡,为宫颈癌治疗提供了新的作用靶点和治疗方向。     

Salubrinal抑制射线诱导NF-κB活化增加口腔癌细胞凋亡

目的 探讨Salubrinal调控射线诱导口腔癌细胞凋亡的作用机制。方法 构建放射抗拒口腔癌细胞KBR (4 Gy/次,7~10d 1次共4次);克隆形成实验检测Salubrinal预处理后口腔癌细胞放射敏感性;蛋白印迹法检测射线及Salubrinal调控口腔癌细胞NF-κB-HIF-1α信号通路及凋亡标志蛋白cleaved PARP的表达;Annexin V、PI染色、流式细胞仪检测凋亡分数。结果 克隆形成实验示Salubrinal增加口腔癌细胞放射敏感性,KB及KBR细胞放射增敏比分别为1.19和1.24。蛋白印迹法结果示射线诱导口腔癌细胞NF-κB-HIF-1α细胞活化具有时间依赖性,而Salubrinal抑制射线诱导其异常活化。Salubrinal增加射线诱导口腔癌细胞凋亡标志蛋白cleaved PARP表达及凋亡指数,而NF-κB激活剂TNF-α逆转了这一作用,提示Salubrinal通过抑制NF-κB活化增加射线调控口腔癌细胞凋亡。进一步应用NF-κB抑制剂Bay11-7082同样增加射线诱导口腔癌细胞凋亡,KB及KBR细胞系Bay11-7082+IR组cleaved PARP的表达为2.67±0.26、1.91±0.17,IR组为2.1±0.16、1.44±0.15(P<0.05)。结论 Salubrinal抑制射线诱导NF-κB活化增加射线诱导口腔癌细胞凋亡进而调控口腔癌细胞放射敏感性。     

DNA repair gene polymorphisms and risk of adult meningioma,glioma, and acoustic neuroma

Although the etiology of primary brain tumors is largely unknown, prior studies suggest that DNA repair polymorphisms may influence risk of glioma. Altered DNA repair is also likely to affect the risk of meningioma and acoustic neuroma, but these tumors have not been well studied. We estimated the risk of glioma (n = 362), meningioma (n = 134), and acoustic neuroma (n = 69) in non-Hispanic whites with respect to 36 single nucleotide polymorphisms from 26 genes involved in DNA repair in a hospital-based, case–control study conducted by the National Cancer Institute. We observed significantly increased risk of meningioma with the T variant of GLTSCR1 rs1035938 (OR_CT/TT = 3.5; 95% confidence interval: 1.8–6.9; P_trend .0006), which persisted after controlling for multiple comparisons (P = .019). Significantly increased meningioma risk was also observed for the minor allele variants of ERCC4 rs1800067 (P_trend .01); MUTYH rs3219466 (P_trend .02), and PCNA rs25406 (P_trend .03). The NBN rs1805794 minor allele variant was associated with decreased meningioma risk (P_trend .006). Risk of acoustic neuroma was increased for the ERCC2 rs1799793 (P_trend .03) and ERCC5 rs17655 (P_trend .05) variants and decreased for the PARP1 rs1136410 (P_trend .03). Decreased glioma risk was observed with the XRCC1 rs1799782 variant (P_trend .04). Our results suggest that common DNA repair variants may affect the risk of adult brain tumors, especially meningioma.