原发性肝癌骨转移55例预后分析

目的 提高对原发性肝癌骨转移的认识及影响预后的相关因素。方法 回顾性分析55例原发性肝癌骨转移的诊治方法 、疗效及总生存期。结果 本组原发性肝癌患者的1、2、3年生存率分别为54.5%、25.5%、16.4%,中位生存期13.0个月;发生骨转移后的1、2、3年生存率分别为23.6%、10.9%、1.8%,中位生存期5.5个月。经单因素和多因素分析,确诊原发性肝癌时是否伴有其他脏器或部位转移、肝功能是否异常、对原发病灶及转移灶是否采取综合治疗是独立的预后因子(P＜0.05)。骨转移灶的数目、甲胎蛋白的水平及肝内病灶的数目与生存率无明显相关。结论 肝癌骨转移的预后相对较差,强调综合治疗的重要性,对缓解症状、提高生活质量及延长生存期均有积极意义。     

肝癌肝移植术后骨转移的放射治疗及其对预后的影响

目的通过回顾性分析肝细胞肝癌(以下简称肝癌)肝移植后骨转移患者的临床特征、放疗疗效及预后因素,探讨其有效治疗方法。方法 随访853例肝癌患者。其中30例在肝移植后出现骨转移,接受针对骨转移部位放疗,剂量范围8～60 Gy(中位剂量为40 Gy)。用Kaplan-Meier法进行生存分析,单因素分析用Log-rank方法,多因素分析采用Cox回归模型Backward-Wald法。结果 30例患者肝移植后出现骨转移,1年、2年生存率分别为39.7%、24.4%,中位生存时间8.6月。96.7%的患者接受放疗后疼痛缓解(29/30)。放疗剂量在30～60 Gy之间对疼痛的缓解在剂量效应关系上无相关性(P=0.670)。结论 放疗可以缓解肝细胞癌患者肝移植后骨转移的疼痛,从而提高患者的生存质量。     

结直肠癌骨转移28例诊治分析

目的 探讨结直肠癌骨转移的诊治方法。方法 回顾性分析28例结直肠癌骨转移患者的临床资料。结果 结直肠癌发生骨转移后，中位生存期为8．5个月，放疗对骨转移瘤引起的局部疼痛具有较明显的缓解作用，化疗无明显疗效。结论 骨转移常为结直肠癌的终末期的表现，多同时合并其他重要脏器的转移，预后差。严格掌握手术治疗适应证，强调支持、对证治疗，以期提高生活质量，延长生存期。     

肝细胞性肝癌骨转移的诊疗进展与预后因素研究

随着临床诊治水平的不断进步，肝细胞性肝癌（hepatocellular carcinoma，HCC）患者的总生存时间获得延长，但是HCC骨转移发生率则显著升高，HCC骨转移的筛查与诊治已成为全球性热点与难点问题。明确HCC骨转移的致病机制有助于临床肿瘤筛查及诊疗手段的提高，血管形成和上皮-间质转化（epithelial mesenchymal transition，EMT）是HCC骨转移的主要致病机制，骨微环境使得HCC骨转移持续发生。明确HCC骨转移的预后因素有利于对此类患者进行早期干预以延长患者总生存期，但目前尚未就HCC骨转移患者的治疗策略达成共识。本文就HCC骨转移分子病理学致病机制的研究进展进行综述，为早期筛查、精准诊断和个体化治疗提供依据。      

36例原发性肝癌合并骨转移的治疗

肝癌骨转移多预后不良,近年来对肝癌骨转移诊断技术的发展和对骨转移随访工作的重视,肝癌骨转移的发生率有所上升,因此有必要研究控制肝癌骨转移的手段以改善肝癌的预后。作者对1990～2001年间我院合并骨转移的原发性肝癌患者治疗的方法及疗效进行了回顾性分析,现报告如下。1临床资料1990～2001年间在我院住院治疗的1000例原发性肝癌患者,36例发生骨转移。其中男性34例,女性2例;年龄35～88岁,中位年龄50.96岁。30例(83.3%)经细针肝穿刺细胞病理学确诊为肝细胞肝癌,6例综合病史、体征、甲胎蛋白(AFP)、影像学作出诊断。肝癌灶单发15例,多发…     

肝细胞癌骨转移的血清蛋白质组学的研究

我国是原发性肝细胞癌(hepatocellular car-cinoma,HCC,以下简称肝癌)高发的国家,肝癌占恶性肿瘤死亡率的第2位。肝癌骨转移严重影响患者的生活质量,多以姑息治疗提高患者生活质量为主[1]。目前骨转移的主要诊断方法是ECT、CT、MRI、PET,但对早期骨转移缺乏有效的预测和诊断方法[2],给其早期干预造成了困难。因此早期预测     

原发性肝癌骨转移的放射治疗疗效及相关预后因素的分析

目的　分析原发性肝癌骨转移患者的放射治疗疗效及预后的相关因素。方法　回顾性分析了 5 2例原发性肝癌伴骨转移放射治疗的效果 ,放疗方法采用常规分割 ,每周 5次 ,每次 2Gy ,中位肿瘤剂量 4 0 .0Gy。生存率用Kaplan Meier法计算 ,单因素分析采用log rank方法 ,多因素分析采用COX回归模型。 结果　 1、2、3年生存率分别为 2 7.6 %、11.8%、8.9%。经单因素和多因素分析表明肝内病灶的控制情况、肝功能状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器转移因素是独立的预后因子 (P值均 <0 .0 1)。骨转移灶的数目、诊断骨转移时AFP的水平与生存率无明显相关。结论　原发性肝癌骨转移患者经外照射后症状明显缓解 ,但远期疗效很差 ,绝大多数在一年内死亡。肝内病灶控制与否、肝功能的状况、肝内肿瘤灶的数目、骨转移时是否伴有其它脏器的转移与预后相关。     

肝细胞肝癌骨转移在病理生理学及放射治疗中的研究进展

随着肝细胞肝癌(hepatocellular carcinoma,HCC)诊断技术及治疗方法的进步,近年来HCC患者的总生存期获得明显延长,因此HCC骨转移的发生率也有所提高。HCC骨转移大多数为溶骨性改变,血管形成、上皮-间质转化(epithelial mesenchymal transition,EMT)、转化生长因子-β(transforming growth factor-β,TGF-β)和破骨细胞在HCC骨转移的发生和发展中均有重要作用。而HCC骨转移预测模型的建立,将有利于对HCC骨转移进行早期干预,改善预后。局部放射治疗能显著缓解HCC骨转移的症状,尤其是骨痛症状。因此,本文就HCC骨转移在病理生理学方面的研究进展及放射治疗方面的研究进展作一综述,以期为HCC骨转移的治疗提供一些新的理论依据。     

原发性肝癌骨转移的相关预后因素分析及放疗效果

目的观察原发性肝癌骨转移的放疗效果，探讨相关预后因素。方法对105例原发性肝癌骨转移病例进行回顾性分析，所有病例的骨转移灶均行常规放疗，中位肿瘤剂量40．0Gy。对性别、肝功能状况、原发灶大小和数目、原发灶控制情况、有无手术切除、骨转移灶数目、骨转移时AFP水平、r-GT水平及骨转移时是否伴骨旁软组织和其他脏器转移等多项因素进行分析。运用Kaplan-Meier法进行生存分析，单因素分析采用Logrank法，多因素分析采用Cox回归模型。结果原发性肝癌骨转移患者1、2、3年生存率分别为21．9％、5．6％、4．2％，中位生存期6个月。肝内原发灶控制情况、有无手术、骨转移时AFP和r-GT水平、骨转移时是否伴骨旁软组织和其他脏器转移为独立预后因子（P值均〈0．05）。其余因素与生存率无明显相关。结论原发性肝癌骨转移患者经外照射后症状明显缓解，但远期疗效仍然很差。肝内原发灶控制情况、肝内原发灶有无手术切除、骨转移时AFP和r-GT的水平、骨转移灶旁软组织转移和其他脏器转移与预后有关。     

骨改良药治疗骨转移的研究进展

骨改良药是一类缓解因骨转移引起的疼痛、病理性骨折、脊髓压迫、高钙血症等一系列骨相关事件药物的总称。目前主要有双膦酸盐类药物和地诺单抗。骨改良药应用于证实有骨质破坏的骨转移患者,作为化疗、放疗的辅助用药,可以明显提高疗效,延长患者的生存期。此外,中医中药也可以有效缓解骨转移引起的一系列相关症状,改善预后。临床工作中要选择合理的药物,才能最大限度地降低骨转移患者的痛苦,提高生活质量。     

Differential response to EGFR- and VEGF-targeted therapies in patient-derived tumor tissue xenograft models of colon carcinoma and related metastases

Heterogeneity in primary tumors and related metastases may result in failure of antitumor therapies, particularly in targeted therapies for the treatment of cancer. In this study, patient-derived tumor tissue (PDTT) xenograft models of colon carcinoma with lymphatic and hepatic metastases were used to evaluate the response to EGFR- and VEGF-targeted therapies. Our results showed that primary colon carcinoma and its corresponding lymphatic and hepatic metastases have a different response rate to anti-EGFR (cetuximab) and anti-VEGF (bevacizumab) therapies. However, the underlying mechanism of these types of phenomenon is still unclear. To investigate whether such phenomena may result from the heterogeneity in primary colon carcinoma and related metastases, we compared the expression levels of cell signaling pathway proteins using immunohistochemical staining and western blotting, and the gene status of KRAS using pyrosequencing in the same primary colon carcinoma and its corresponding lymphatic and hepatic metastatic tissues which were used for establishing the PDTT xenograft models. Our results showed that the expression levels of EGFR, VEGF, Akt/pAkt, ERK/pERK, MAPK/pMAPK, and mTOR/pmTOR were different in primary colon carcinoma and matched lymphatic and hepatic metastases although the KRAS gene status in all cases was wild-type. Our results indicate that the heterogeneity in primary colon carcinoma and its corresponding lymphatic and hepatic metastases may result in differences in the response to dual-inhibition of EGFR and VEGF.     

Hepatocellular carcinoma presenting with bone metastasis

Bone metastasis is an unusual complication of hepatocellular carcinoma. We report here 2 cases of patients with bone metastases of hepatocellular carcinoma at presentation. Patient No. 1 with liver cirrhosis and hepatocellular carcinoma was admitted with a bone metastasis in the rib. The patient was treated with hepatic arterial chemotherapy and rib resection. Patient No.2 was known to have an asymptomatic liver mass of uncertain histology for a year when he presented with back pain. Because of signs of spinal compression, laminectomy was performed, and the diagnosis of metastatic hepatocellular carcinoma was established. The presence of bone metastases in hepatocellular carcinoma at presentation is extremely rare. More frequently, bone lesions are observed after successful treatment of the primary liver tumor. Both surgery and radiotherapy are used as palliative treatment in bone metastases of hepatocellular carcinoma. The treatment of hepatocellular carcinoma presenting with bone metastasis by bone resection and intraarterial chemotherapy seems to be of limited impact on patient survival because of dissemination of micrometastases in other organs and the frequent presence of other comorbid conditions. However, effective palliation using this multimodality approach is feasible. Hepatocellular carcinoma should be considered in the differential diagnosis of bone metastases.     

Cancer of the prostate: value of bone scintigraphy. Point of view

Radionuclide bone scanning carried out with technetium radiopharmaceutics detects almost all prostatic carcinoma osseous metastases. It is easy to recognize focal areas of increased tracer uptake or a diffuse increased uptake, and the test provides a synthetic view of the entire skeleton. Complementary bone radiographs are necessary if the diagnosis remains doubtful, if mechanical complications are searched and if there is a post-radiotherapeutic decrease of the tracer uptake. A bone scan is necessary before the radical treatment of the primary tumour, in order to rule out the possibility of bone metastases. The initial bone scan has also a pronostic value. However, in the follow-up of initially non-metastatic patients, serial bone scans should not be realized when clinical symptoms or biological abnormalities lack. Bone scintigraphy is also useful to monitor the course of bone metastases under treatment, especially when the value of new therapeutic agents is investigated.     

Widespread osteoblastic metastases and marked elevation of CA19-9 as a presentation of signet ring cell gastric carcinoma

Widespread osteoblastic metastases, as well as marked elevations of CA19-9 and carcino-embryonic antigen (CEA), are the initial manifestations of gastric signet ring cell carcinoma. CT Imaging revealed diffuse sclerotic metastases in the axial skeleton. It was only following gastric biopsy that the primary site of metastatic bone tumor was identified. Recent studies suggest that early diagnosis of cancer origin, including tumor molecular profiling, may dictate specific therapy, improve prognosis and increase patient survival rates.     

Regional treatment of hepatic metastases and hepatocellular carcinoma

Hepatic metastases represent a common site of dissemination for a number of primary malignancies related in part to the dual blood supply, large blood flow, and receptive environment of the hepatic parenchyma. Although this review focuses on regional therapy, we have included sections on systemic therapy to better interpret the results with intrahepatic therapy. We will also discuss the efficiency of hepatic arterial ligation, embolization, and radiotherapy of hepatic metastases. Primary gastrointestinal neoplasms are particularly prone to produce hepatic metastases. Because colorectal carcinoma metastasizes to the liver in up to 70% of patients with advanced disease, the treatment of hepatic metastases is a relevant topic. We will discuss the systemic and regional therapy of colorectal, gastric, and gallbladder cancers. Breast carcinoma and malignant melanoma frequently metastasize to the liver, and we have described systemic and regional treatments of these diseases. Because sarcomas are often treated by regional therapy, we have included a section on the treatment of hepatic sarcomas. Neuroendocrine tumors (carcinoid and islet cell), although often slow growing, frequently metastasize to the liver and then cause symptomatic problems. Much of the work done with embolization and hepatic ligation in the treatment of hepatic metastases has been performed in neuroendocrine tumors, and these studies, as well as the systemic and regional chemotherapy of hepatic metastases, will be described. The last section concerns the treatment of hepatocellular carcinoma. We have outlined the staging systems used. We then detail the results of systemic and intrahepatic therapy, embolization, and hepatic ligation in the treatment of hepatocellular carcinoma. Because hepatic metastases are a frequent problem, many patients are available for clinical investigation. It is hoped that newer strategies for the treatment of liver metastases will lead to higher response rates and perhaps control of local disease. These therapeutic approaches may also give us leads to the treatment of systemic disease.     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

500例原发性肝癌的磁共振表现

背景与目的:磁共振成像(magneticresonanceimaging,MRI)是肝内恶性肿瘤的主要影像学诊断方法之一。本文总结了500例原发性肝癌的MRI表现,以评价钆-二乙烯三胺五乙酸(gadolinium-diethylenetriaminepentaacetic,Gd-DTPA)增强及超顺磁氧化铁(superparamagneticironoxideparticles,SPIO)增强扫描对小肝癌的诊断价值。资料与方法:收集我院行MR检查并经病理确诊为原发性肝癌的患者500例,分别行平扫、平扫+Gd-DTPA增强T1加权扫描、平扫+Gd-DTPA增强T1加权+SPIO增强重T2加权扫描。结果:500例原发性肝癌中,小肝癌有65例(13%),结节型肝癌81例(16.2%),块状型肝癌325例(65%),弥漫型肝癌29例(5.8%);单发310例(62%),多发190例(38%)。全组淋巴结转移率为12%;静脉癌栓率为31.4%。非弥漫型肝癌的肿块最大直径与子灶、异叶转移、淋巴结转移、癌栓之间存在正相关(P<0.05)。65例小肝癌的病灶总数为71个,平扫和增强、Gd-DTPA+SPIO增强和Gd-DTPA增强所发现病灶的平均数之间均存在显著差异(P<0.05)。结论:非弥漫型肝癌的肿块直径越大越容易发生子灶、异叶转移,淋巴结转移及癌栓。MRI诊断小肝癌,增强扫描比平扫有利于发现较多的病灶,而SPIO+Gd-DTPA增强比单纯Gd-DTPA增强发现的病灶多。     

胰腺癌伴肝、左眼眶转移1例

眼眶转移癌发生比例较小,及早发现原发病灶非常关键。原发性胰腺癌眼眶转移更为罕见,机理尚不清楚。本文报告1例原发胰腺癌伴肝、左眼眼眶转移病例,为临床诊断提供了一定参考。患者经过颅骨和上腹部断层扫描、左眼眶占位摘除活检术,再结合术后病理及实验室检查结果拟诊。行单药健择化疗3周期,患者病症有所减轻。     

胃肠道间质肿瘤伴肝转移18例临床分析

目的:总结胃肠道间质肿瘤(gastrointestinal stromal tumors,GIST)伴肝转移的诊断及治疗经验。方法:回顾性分析18例胃肠道间质肿瘤伴肝转移的临床资料。结果:胃肠道间质瘤伴肝转移18例,其中12例位于胃,2例位于十二指肠,4例位于结肠。临床表现主要为消化道出血(60%),腹部包块(25%),体检发现贫血(25%)。术前均行内窥镜、B超及CT检查,术前12例病理确诊(66.7%)。全组均行手术切除,无手术死亡和手术并发症,其中局部切除3例,12例扩大切除 肝转移灶切除 淋巴结清扫。6例患者术后服用甲磺酸伊马替尼(格列卫)辅助治疗。16例患者获得随访,1年生存率为88.9%,3年生存率为48.6%。结论:GIST伴肝转移术前确诊率低,综合分析有助于提高确诊率。手术切除为主的综合治疗是最可靠的治疗方法。