低分子肝素治疗Trousseau′s综合征

1865年,Trousseau首次报告肿瘤与血栓栓塞性疾病的关系,游走性静脉血栓形成首次被描述。而且,目前在肿瘤病人中,各种静脉和动脉其他的血栓栓塞性疾病被称为Trousseau′s综合征。尽管有争论,血栓栓塞现象一直被认为是潜隐性肿瘤,尤其是未有血栓形成的其他危险因素的癌症病人的先兆。血栓形成常可提示恶性肿瘤的诊断。 本文报告4例病人患有广泛的静脉血栓栓塞性疾病,随之诊断又患有恶性肿瘤。所有病人最后均应用enoxaparin(一种低分子肝素,low-Molecular-weight heparin,LMWH)皮下给药治疗,理想地控制了血栓栓塞。     

恶性肿瘤合并血栓栓塞性疾病22例临床分析

[目的]探讨恶性肿瘤合并血栓栓塞性疾病的特点。[方法]回顾性分析22例经病理学证实的恶性肿瘤合并血栓栓塞性疾病患者的临床资料。[结果]22例恶性肿瘤合并血栓栓塞性疾病中,并发颈内静脉血栓形成4例,单纯下肢深静脉血栓形成（DVT）10例,单纯肺血栓栓塞（PTE）3例,DVT合并PTE5例。5例合并PTE患者中3例有较典型的临床症状,多有低氧血症、血D-二聚体明显升高。心电图仅1例有典型SIQIIITIII表现。[结论]恶性肿瘤并发血栓栓塞性疾病临床常见,对手术、化疗、放疗、PICC置管或疾病进展可能导致血液高凝状态患者应及早进行抗凝治疗,预防血栓栓塞性疾病的发生。     

肿瘤患者合并深静脉血栓的临床分析

目的:探讨恶性肿瘤并发血栓性疾病的危险因素,为及早预防提供依据.方法:收集30例恶性肿瘤并发血栓栓塞患者为病例组,并收集同期不伴有血栓栓塞的38例恶性肿瘤患者为对照组,回顾性分析恶性肿瘤并发血栓栓塞的危险因素.结果:病例组30例患者中,下肢深静脉血栓形成者24例,上肢深静脉血栓5例,肺栓塞者1例.观察组红细胞计数和血红蛋白值均低于对照组,血小板计数和D-二聚体高于对照组,差异均有统计学意义(P<0.05).恶性肿瘤并发血栓性疾病的发生在并发感染、接受手术、地塞米松治疗和中心静脉置管上存在差异(P<0.05).30例患者在肿瘤确诊2个月内并发血栓性疾病.结论:恶性肿瘤并发感染、地塞米松的应用、接受手术和中心静脉置管的应用时易并发血栓形成.     

恶性肿瘤并发血栓栓塞61例临床分析

目的 探讨恶性肿瘤并发血栓性疾病的危险因素、临床表现、诊断和治疗的特点.方法 收集我院的61例恶性肿瘤并发血栓栓塞患者为病例组,并收集同期不伴有血栓栓塞的49例恶性肿瘤患者为对照组,回顾性分析恶性肿瘤并发血栓栓塞的危险因素、临床表现、诊断和治疗的特点.结果 病例组61例患者中,下肢深静脉血栓形成者44例,上肢深静脉血栓...     

药物调节凝血机制在抗癌治疗中的意义

肿瘤病人凝血机制异常和血栓栓塞性疾病的发病率增高,提示凝血系统参与了肿瘤的生长与转移过程。药物调节凝血机制能提高肿瘤的治疗效果,检测凝血机制的某些指标对肿瘤诊断、疗效评价以及预后估计均有一定价值。     

恶性肿瘤患者合并深静脉血栓的护理观察

早在1865年Trousseau已经注意到胃癌患易发生四肢深静脉血栓,现在血栓栓塞症（venous thromboembolism,VEF）已被认为是恶性肿瘤患的一个重要死因。深静脉血栓（deep venous thrombosis,DVT）是肿瘤患中最常见的血栓栓塞性疾病,现收集我科诊治的26例恶性肿瘤合并DVT的患,结合其临床表现、诊断和护理特点报告如下。     

妇科肿瘤围手术期并发血栓性疾病30例的临床分析

目的：探讨妇科肿瘤患者围手术期并发血栓性疾病的诊疗措施及相关因素。方法回顾性分析30例妇科肿瘤围手术期并发血栓性疾病患者的临床特征、诊治过程,并根据相关因素提出针对性的预防措施。结果29例深静脉血栓（ DVT）患者给予溶栓、抗凝及祛聚治疗后,28例痊愈,1例左侧下肢伴有轻微下肢功能障碍。1例肺栓塞（ PTE）患者转入心内科治疗后痊愈。大龄女性、静脉血栓史、合并慢性病、恶性肿瘤、术后服用止血药及雌激素、盆腔淋巴结清扫术是妇科肿瘤患者术后并发血栓性疾病的可能危险因素。结论手术前后积极预防,充分评估,早期诊断,及时治疗,可降低妇科肿瘤围手术期血栓性疾病发生的危险,改善并发PTE患者的预后。     

恶性肿瘤与血栓栓塞性疾病

目的提高对恶性肿瘤患者合并血栓栓塞性疾病的认识。方法对46例合并血栓栓塞性疾病的恶性肿瘤患者进行回顾性分析。结果本组脑恶性肿瘤6例,占13.0%;前列腺癌5例,占10.9%;肺癌7例,占15.2%;大肠癌3例,占6.5%;胃癌4例,占8.7%;卵巢癌3例,占6.5%;子宫颈癌4例,占8.7%;乳腺癌3例,占6.5%;肾癌2例,占4.4%;胰腺癌7例,占15.2%;非霍奇金淋巴瘤2例,占4.4%;深静脉血栓31例,占67.4%;脑血栓7例,占15.2%;D IC 4例,占8.7%;PE 3例,占6.5%;PVT 1例,占2.2%。病理类型主要为腺癌,27例占58.7%。结论恶性肿瘤患者可伴发血栓栓塞性疾病,可能与血液的高凝状态、肿瘤化疗和中心静脉导管植入有关。     

宫颈癌合并深静脉血栓30例临床分析

目的：静脉血栓栓塞症（VTE）是恶性肿瘤患者常见并发症。本文结合文献分析我院住院病人宫颈癌患者静脉血栓的临床特征,分析VTE形成机制及诱发因素,探索最佳治疗方法。方法：对近5年我科收治的宫颈癌合并深静脉血栓30例患者的临床资料进行分析。结果：30例患者中17例VTE的发生和介入手术化疗有关。2例（6.7%）血栓栓塞发生在宫颈癌确诊之前,28例（93.3%）发生在宫颈癌确诊之后,单纯并发下肢深静脉血栓形成（DVT）27例,合并肺栓塞（PTE）2例,DVT合并PTE 1例。22例在栓塞前有化疗史。结论：血栓可能为肿瘤病人的首发表现,病人出现不能解释的血栓栓塞性疾病应考虑有肿瘤的可能。抗凝治疗对于血栓栓塞症疗效确切。及时诊断和治疗可以延长患者的生存期,降低患者的死亡率。口服避孕药、口服甲地孕酮、介入手术与VTE的发生几率可能有关。分期晚,远地转移的肿瘤患者易出现血栓栓塞。     

宫颈癌合并深静脉血栓30例临床分析

目的:静脉血栓栓塞症(VTE)是恶性肿瘤患者常见并发症。本文结合文献分析我院住院病人宫颈癌患者静脉血栓的临床特征,分析VTE形成机制及诱发因素,探索最佳治疗方法。方法:对近5年我科收治的宫颈癌合并深静脉血栓30例患者的临床资料进行分析。结果:30例患者中17例VTE的发生和介入手术化疗有关。2例(6.7%)血栓栓塞发生在宫颈癌确诊之前,28例(93.3%)发生在宫颈癌确诊之后,单纯并发下肢深静脉血栓形成(DVT)27例,合并肺栓塞(PTE)2例,DVT合并PTE 1例。22例在栓塞前有化疗史。结论:血栓可能为肿瘤病人的首发表现,病人出现不能解释的血栓栓塞性疾病应考虑有肿瘤的可能。抗凝治疗对于血栓栓塞症疗效确切。及时诊断和治疗可以延长患者的生存期,降低患者的死亡率。口服避孕药、口服甲地孕酮、介入手术与VTE的发生几率可能有关。分期晚,远地转移的肿瘤患者易出现血栓栓塞。     

Gallbladder cancer: Historical treatment and new management options

Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.     

复合性与单纯性小细胞肺癌预后分析及比较

  目的   回顾性分析和比较复合性小细胞肺癌（combined small cell lung cancer,CSCLC）与单纯性小细胞肺癌（pure small cell lung cancer,PSCLC）预后及其影响因素。   方法   收集天津医科大学肿瘤医院2006年1月至2010年12月首诊并经病理证实为小细胞肺癌343例,回顾其临床病理特征,对预后及影响因素进行分析。   结果   CSCLC中位总生存期（overall survival,OS）为31个月,中位无进展生存期（progression free survival,PFS）为21个月,PSCLC的中位OS为15个月,中位PFS为9个月。Kaplan-Meier结果显示CSCLC的预后明显好于PSCLC。Cox分析结果提示分期、病理分型与治疗方式是影响总体小细胞肺癌OS的独立影响因素。单因素分析显示,小细胞肺癌尤其是CSCLC更受益于手术为主的治疗方式。在PSCLC组,中性淋巴细胞比率（neutrophil-lymphocyte ratio,NLR）、治疗方式和分期影响预后,而分期和治疗方式影响CSCLC的预后。多因素分析显示分期和治疗方式均为影响CSCLC的独立影响因子。   结论   CSCLC与PSCLC相比预后较好。局限期的小细胞肺癌尤其是CSCLC应采取手术为主的治疗。      

Human epidermal growth factor receptor 2 targeted therapy in endometrial cancer: Clinical and pathological perspectives

Endometrial cancer is the most common gynecological cancer in developed countries, and its incidence has increased. The majority of patients with endometrial cancer have an early disease and favorable prognosis; however, a significant proportion of endometrial cancer, which mainly comprises high-grade or type II endometrial cancer such as serous, clear cell, and carcinosarcoma, shows advanced/recurrent disease and dismal prognosis. Novel therapeutic development is required for patients with aggressive endometrial cancers. Recent genomic and immunohistochemical analyses revealed human epidermal growth factor receptor 2 (HER2) overexpression/gene amplification in 20%-40% of patients with type II endometrial cancer. Historically, HER2 targeted therapy has been developed for various major cancers, including breast and gastric cancer. Notably, recent advances in HER2 targeted therapy for patients with type II endometrial cancer are also expected to change. Simultaneously, an optimized HER2 test for endometrial cancer as companion diagnostics should be established. In this review, we summarize the recent findings on endometrial cancer, current treatment, optimized HER2 testing, key clinical trials on HER2 targeted therapy, and future directions in aggressive endometrial cancer, including serous carcinoma and carcinosarcoma.     

Bilateral primary breast cancer in patients treated with adjuvant therapy

Between 1974 and 1986, 1036 patients with operable breast cancer were treated with doxorubicin-containing combination chemotherapy regimens. Of these, 44 patients had bilateral breast cancer prior to initiation of adjuvant therapy (prechemotherapy) and 17 patients developed primary breast cancer on the contralateral side during or after completion of adjuvant therapy (postchemotherapy). The objectives of the study were twofold: to determine the incidence of bilateral primary breast cancer and to determine the effect of second primary breast cancer on prognosis of patients treated for disease in the contralateral breast. The estimated disease-free and overall survival of patients with prechemotherapy bilateral disease was similar to the patients with unilateral breast cancer. Four hundred eight patients received tamoxifen in addition to combination chemotherapy during adjuvant therapy. The incidence of contralateral breast cancer at 2 years in patients treated with tamoxifen was 0.4% in comparison to 0.8% in patients treated with chemotherapy alone. Time to development of second breast cancer in patients treated with or without tamoxifen was not significantly different (p = 0.41). We conclude that patients with bilateral breast cancer have a prognosis similar to that of patients with comparably staged unilateral disease. Although the rate of bilateral disease observed among patients treated with adjuvant chemotherapy and tamoxifen was somewhat lower than for those receiving chemotherapy only, the difference was not statistically significant.     

The impact of age on outcome in early-stage breast cancer

Multiple studies have shown that breast-conserving therapy (BCT) and mastectomy have equivalent outcomes for large populations of women with early-stage breast cancer. For individual treatment decisions, however, it is important to appreciate the heterogeneity of disease. Recent molecular studies have suggested that "breast cancer" includes biologically distinct classes of disease; although these molecular distinctions are important, other patient-related factors also affect outcome and influence prognosis. One of the most important of these patient factors is the age of the patient at diagnosis. Numerous studies have shown very different breast cancer outcomes based on patient age; younger women typically have more aggressive tumors that are more likely to recur both locoregionally and distantly, and older women more commonly have less aggressive disease. The overall disease-specific outcomes, techniques, and doses for adjuvant radiation therapy and toxicity of treatments should be discussed within the context of age because breast cancer is a very different disease based on this factor. Arguments can be made that more aggressive locoregional therapy is warranted in populations of young women with breast cancer and perhaps less aggressive therapy in the elderly.     

Prise en charge des métastases cérébrales des cancers du poumon

Brain metastases of lung cancer are common and have a poor prognosis. Their managment is complex, and the objective of the treatment is at the same time to avoid the neurologic degradation and to treat the extracranial disease. In this review, we revised the management of BM in nonsmall cell lung cancer and small cell lung cancer, including advancements in supportive therapy, neurosurgery, radiation therapy, chemotherapy, and targeted therapy.     

Expression of prostate-specific antigen (PSA) correlates with poor response to tamoxifen therapy in recurrent breast cancer

Prostate-specific antigen (PSA) is a serine protease which may play a role in a variety of cancer types, including breast cancer. In the present study, we evaluated whether the level of PSA in breast tumour cytosol could be associated with prognosis in primary breast cancer, or with response to tamoxifen therapy in recurrent disease. PSA levels were determined by enzyme-linked immunosorbent assay (ELISA) in breast tumour cytosols, and were correlated with prognosis in 1516 patients with primary breast cancer and with response to first-line tamoxifen therapy in 434 patients with recurrent disease. Relating the levels of PSA with classical prognostic factors, low levels were more often found in larger tumours, tumours of older and post-menopausal patients, and in steroid hormone receptor-negative tumours. There was no significant association between the levels of PSA with grade of differentiation or the number of involved lymph nodes. In patients with primary breast cancer, PSA was not significantly related to the rate of relapse, and a positive association of PSA with an improved survival could be attributed to its relationship to age. In patients with recurrent breast cancer, a high level of PSA was significantly related to a poor response to tamoxifen therapy, and a short progression-free and overall survival after start of treatment for recurrent disease. In Cox multivariate analyses for response to therapy and for (progression-free) survival, corrected for age/menopausal status, disease-free interval, site of relapse and steroid hormone receptor status, PSA was an independent variable of poor prognosis. It is concluded that the level of PSA in cytosols of primary breast tumours might be a marker to select breast cancer patients who may benefit from systemic tamoxifen therapy.     

非手术治疗食管癌的临床分期研究

目的 验证中国非手术治疗食管癌临床分期专家小组制定的非手术治疗食管癌临床分期标准的临床指导意义,进一步探讨非手术治疗食管癌的预后相关因素,为下一步的分期标准修订提供依据.方法 回顾性分析542例经非手术治疗的食管鳞癌患者的临床资料和随访资料,按照中国非手术治疗食管癌临床分期专家小组制定的临床分期标准进行分期,分析不同分期下的生存情况.结果 542例患者1、3、5年生存率分别为86.8％、63.2％、47.3％.不同临床分期的患者比较,总生存时间差异有统计学意义(P＜0.0001).上段食管癌非手术治疗生存期好于中段和下段,差异均有统计学意义(P值分别为0.000和0.004).不同病理分化程度比较,生存差异同样具有统计学意义(P=0.019).结论 中国食管癌专家组制定的非手术治疗食管癌的临床分期标准,能够较好地估计预后.不同解剖部位和病理分化程度也应作为临床分期的因素予以考虑.     

Developments and Current Treatment Standards in Cervical Cancer

The prognosis of patients with cervical cancer has improved dramatically in the last 20 years due to the success of systematic screening programs; however, the disease remains a major health problem worldwide. Patients with advanced, recurrent or metastatic disease still have a poor prognosis. Over the last century, radical surgery and radiotherapy have been used to improve survival rates in patients with primary cervical cancer. Both methods have been extensively modified over the years; however, neither improvements in surgical therapy (e.g. radical lymph node dissection) nor modified radiotherapy methods (e.g. neutron irradiation, hyperthermia, interstitial brachytherapy) have significantly decreased the mortality rates. Recently, cooperative clinical trials have demonstrated the superiority of multimodality strategies for patients with high-risk cervical cancer. In these studies, chemotherapy has been integrated into primary therapy; results have shown the most significant improvement of locally advanced disease in more than three decades. The introduction of modern surgical techniques, such as laparoscopic lymphonodectomy and radical pelvic exenteration, are new developments that will change the treatment of cervical cancer in the near future. This review summarizes different aspects of cervical cancer therapy, with emphasis on invasive disease, and provides a perspective on developments which may improve both local and systemic treatment of the disease.     

Overview of anal cancer for the surgeon

Cancers of the anal canal represent a diverse group of pathology and require a multidisciplinary approach for treatment. For the most common anal canal cancer, anal SCC, the primary therapy is CMT with systemic chemotherapy and radiation. The surgeon plays a key role in the diagnosis and follow-up after treatment, with surgical intervention reserved for residual or recurrent disease. The overall prognosis for this disease is favorable. For anal adenocarcinoma, aggressive surgical resection remains the mainstay of therapy, with radiation therapy and chemotherapy used to aid in local disease control and for treatment of metastatic disease. A high rate of distant failure in this disease is responsible for the poor long-term prognosis. Anorectal melanoma has a high rate of distant failure and a poor overall survival rate. Surgical intervention is focused on local disease control with preservation of sphincter function. The biggest improvements in survival for this disease will come with more effective systemic therapy.