原发性胃肠道非霍奇金淋巴瘤的临床特征及疗效分析

背景与目的:原发性胃肠道淋巴瘤是来源于结外淋巴组织的非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL),具有独特的临床病理特征。本文报告原发性胃肠道淋巴瘤的临床病理特征及其治疗效果。方法:回顾性分析我院1994年1月至2000年6月收治的经病理检查证实的22例原发性胃肠道淋巴瘤患者的病例资料。结果:本研究所有病例均随访3年以上,随访5年以上13例,3、5年生存率分别为45.5%(10/22)、38.5%(5/13);随着临床分期增高,3、5年生存率降低;低度恶性边缘带粘膜相关淋巴组织淋巴瘤较其它病理类型预后为佳;16例治疗后达到完全缓解者,3、5年生存率分别为62.5%(10/16)、45.5%(5/11),而6例原发灶未控者3年生存率为0,有显著性差异(P<0.05);12例单纯手术治疗者3、5年生存率分别为33.3%(4/12)、10%(1/10),6例手术联合化、放疗者(5例手术后辅助化疗,1例手术后行全腹照射)的3、5年生存率分别为83.3%(5/6)、66.7%(2/3)。结论:原发性胃肠道淋巴瘤应以综合治疗为主,原发灶未控可影响预后。     

European Society of Surgical Oncology's strategy for clinical research: Paving the way for a culture of research in cancer surgery

As part of its mission to promote the best surgical care for cancer patients, the European Society of Surgical Oncology (ESSO) has been developing multiple programmes for clinical research along with its educational portfolio. This position paper describes the different research activities of the Society over the past decade and an action plan for the upcoming five years to lead innovative and high quality surgical oncology research. ESSO proposes to consider pragmatic research methodologies as a complement to randomised clinical trials (RCT), advocates for increased funding and operational support in conducting research and aims to enable young surgeons to be active in research and establish partnerships for translational research activities.     

循环肿瘤细胞检测的临床有效性和实用性分析

循环肿瘤细胞(Circulating tumor cells,CTC)是一种特殊的可以作为诊断、预测多种肿瘤预后的生物标记物。目前,循环肿瘤细胞并未开始全面的临床应用,但关于循环肿瘤细胞的研究已经展示出较高的临床有效性,尤其是在乳腺癌、肺癌、前列腺癌及结直肠癌领域。本文综述了循环肿瘤细胞在转移癌和非转移癌的研究进展,并分析了循环肿瘤细胞的临床有效性和实用性。     

Lymphoma Study Titles on ClinicalTrials.gov Lack Details Necessary for Study Identification

BackgroundClinicalTrials.gov is used by clinicians and patients to identify clinical trials. We assessed the ease with which users could identify relevant trials related to lymphoma using the short and official titles. We hypothesized that lymphoma titles frequently lack important information.Materials and MethodsWe performed 2 searches on ClinicalTrials.gov. The first search was performed before June 2017, when ClinicalTrials.gov underwent updates to improve usability. The second was performed after 2017. We assessed whether the short and official titles of each trial provided information on the study phase, eligible disease status, lymphoma histologic subtype, study intervention, primary objective, and the presence of randomization and placebo control.ResultsOf the pre-overhaul lymphoma trials, the official versus short titles included information regarding study intervention (99% vs. 96%), study phase (82% vs. 14%), lymphoma histologic subtype (78% vs. 72%), disease status (46% vs. 35%), randomization (13% vs. 2%), presence of placebo (6% vs. 2%), and primary objective (38% vs. 26%). Of the post-overhaul trials, the official versus short titles included information regarding study intervention (97% vs. 96%), lymphoma histologic subtype (83% vs. 78%), study phase (78% vs. 8%), disease status (64% vs. 50%), primary objective (38% vs. 23%), presence of placebo (11% vs. 0%), and randomization (18% vs. 0%).ConclusionThe official titles were more informative than were the short titles on ClinicalTrials.gov. However, the short and official titles both often lacked the basic information needed to understand a clinical trial. This has persisted despite updates to the platform. These results highlight the need for standardization of the format and content included in study titles.     

Imaging as a diagnostic and therapeutic tool in clinical oncology

According to the WHO report published in 2010, about 13% of all deaths are due to cancer. Of these, lung, liver, stomach, colon and breast cancer are the most prevalent. It was also reported that about 30% of the deaths due to cancer can be avoided, if diagnosed and treated early. Hence, there is an urgent need to diagnose these cancers efficiently. Various imaging and therapeutic methods have been proposed and used to accurately detect cancer. In this special two issues, there are eight papers covering different aspects of oncology using various imaging or therapeutic methods.     

Compliance in Early‐Phase Cancer Clinical Trials Research

Regulations and ethical principles require that investigators seek consent and that patients participate in experimental studies only under circumstances that minimize the possibility of undue pressure and/or enticements. In recent years, there has been a rapid rise in the monitoring requirements of early‐phase trials accompanied by an increasing emphasis on assuring “investigator” compliance with the protocol. It is actually, however, the patient who must comply with the requirements of the study. If there is divergence from the protocol, investigators may be reported to regulatory bodies or agencies. Whereas the investigative community is expected to be vigilant about ensuring that patients participate in studies voluntarily and that their consent is procured without duress, it is also required to guarantee that complex protocols, which entail multiple procedures, be followed exactly by participants who suffer from the complications of advanced cancer. We explore the issue of compliance in a research environment in which investigators are subject to disciplinary action if they fail to ensure that patients adhere precisely to the intense monitoring mandates of a clinical trial.     

Audit in clinical practice

Background and objectives

Audit dates back to as early as 1750 BC when king Hammurabi of Babylon instigated audit for clinicians with regard to outcome. Clinical audit is a way of fi nding out whether we are doing what we should be doing. It also verifi es whether we are applying the best practice.

Methods

An audit cycle involves setting-up of standards, measuring current practice, comparing results with standards (criteria), changing practice and re-auditing to make sure practice has improved

Results and interpretations

A ‘clinical audit’ is a quality improvement process that seeks to improve patient care and clinical outcomes through a systematic review of care against explicit criteria, and the implementation of change. Changes are implemented at an individual, team or service level and a subsequent re-audit is done to confi rm improvement in health care delivery.

Conclusion

The importance of audit in healthcare sector needs to be appreciated by the relevant authorities. The most frequently cited barrier to successful audit is the failure of organizations to provide suffi cient fund and protected time for healthcare teams.     

嗜铬细胞瘤的诊断问题：附14例分析

本文分析经手术、病理确诊嗜铬细胞瘤14例,其中2例恶性,肿瘤在肾上腺者11例,肾上腺外者3例,主要表现为高血压和代谢紊乱,呈阵发性高血压11例,持续性高血压3例。阵发性高血压的发作日及持续性高血压者VMA均增高。儿茶酚胺的测定有一定意义,肾上腺区B超检查可为首选定位诊断方法,临床高度怀疑属肾上腺嗜铬细胞者,CT检查有较高的诊断价值。本文就嗜铬细胞瘤的诊断进展略加讨论。     

577例脾肿大患者的临床分析

目的回顾性分析导致脾肿大的常见病因,为其临床诊断提供一定依据。方法对577例脾肿大患者的临床资料进行回顾性分析。结果 577例患者,年龄2个月至84岁,平均年龄48.8岁;其中男性361例,女性216例。肿瘤占32.6%,肝脏疾病占27.6%,血液病占13.7%,感染占12.8%,其他占13.4%;不同年龄阶段疾病有所不同,儿童脾肿大以感染为主（50.0%）,青中年人则以肿瘤、肝脏疾病为主（48.2%）,老年则以肿瘤多见（31.5%）。结论肿瘤、肝脏疾病、血液病和感染是导致脾肿大的最主要原因,不同年龄段脾肿大患者所患疾病不同,以上临床特点为临床上脾肿大患者的确诊提供了诊断思路。     

Keynote address: The scientific basis of the present and future practice of clinical radiotherapy

At mid-century radiotherapy was more an art than a science, but is presently based on radiobiological parameters and cell kinetics. This close interaction between basic scientific principles and clinical practice has been made possible because one can correlate quantitatively doses of irradiation with observed responses. First, a short historical review will be made because it gives a perspective for the understanding both of progress made and prevailing misconceptions. The important radiobiological parameters and cell kinetics will then be discussed in some detail to demonstrate that they should be thoroughly understood in their relationship to radiotherapy. The overall treatment planning must be based on the clinical applications of the main radiobiological parameters. The combined treatment with surgery, either pre- or postoperatively, and multiple daily fractionations will be used as examples. The teaching of radiobiology should be considerably expanded, not only for its own scientific merit but also to show how it applies to clinical situations. This should be reflected in the expansion of the board examination.     

Temozolomide for treatment of brain metastases: A review of 21 clinical trials

Brain metastases from solid tumours are associated with poor prognosis despite aggressive treatment. Temozolomide can be used for the treatment of glioblastoma multiforme as well as melanoma. It has also been shown to have activity in patients with brain metastases from various malignancies, since it can cross the blood-brain barrier. To better understand the efficacy of temozolomide in the treatment of brain metastases, we carried out a review of 21 published clinical trials to determine whether temozolomide would benefit patients with brain metastases from solid tumours. Information regarding complete response, partial response, stable disease, objective response and objective response rate were collected to assess clinical outcomes. A modest therapeutic effect was observed when temozolomide was used as a single agent, however, the combination of temozolomide with whole-brain radiotherapy and/or other anticancer drugs exhibited encouraging activity. Thus, future high quality studies are warranted to confirm our findings.     

35岁以下宫颈癌患者的临床发病因素分析及其预后

目的探讨35岁以下宫颈癌患者临床病理特点及预后情况。方法回顾性分析80例35岁以下宫颈癌患者的临床病理特点及预后情况(观察组),并选择80例35岁及以上宫颈癌患者为研究对照组,分析与比较2组临床特点及影响因素。结果经研究分析发现,2组患者避孕药使用史、初次性交≤20岁、HPV感染史、临床分期、肿瘤大小、病理类型、浸润深度及淋巴结转移情况相比,存在明显差异(P<0.05)。观察组患者5年生存率明显低于对照组,2年内复发率明显高于对照组,P<0.05。经Logistic多因素回归分析发现,35岁以下宫颈癌患者5年生存期的高危因素为临床分期(B=0.927)、浸润深度(B=1.873)、淋巴结转移(B=1.254),P<0.05。结论 35岁以下宫颈癌患者临床病理特点为临床分期晚且恶性程度高,影响因素较多,且预后较差,因此加强早期筛查及诊治十分关键。     

Idiotype vaccines for lymphoma: Potential factors predicting the induction of immune responses

Over the last two decades, lymphoma idiotype vaccines have been the first human cancer vaccines to show striking evidence of biological and clinical efficacy on the one hand, as well as clinical benefit on the other. More recently, however, three large-scale, independent, randomized clinical trials on idiotypic vaccination have failed to achieve their main clinical endpoints for reasons likely to depend more on flaws in each clinical trial's study design than on each vaccination strategy per se. Independently of these considerations, a major hurdle for the development of this substantially innocuous and yet potentially very effective type of treatment has been the fact that, even to date, no factors ascertainable before vaccination have been prospectively singled out as predictors of subsequently vaccine-induced, idiotype-specific immune as well as clinical responses. The aim of this review article is precisely to analyze what has been and what could be done in this respect in order to give a greater chance of success to future trials aimed at regulatory approval of idiotype vaccines.     

Review: tubulin function, action of antitubulin drugs, and new drug development

Anticancer agents that interfere with microtubulin function are in widespread use in man and have a broad spectrum of activity against both hematological malignancies and solid tumors. The mechanisms of actions of these agents have been better defined during the past decade, indicating that there are distinct binding sites for these agents and that they interfere with microtubulin dynamics (growth and shortening of tubules) at low concentrations and only evoke microtubulin aggregation or dissociation at high concentrations. Tubulin has been recently described in the nucleus of cells and in mitochondria. Downstream events from tubulin binding are believed to be critical events for the generation of apoptosis in the malignant cell. The effects of vinca alkaloids and taxanes are distinct, suggesting that the interference with the tubulin cap by high-affinity binding of effective agents is not the only mechanism of cytotoxic effect, and the low-affinity binding of drug, which distorts microtubulin function, may also be important. The epothilones share some of the binding characteristics of the taxanes and are in clinical trials because of cytoxic activity in taxane resistant cells. Tubulin has additional target sites for anticancer drugs including interference with the binding and function of microtubule associated proteins and interference with motor proteins which are essential for the transport of substances within the cell. Because many of these microtubule associated proteins have an ATP binding site, both computer-aided design and combinatorial chemistry techniques can be used to make agents to interfere with their function analogous to imatinib mesylate (Gleevec™). Agents that interfere with the motor protein kinesin are entering clinical trials.     

子宫内膜癌257例临床分析

目的分析子宫内膜癌的临床特点,为其治疗提供参考依据。方法对257例子宫内膜癌患者临床资料进行回顾性分析。结果术前B超检查在癌浸润深度上诊断符合率:无肌层浸润为41.1%;肌层浸润<1/2为41.8%;肌层浸润≥1/2为86.7%,与术后病理检查相比有显著性差异(P<0.01);肌层浸润>1/2,两者相比无显著性差异(P>0.05)。盆腔淋巴结转移率为16.8%(38/226),临床Ⅰ期为7.3%(11/151),Ⅱ期为35.1%(26/74),Ⅲ期为1例(1/1)。盆腔转移率为16.7%(43/257),临床Ⅰ期为9.6%(16/167),Ⅱ期为28.1%(25/89),Ⅲ期为1例(1/1)。经单因素分析,临床期别、浸润深度、病理级别和组织学类型均与盆腔淋巴结转移和盆腔转移有关(P<0.01,或P<0.05)。经多因素相关回归分析,前3个因素间相比较,有显著性差异(P<0.05)。结论B超检查对判断癌浸润深度(肌层受浸>1/2时)有一定价值。子宫内膜癌盆腔转移和盆腔淋巴结转移与临床期别、浸润深度和病理级别密切相关。临床Ⅰ期低危组可行全子宫双附件切除,不必行盆腔淋巴结清扫。     

头颈部恶性纤维组织细胞瘤21例临床分析

背景与目的;恶性纤维组织细胞瘤是一类组织结构较复杂的多形性肿瘤,其组织来源和是否应定为独立的疾病尚存在争议,既往文献常将其混同于其他类型恶性肿瘤。本文旨在研究恶性纤维组织细胞瘤的临床及病理特点,以探讨其最佳诊疗方法。方法：回顾性分析我科1984年6月至1999年6月收治的经病理检查证实的头颈部恶性纤维组织细胞瘤患者21例的病例资料。结果：本研究的病例中除有1例失访(按死亡计算)外,其余均已随访3年以上,3年生存率为42．9％(9／21)。采用非手术治疗的2例,因就诊时即已相对晚期,疗效不佳,分别在就诊后2个月、5个月死亡;采用手术治疗的19例,6例术后3年内无复发,13例术后2年内局部复发,9例发生转移,其中7例经再次手术,3例已生存3年以上。21例中,12例术后证实有颈淋巴结转移,颈部淋巴转移率为57．1％。结论：头颈部恶性纤维组织细胞瘤是一类复发率较高的恶性肿瘤,治疗以扩大根治术为首选方法,单独放疗或化疗效果不佳。对术后复发的病例,不应放弃再次手术的机会。     

青年人胃癌46例临床病理分析

目的：探讨青年人胃癌的临床、病理特点,分析误诊的原因。方法：对1980年1月－1995年1月间经手术治疗、病理检验诊断的527例胃癌患者进行回顾性分析,着重对≤35岁青年人胃癌进行分析,并与其他年龄组胃癌进行比较。结果：本组青年人胃癌患者中妇性少于男性,男女之比为1：0.77;5年生存率低于其他年龄组胃癌患者（P＜0.05）;本组最多见的大体形态为BorrmannⅢ型和Ⅳ型,占87％;其病理学类型主要是低分化腺癌（37％）、粘液细胞癌（26.1％）和未分化癌（19.6％）。结论：青年人胃癌发病率低、病程短、恶性程度高、预后差,一旦确诊,应尽早手术。