血清可溶性尿激酶型纤溶酶原激活物受体在预测多发性骨髓瘤患者预后中的作用

 目的　探讨血清可溶性尿激酶型纤溶酶原激活物受体（suPAR）在多发性骨髓瘤（MM）患者血清中的表达、与2年生存率的关系及其对疾病预后的意义。方法　采用酶联免疫吸附法检测40例新诊断的MM患者和30名健康对照者血清suPAR水平。患者分为缓解（完全缓解／非常好的部分缓解）、进步（部分缓解／疾病稳定）、无效（疾病进展）3组,分别为13、19、8例,前两组统称有效组。结果　健康成年人血清均有suPAR表达,表达水平为（233.47±83.22）pg／ml。缓解组和进步组治疗前血清suPAR表达水平分别为（257.60± 32.47）、（331.00±99.80）pg／ml,与健康对照组比较差异无统计学意义（t＝2.04,t＝1.83,P＞0.05）。无效组治疗前血清suPAR表达水平为（562.20±291.0）pg／ml,与健康照组和有效组比较差异均有统计学意义（t＝3.92,t＝1.93,均P＜0.05）。监测17例患者治疗前suPAR为（437.65±131.43）pg／ml,该17例中有效者（11例）治疗后的（298.76±108.59）pg／ml与健康对照组比较,差异均有统计学意义（均P＜0.05）。生存期大于2年患者初诊时血清suPAR值为（333.02±85.37）pg／ml,与健康对照组比较差异无统计学意义（t＝1.81,P＞0.05）;生存期不足2年患者血清suPAR值为（646.01±103.97）pg／ml,与健康对照组及生存期大于2年组比较差异均有统计学意义（t＝3.84,t＝3.50,均P＜0.01）。结论　初诊及治疗后的血清suPAR水平均与MM患者病情稳定程度相关,且可用于MM预后及生存期的判断,suPAR表达水平高与不良预后相关。     

肝细胞癌患者血清miR-4686表达及意义

[目的]探讨miR-4686在肝细胞癌(HCC)患者血清中的表达及与临床病理特征的关系。[方法]收集57例肝细胞癌患者血清,同时收集慢性乙肝患者32例、健康体检者30例为对照组,RT-qPCR法检测血清中miR-4686的相对表达量,分析miR-4686在HCC、慢性乙肝与正常对照者间的差异;分析miR-4686表达与HCC患者临床病理特征的关系。[结果]mi R-4686在HCC组、慢性乙肝组、正常对照组的表达量分别为3.72±1.03、1.59±0.44、1.37±0.38,HCC组表达水平显著高于慢性乙肝组与正常对照组(P=0.015、0.011),慢性乙肝组与正常对照组间差异无统计学意义(P=0.873)。miR-4686表达水平与HCC患者分化程度、血管侵犯、TMN分期及APF水平有关(P均<0.05)。[结论] miR-4686在HCC患者血清的表达水平上升,可判断HCC的恶性程度。     

血清磷脂酰肌醇蛋白聚糖3在肝细胞癌中的表达及其与临床病理因素的相关性

目的 初步探讨肝细胞癌（HCC）患者血清和组织中磷脂酰肌醇蛋白聚糖3（GPC3）在HCC诊断中的临床应用价值.方法 采用酶联免疫吸附试验（ELISA）法和免疫组织化学染色法检测79例HCC患者血清和组织中GPC3表达水平,并与35例肝炎后肝硬化患者和30例健康体检者GPC3含量检测结果进行比较,采用Logistic回归模型对HCC患者GPC3表达水平与影响因素进行分析.结果 HCC组患者血清GPC3水平[（143.02±40.26） μg/L]明显高于肝硬化患者组[（6.15±4.31） μg/L]和健康对照组[（4.47±3.22）μg/L],三组间比较差异均有统计学意义（均P＜0.01）;GPC3阳性表达水平在HCC组织高于癌旁和远癌肝组织;GPC3蛋白表达与患者年龄、性别、肿瘤大小及甲胎蛋白（AFP）水平无明显相关性;与临床分期（x2 =4.250,P＜0.05）及肿瘤有无远处转移（x2=13.182,P＜ 0.001）关系密切.结论 GPC3检测对于HCC的诊断具有较好的特异性,联合血清AFP更有利于提高HCC诊断的敏感性,可作为HCC患者诊断及预后评估的标志物.     

肝动脉化疗栓塞联合重组人血管内皮抑制素介入治疗原发性肝细胞癌

[目的]探讨肝动脉化疗栓塞(TACE)联合重组人血管内皮抑制素介入治疗原发性肝细胞癌(HCC)的临床疗效.[方法]将52例HCC患者随机分为观察组和对照组各26例,观察组给予TACE联合重组人血管内皮抑制素介入治疗,对照组单纯给予TACE治疗,比较两组的不良反应、临床疗效及治疗前后AFP水平、肝外转移等情况.[结果]治疗后两组AFP水平、不良反应发生率等比较差异无统计学意义(P＞0.05);观察组总有效率明显高于对照组(46.15％vs15.38％,x2=6.753,P=0.034);术后1年的肝外转移发生率明显低于对照组(0 vs 23.08％,x2=6.783,P=0.009).[结论]TACE联合重组人血管内皮抑制素介入治疗HCC能提高疗效,有效地减少肿瘤肝外转移,安全有效.     

明胶海绵微粒经导管动脉化疗栓塞治疗肝细胞癌的疗效及免疫调节作用的研究

目的:探讨明胶海绵微粒经导管动脉化疗栓塞（GSMs-TACE）治疗肝细胞癌（HCC）的效果及对患者的免疫调节作用。方法:选取我院收集的HCC患者97例，根据TACE方法分为研究组49例（采用GSMs-TACE方法治疗）和对照组48例（采用碘化油TACE方法治疗），对比两种方法的治疗效果及对患者免疫功能的影响。结果:研究组的缓解率89.80%、总有效率97.96%，对照组缓解率81.25%、总有效率95.83%，两组患者比较，差异不具有统计学意义（P＞0.05）；治疗后，两组患者的血清AFP水平较本组治疗前均显著的降低（P＜0.05），研究组的KPS评分高于对照组（P＜0.05）；治疗后，研究组的IL-1、IL-6水平低于对照组（P＜0.05），研究组的CD3+、CD4+、NK水平显著的高于对照组（P＜0.05）；两组患者治疗后的IL-1、IL-6、TNF-α、CD8+水平较治疗前显著的降低（P＜0.05），CD3+、CD4+、NK水平较治疗前显著的升高（P＜0.05）；研究组的肝区疼痛、消化道不良反应发生率显著的低于对照组（P＜0.05）。结论:GSMs-TACE与碘化油TACE治疗HCC患者的效果均肯定，但免疫调节GSMs-TACE具有优势。     

血清VEGF-A及其受体VEGFR-2水平与鼻咽癌患者淋巴转移的关系

目的探讨鼻咽癌患者血清血管内皮生长因子-A(VEGF-A)及血管内皮生长因子受体2(VEGFR-2)水平在鼻咽癌淋巴转移中的意义。方法采用ELISA法检测68例鼻咽癌患者和20例健康对照者血清VEGF-A和VEGFR-2水平,并分析这些指标变化的意义。结果初治及复发组鼻咽癌患者血清VEGF-A、VEGFR-2水平明显高于健康对照组及完全缓解组(P均<0.05)。血清VEGF-A和VEGFR-2水平与鼻咽癌T分期及N分期均有关(P均<0.05)。有淋巴转移的鼻咽癌患者血清VEGF-A和VEGFR-2水平明显高于无淋巴转移患者(P<0.05)。32例初治鼻咽癌患者血清VEGF-A与VEGFR-2水平呈正相关(r=0.810,P<0.05)。结论高水平的血清VEGF-A、VEGFR-2在鼻咽癌发展中起重要作用,能促进鼻咽癌发生淋巴转移。     

子宫颈癌患者可溶性尿激酶受体、鳞状细胞癌抗原、人乳头瘤病毒16、人乳头瘤病毒18联合检测的意义

目的 探讨可溶性尿激酶受体（suPAR）、鳞状细胞癌抗原（SCC-Ag）、人乳头瘤病毒（HPV） 16、HPV18联合检测在子宫颈癌患者病情监测及预后评估中的意义.方法 选择206例子宫颈癌患者及60名健康对照者血液和子宫颈分泌物标本,通过酶联免疫吸附试验（ELISA）检测血浆suPAR及SCC-Ag水平,用荧光定量反转录聚合酶链反应法检测子宫颈分泌物HPV16、HPV18的表达,并分析三者的相关性.结果 子宫颈浸润癌患者血浆suPAR、SCC-Ag水平均比健康对照组升高[（1.072 5±0.305 2）ng/ml比（0.501 7 ±0.179 3）ng/ml、（0.980 6±0.162 7）μg/ml比（0.261 4±0.006 3）μg/ml],差异有统计学意义（均P＜ 0.05）;子宫颈浸润癌患者及原位癌患者分泌物HPV16、HPV18阳性表达率分别为53.89％（90/167）和46.15％（18/39）,比健康对照组（6.67％,4/60）升高,差异有统计学意义（P＜0.05）.子宫颈浸润癌患者血浆suPAR水平与SCC-Ag水平呈正相关（r=0.564,P＜0.05）,子宫颈浸润癌患者子宫颈分泌物HPV16、HPV18表达阳性组和阴性组的血浆suPAR水平差异无统计学意义（P＞0.05）.结论 子宫颈浸润癌患者血浆suPAR水平与SCC-Ag水平存在正相关关系,尚不能认为子宫颈浸润癌患者血浆suPAR水平与感染HPV16、HPV18有关.     

加用重组人血管内皮抑素的TACE治疗对肝癌组织VEGF和MVD的影响

目的 探讨经导管肝动脉化疗栓塞（TACE）中加用抗血管生成药物治疗肝细胞癌（HCC）后肝癌组织中血管内皮生长因子（VEGF）和微血管密度（MVD）的变化情况。方法 经确诊的HCC患者85例按照数字表法随机分为TACE组（对照组）和TACE中加用重组人血管内皮抑素组（治疗组）;对照组和治疗组均给予常规化疗栓塞药物,治疗组加用重组人血管内皮抑素注射液（恩度）30mg栓塞;TACE术当天和第28天分别穿刺取肿瘤组织,对其进行VEGF和MVD的测定。结果 对照组治疗前、后的MVD分别为61.76±20.12和 62.64±22.83（P＞0.05）,VEGF分别为125.94±75.41和190.07±86.96 （P＜0.01）;治疗组治疗前、后的MVD分别为62.00±24.18和51.48±15.79（P＜0.01）,VEGF分别为127.10±77.81和88.47±75.89（P＜0.01）。 治疗组和对照组的1年生存率分别为62.5％（25／40）和61.9％（26／42）。结论 TACE能够减少HCC组织内已生成的血管数量,影响VEGF分泌,促进病灶内新生血管生成;TACE术中栓塞加用恩度能够有效降低HCC组织中MVD和VEGF表达,增加TACE抗肿瘤血管生成的效果。     

多种血清细胞因子联合检测对胃腺癌的诊断价值

目的：探讨血清细胞因子在胃腺癌早期筛查及进展评估中的临床应用价值。方法：收集2017 年11 月至2018 年2 月在山西省肿瘤医院经病理确诊的81 例胃腺癌患者（胃癌组）和85 例健康体检者（对照组）的外周血标本，应用AimPlex 流式高通量多因子检测技术检测两组人群血清中17 种细胞因子（包括IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12p70、IL-15、IL-17A、TNF-α、TNF-β、GM-CSF、G-CSF、IFN-γ、IP-10、MCP-1 和VEGF-A）的水平。应用受试者工作特征曲线进行诊断价值分析。结果：胃癌组患者血清IL-10、IL-8、IL-6、IP-10、MCP-1、VEGF-A和IL-12p70 的水平显著高于对照组（均P<0.01）；晚期胃癌组（Ⅲ/Ⅳ期）的IL-8、IL-6 和VEGF-A 的水平显著高于早期胃癌组（Ⅰ/Ⅱ期）（均P<0.01）。在区分早期胃癌组与对照组中，IL-8、IL-6、IL-10、IP-10、MCP-1、IL-12p70 和VEGF-A 的曲线下面积（AUC）分别是0.98、0.92、0.89、0.84、0.76、0.74 和0.58；其中IL-8、IL-6 和IL-10 的敏感性分别是97.4%、89.5%和97.4%，特异性分别是87.1%、85.9%和77.6%。在区分晚期胃癌组与早期胃癌组中，IL-8、IL-6 和VEGF-A的AUC分别是0.82、0.72 和0.69，敏感性分别是83.7%、60.5%和41.9%，特异性分别是71.1%、76.3%和92.1%。结论：血清IL-8、IL-6 和IL-10 联合检测有望用于胃腺癌的早期筛查，IL-8、IL-6 和VEGF-A的联合检测可用来评估胃腺癌进展程度。     

恶性肿瘤患者血清胱抑素C和可溶性尿激酶受体检测的临床意义

目的:探讨恶性肿瘤患者血清胱抑素C(Cystatin C)和可溶性尿激酶受体(suPAR)水平与肿瘤浸润转移和治疗的关系.方法:Cystatin C应用颗粒增强散射免疫比浊法(PENIA)检测;suPAR采用ELISA法检测.共检测了82例健康成人和172例恶性肿瘤患者血清Cystatin C和suPAR水平并进行比较.结果:恶性肿瘤患者血清Cystatin C和suPAR水平较健康对照组显著增高(P＜0.01和P＜0.01),差异有显著性;中晚期、已转移组的肿瘤患者Cystatin C和suPAR测定值均显著高于各自对照组;在治疗过程中,患者血清Cystatin C和suPAR水平,术后与术前比较,两组指标均明显降低,但接受化疗及放疗的患者,血清Cystatin C和suPAR水平与治疗与否无差异.结论:恶性肿瘤患者血清Cystatin C和suPAR水平与肿瘤细胞的浸润转移以及手术治疗有关.检测血清Cystatin C和suPAR水平对恶性肿瘤患者的病情监测和疗效判断有重要的临床价值.     

Excretion of nitrates with saliva and urine and nitrite excretion with saliva in patients with chronic gastritis and duodenal ulcer

The study assessed excretion of nitrates in urine and saliva and that of nitrites with saliva of patients suffering gastric and duodenal ulcer. In both study groups, a positive correlation was established between nitrate concentration in saliva, on the one hand, and that in urine, and nitrite level in urine, on the other. The groups failed to show a difference in nitrate concentrations in either urine or saliva. Since retention of nitrates in the body of chronic gastritis patients held as precancer of the stomach proved no higher than that in patients with duodenal ulcer, the authors cast doubt on endogenous nitroso compounds as a cause of gastric cancer in cases of chronic gastritis.     

Pathologic states associated with activation of eosinophils and with eosinophilia

Eosinophils are involved in cytotoxicity against helminths and tumor cells and effect both tissue damage and tissue protection in hypersensitivity reactions. Their migratory patterns and oxidative mechanisms are most similar to those of neutrophils, but their tissue longevity and functional variation are more similar to those of monocytes and macrophages. Their enzyme components and behaviors are only now beginning to be defined, and their biologic functions in pathologic states remain a topic of considerable discussion.     

Characteristics and survival of patients with non-Hodgkin's lymphoma with and without acquired immunodeficiency syndrome

Our objective was to determine the characteristics and survival of patients with non-Hodgkin's lymphoma (NHL) with and without acquired immunodeficiency syndrome (AIDS). A cancer registry and AIDS registry linkage for San Diego County was performed in October 1998 as part of a national multicentre study. We performed Kaplan-Meier analysis to compare survival in NHL patients with and without AIDS, after matching for age, sex, and race/ethnicity. We performed logistic regression to determine which patient and tumour characteristics were significantly associated with 1-year survival. Of the 4361 cases of NHL, 324 (7%) had AIDS and 4037 (93%) were not known to have AIDS. Patients with AIDS were more likely to have extranodal, high-grade, and disseminated NHL diagnosed by non-histologic means and were less likely to have received chemotherapy. Patients with AIDS and NHL who survived at least 1 year had less advanced disease stage and received chemotherapy. The median survival in patients with AIDS was 4 months (95% confidence interval (CI): 4-5) and 95 months (95% CI: 58-157) in patients without AIDS (P<0.001). Although these patients with AIDS-related NHL were unlikely to survive, the highly active antiretroviral agents currently used may improve outcomes in future patients.     

Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery

BACKGROUND:

The objective of this study was to identify the factors associated with improved outcome after treatment for stage III nonsmall cell lung cancer (NSCLC).

METHODS:

A retrospective review of stage III NSCLC patients treated at who were treated at the Dana‐Farber Cancer Institute/Brigham and Women's Cancer Center was done with institutional review board approval. Patients were followed for toxicity, local and distant failure, and overall survival. Multivariate Cox logistic regression analysis was used to determine the factors associated with treatment outcome.

RESULTS:

Between August 2000 and November 2006, 144 patients received concurrent chemoradiation (CRT) for stage III NSCLC. Eighty of 144 patients were men (56%), and the median age was 61 years (range, 33‐81 years). Sixty‐two patients (43%) had stage IIIA NSCLC, and 82 patients (57%) had stage IIIB NSCLC. Radiotherapy (RT) was given concurrently with chemotherapy to all patients; 100 patients (69%) received CRT without surgery, and 44 patients (31%) received with neoadjuvant CRT followed by surgical resection. The median RT dose was 60 grays (Gy) (range, 46‐70 Gy). The median follow‐up was 15 months (range, 3‐64 months), the median potential follow‐up was 37 months (range, 12‐84 months), and the median overall survival was 22 months (95% confidence interval, 15‐28 months). The 1‐year and 2‐year survival rates were 68% and 47%, respectively. Among the 44 patients who underwent resection, the median survival was 61 months, and the 2‐year survival rate was 73%. On multivariate analysis, stage at the time of treatment (stage IIIA vs stage IIIB) and use of surgery were the only factors associated with improved outcome (P = .01 and P = .001, respectively).

CONCLUSIONS:

In this retrospective series, those patients who were able to undergo resection appeared to have improved outcome after induction CRT. Cancer 2009. © 2009 American Cancer Society.     

Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer

PURPOSE: Patients with lung cancer might feel more guilt and shame resulting from previous smoking. This study was designed to determine the levels of guilt and shame among patients with non-small-cell lung cancer (NSCLC) compared with breast and prostate cancer. PATIENTS AND METHODS: Surveys were sent to participants 3 times (at enrollment, 2 months, and 6 months). Patients were eligible if they had stage IV NSCLC, breast cancer, or prostate cancer. The survey included tests of generalized guilt, shame, depression, and anxiety as well as guilt, shame, and embarrassment related to one's cancer. RESULTS: One hundred seventy-two participants completed >or= 1 questionnaire: 96 patients with NSCLC, 30 patients with breast cancer, and 46 patients with prostate cancer. Of the patients with NSCLC, 91.7% were current or former smokers versus 67.1% of the comparison patients. A composite score of embarrassment related to one's cancer (perceived cancer-related stigma; PCRS) was higher in patients with NSCLC (P < .01). Mean baseline generalized guilt and shame scores were not different among groups and did not change over time. A history of smoking correlated with increased levels of guilt and shame, regardless of tumor type. A personal identification of past behaviors as contributing to cancer correlated with higher levels of guilt, shame, anxiety, and depression. Of the patients with NSCLC, 29.5% felt that their behaviors contributed to their cancer compared with 10.5% of the comparison patients. CONCLUSION: Patients with NSCLC had higher levels of PCRS than patients with prostate cancer or breast cancer but not higher baseline levels of shame and guilt. Smoking is correlated with higher levels of guilt and shame. A belief that one caused one's own cancer is correlated with higher levels of guilt, shame, anxiety, and depression. These findings could be translated into an increased need for open communication among patients and their providers surrounding issues of cancer causation, guilt, shame, depression, and anxiety.     

VEGF and EMMPRIN expression correlates with survival of patients with osteosarcoma

Aim

To investigate the clinicopathologic characteristics of Vascular Endothelial Growth Factor (VEGF) and Extracellular Matrix Metalloproteinase Inducer (EMMPRIN) expression in osteosarcoma, and to evaluate the clinical significance of these two markers in the survival of osteosarcoma.

Methods

VEGF and EMMPRIN expression in paraffin-embedded specimens gathered from 65 patients with primary osteosarcoma were detected by the method of immunohistochemistry using antibodies against VEGF and EMMPRIN. The correlation of VEGF and EMMPRIN expression with the clinicopathologic features and with the survival of osteosarcoma was subsequently assessed.

Results

The expression of VEGF and EMMPRIN was detected in 47/65 (72.31%) and 45/65 (69.23%) of patients with osteosarcoma, respectively. Positive expression of VEGF and EMMPRIN was significantly correlated with surgical stage and percentage of dead cells of osteosarcoma. A significant correlation was found between the expression of VEGF and EMMPRIN in osteosarcoma (r = 0.89, p = 0.01). Additionally, surgical stage, percentage of dead cells, VEGF and EMMPRIN expression showed significant influence on overall survival (OS) and disease-free survival (DFS) in univariate analysis. In multivariate analysis, surgical stage (IIA versus IIB/III) and percentage of dead cells (≤90% versus >90%) were significant for DFS and OS. Those patients with VEGF+/EMMPRIN+ co-expression showed significantly shorter OS and DFS compared with VEGF−/EMMPRIN− expression.

Conclusion

According to our study, the overexpression of VEGF or EMMPRIN may be an important feature of osteosarcoma. A combined detection of VEGF/EMMPRIN co-expression may benefit us in prediction of a poor survival of osteosarcoma.     

肽胺哌啶酮联合MP化疗方案治疗多发性骨髓瘤的疗效观察

目的：观察肽胺哌啶酮联合MP方案，即马法兰＋泼尼松（强的松）治疗多发性骨须瘤的疗效及其毒副作用。方法：确诊的多发性骨髓瘤病人12例，肽胺哌啶酮－MP方案；肽胺哌啶酮自MP方案开始持续给药，每晚睡前口服，剂量从每天100mg开始，每周日剂量递增50mg，至病人不能耐受或最高至每日400mg;MP方案每月一个疗程。结果：部分缓解6例（50％），进步3例（25％）。总有效率为9／12（75．0），有效的病人中7例在4周内起效，肽胺哌啶酮每天100－400mg不等，中位剂量每天225mg，常见的副反应为皮疹，便秘，嗜睡、乏力、头昏，水肿等，结论：肽胺哌啶酮＋MP方案治疗多发性骨髓瘤副反应少，耐受性好，且反应率可能提高。