微小甲状腺乳头状癌与结节性甲状腺肿的MSCT征象比较

目的比较分析微小甲状腺乳头状癌(PMCT)及结节性甲状腺肿(NG)的多层螺旋CT(multi-slice spiral CT,MSCT)征象,并探讨MSCT鉴别二者的价值。方法回顾性分析病理证实的34例PMCT及46例NG的MSCT表现,从结节的形态及边缘、有无钙化、钙化的部位及形态、增强后结节边缘及轮廓改变、有无淋巴结增大方面,分析PMCT瘤体与NG结节的MSCT特征,用SPSS19.0软件进行统计学处理。结果 PMCT与NG组间结节的边缘、钙化部位、钙化形态、增强后结节边缘及轮廓改变的比较具有显著性差异(P0.05);结节的形态、有无钙化、有无淋巴结增大的比较无显著性差异(P0.05)。结论综合分析PMCT与NG结节的各种MSCT征象,有助于PMCT与NG的鉴别诊断,并提高PMCT的检出率。     

临床舌鳞癌N0患者的颈部处理

目的 :探讨舌鳞癌N0 的治疗方法。方法 :对四川大学华西口腔医院 1986～ 1998年间 14 5例舌鳞癌N0患者进行回顾性研究。对T1患者切除原发灶 ,颈部观察 ,对于T2 以上患者或无法随访者采取选择性颈清扫 ,术后随访 3年以上或至死亡。各组间的比较采用卡方检验。结果 :12 3例行选择性颈淋巴清扫术 (END) ,3 3例术后病理证实淋巴结转移 ,2 2例颈部观察组中 4例出现颈淋巴转移。淋巴结隐匿性转移率为 2 5 .5 2 % ,且随临床T分期的增高而增高。总体颈部失控死亡率 ,观察组 (18.18% )与END组 (5 .69% )相比 ,差异有显著性 (P <0 .0 5 )。T1期观察组和END组的颈部失控死亡率分别为 7.69%和 4.5 5 % ,两组间差异无显著性 (P >0 .0 5 ) ,而将T2 、T3 期作为中期病变合并 ,观察组 (3 3 .3 3 % )和END组 (0 % )差异显著 (P <0 .0 0 1)。结论 :舌鳞癌颈部隐匿性转移率较高 ,对T2 期以上N0 舌鳞癌患者应考虑行选择性颈清扫术 ,可提高其颈部控制率和生存率     

CT导向下125I粒子植入治疗多发骨转移瘤

目的 评价CT导向下125I粒子植入治疗多发骨转移瘤的临床价值.方法 回顾性分析2007年1月至2008年1月来自于第三军医大学西南医院28例经CT导向下125I粒子植入治疗的多发骨转移瘤患者的临床资料,重点总结与分析此类病变的疗效评价.本组共28例,其中男13例,女15例,年龄34～71岁,中位年龄50岁,其中肺腺癌6例,肺鳞状细胞癌、前列腺癌、肾透明细胞癌各4例,肝细胞癌、结肠癌各3例,乳腺癌2例、恶性神经鞘瘤1例、胰腺癌1例.28例转移灶数目为116个,平均每人4.2个.125I粒子活度和数量经北京科霖众医学技术研究所的"三维放射性粒子源植入治疗计划系统V 1. 5"计算获得.在CT导向下按共轴针法将125I粒子植入靶区内.采用临床症状的改善和影像学进行综合疗效评价.结果 28例患者疼痛缓解情况:16例显效,7例有效,5例无效,有效率82.1%,平均术后3～7 d疼痛缓解.2个月后CT复查,116个病灶中局部控制93个,无变化17个,进展6个,总有效率80.2%.术后发现1例累及腰椎神经根(L3～L4)转移性病灶;1例腰椎转移灶在粒子植入,穿刺针途经腰大肌时,引起针道内出血,形成较大椎旁腰大肌血肿;术后2周,2例患者近期出现轻度白细胞下降;术后随访,未见放射性脊髓炎及神经损伤.结论 CT导向下125I粒子植入治疗多发骨转移瘤具有疗效好,创伤小,并发症发生率低等优点,是一种较好的微创治疗方法.     

磁共振监测脑脊液源性转移的形成及其表现基础

目的 建立脑脊液源性转移的动物模型,分析成瘤率及其MRI表现与病理基础,探讨MRI在肿瘤生物学形成中的监测价值.方法 实验组24只新西兰大白兔经枕骨大孔蛛网膜下腔注射VX2肿瘤细胞(1 × 106个细胞/ml)的混悬液;对照组6只,抽取0.5 ml生理盐水经枕骨大孔注入蛛网膜下腔,接种动物不同时间行MRI检查,T1WI,T2WI,FLAIR和注射Gd-DTPA造影剂后T1WI,FLAIR及DCE-MRI扫描.MRI扫描后立即获取标本观察形态学特点,镜下分析肿瘤生长特性.结果 MRI平扫:①实验组:2只在延髓,1只在颈胸交界处脊髓实质内发现结节状异常信号灶(阳性率12.5%),T1WI呈低信号,T2WI呈等低信号.6只(25%)FLAIR序列见脑脊膜及结节灶呈略高信号.②对照组6只MRI均呈阴性表现.MRI增强表现:①实验组:T1WI增强扫描15/24只(62.5%)实验兔发现脑脊膜和(或)蛛网膜下腔呈线样不规则增厚或结节状强化.其中3只延脑和脊髓内病灶增强明显.FLAIR增强发现16/24只(66.67%)实验兔呈阳性征象.DCE-MRI扫描发现18/24只(75%)实验兔呈阳性征象.②对照组:5/6只实验兔MRI均呈阴性表现.大体标本证实20/24只转移的脑脊膜增厚,局部结节.镜下22/24只脑脊膜见多量肿瘤细胞沿软脑膜及蛛网膜浸润,部分肿瘤侵入脑及脊髓内.对照组未见明显异常改变.X2检验统计学结果:脑脊液源性转移的成瘤率91.67%.MRI平扫与增强后T1WI比较两者间差异有统计学意义(P<0.01).FLAIR增强和FLAIR平扫差异有统计学意义(P<0.01).T1WI,FLAIR增强阳性率与病理比较差异有统计学意义(P<0.05).DCE-MRI阳性率与病理结果差异有统计学意义(P>0.05).结论 经枕骨大孔接种VX2瘤细胞成瘤率91.67%.MRI监测脑脊液转移瘤具有较高的敏感性并且可观察肿瘤的生长情况,DEC-MRI是检出脑脊膜转移的最佳序列.MRI检查的阳性率与病理结果仍存在差距,我们认为提高设备的分辨率,探讨最佳检查序列对脑脊液转移瘤的检出仍是至关重要的因素.     

乳腺癌患者外周血癌胚抗原及细胞角蛋白19 mRNA表达的临床意义

目的 探讨细胞角蛋白19(CK19)mRNA、癌胚抗原(CEA)mRNA的表达在诊断乳腺癌患者外周血微转移的临床意义及与临床病理指标的关系.方法 采用实时定量聚合酶链反应(RQ-PCR)法,测定28名健康女性志愿者、20例良性乳腺疾病患者、108例乳腺癌患者(88例行手术切除乳腺癌患者、20例复发转移乳腺癌患者)的外周血中CK19、CEA mRNA的表达.以上有一项为阳性即判定为转移.结果 28名健康对照者CK19 mRNA和CEA mRNA两个指标检测结果均为阴性.20例良性乳腺疾病患者中,CK19 mRNA阳性1例(5%),无CEA mRNA表达阳性者.108例乳腺癌患者中,26例(24.1%)CK19 mRNA阳性,23例(21.3%)CEA mRNA阳性,15例(13.9%)两者均阳性.在108例乳腺癌患者中,复发转移乳腺癌患者CK19 mRNA和(或)CEA mRNA的表达高于行手术切除乳腺癌患者.88例行手术切除乳腺癌患者外周血微转移阴性组、阳性组在肿瘤大小、病理分期、kI67,细胞黏附分子CD44变异型v6(CD44v6),血管内皮生长因子(VEGF)表达方面差异有统计学意义(P<0.05),但在年龄、肿瘤位置、病理组织学类型、淋巴结转移、雌激素受体(ER)、孕激素受体(PR)、CerbB2、基质金属蛋白酶9(MMP9)表达等方面差异无统计学意义(P>0.05).多因素分析表明肿瘤大小、病理分期、kI67、CD44v6、VEGF与患者外周血微转移有关.结论 联合检测CK19mRNA和CEA mRNA可提高乳腺癌患者外周血微转移的检出率.肿瘤大小、病理分期、kI67、CD44v6、VEGF可评估乳腺癌患者外周血微转移风险.     

Isolated tumor cells and micrometastases in regional lymph nodes in stage I to II endometrial cancer

Objective

The aim of this study was to clarify the clinical significance of isolated tumor cells (ITCs) or micrometastasis (MM) in regional lymph nodes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II endometrial cancer.

Methods

In this study, a series of 63 patients with FIGO stage I to II were included, who had at least one of the following risk factors for recurrence: G3 endometrioid/serous/clear cell adenocarcinomas, deep myometrial invasion, cervical involvement, lympho-vascular space invasion, and positive peritoneal cytology. These cases were classified as intermediate-risk endometrial cancer. Ultrastaging by multiple slicing, staining with hematoxylin and eosin and cytokeratin, and microscopic examination was performed on regional lymph nodes that had been diagnosed as negative for metastases.

Results

Among 61 patients in whom paraffin-embedded block was available, ITC/MM was identified in nine patients (14.8%). Deep myometrial invasion was significantly associated with ITC/MM (p=0.028). ITC/MM was an independent risk factor for extrapelvic recurrence (hazard ratio, 17.9; 95% confidence interval [CI], 1.4 to 232.2). The 8-year overall survival (OS) and recurrence-free survival (RFS) rates were more than 20% lower in the ITC/MM group than in the node-negative group (OS, 71.4% vs. 91.9%; RFS, 55.6% vs. 84.0%), which were statistically not significant (OS, p=0.074; RFS, p=0.066). Time to recurrence tended to be longer in the ITC/MM group than in the node-negative group (median, 49 months vs. 16.5 months; p=0.080).

Conclusions

It remains unclear whether ITC/MM have an adverse influence on prognosis of intermediate-risk endometrial cancer. A multicenter cooperative study is needed to clarify the clinical significance of ITC/MM.     

A human papillomavirus (HPV)-16 or HPV-18 genotype is a reliable predictor of residual disease in a subsequent hysterectomy following a loop electrosurgical excision procedure for cervical intraepithelial neoplasia 3

Objective

This study was conducted using the human papillomavirus (HPV) DNA chip test (HDC), in order to determine whether the HPV genotype is a predictor of residual disease in a subsequent hysterectomy following a loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 3.

Methods

Between January 2002 and February 2015, a total of 189 patients who underwent a hysterectomy within 6 months of LEEP caused by CIN 3 were included in this study. We analyzed their epidemiological data, pathological parameters, high-risk HPV (HR-HPV) load as measured by the hybrid capture II assay, and HR-HPV genotype as measured by the HDC. A logistic regression model was used to analyze the relationship between covariates and the probability of residual disease in subsequent hysterectomy specimens.

Results

Of the 189 patients, 92 (48.7%) had residual disease in the hysterectomy specimen, CIN 2 in seven patients, CIN 3 in 79 patients, IA1 cancer in five patients, and IA2 cancer in one patient. Using multivariate analysis, the results were as follows: cone margin positivity (odds ratio [OR], 2.43; 95% CI, 1.18 to 5.29; p<0.05), HPV viral load ≥220 relative light unit (OR, 2.98; 95% CI, 1.38 to 6.43; p<0.01), positive endocervical cytology (OR, 8.97; 95% CI, 3.81 to 21.13; p<0.001), and HPV-16 or HPV-18 positivity (OR, 9.07; 95% CI, 3.86 to 21.30; p<0.001).

Conclusion

The HPV-16 or HPV-18 genotype is a reliable predictive factor of residual disease in a subsequent hysterectomy following a LEEP for CIN 3.     

不同化疗方案治疗转移性乳腺癌的临床效果比较

目的 探讨不同化疗方案对转移性乳腺癌的临床疗效.方法 选择2008年1月-2012年1月收治的乳腺癌100例,按化疗方案分为A组和B组,每组50例.A组采用氟尿嘧啶+表柔比星+环磷酰胺,B组采用表柔比星+紫杉醇,化疗2个周期后进行疗效评定.结果 A组总有效率低于B组,脱发、乏力、神经毒性和面色潮红症状较B组轻,生活质量优于B组(P＜0.05).结论 2种化疗方案治疗转移性乳腺癌均有效,表柔比星+紫杉醇总有效率较高,毒副反应较严重,患者生活质量较低.     

非小细胞肺癌脑转移患者血清肿瘤标志与临床病理、近期疗效及预后的相关性分析

目的 探讨非小细胞肺癌(NSCLC)脑转移患者血清肿瘤标志与临床病理、近期疗效及预后的相关性.方法 选取2004年5月—2012年1月收治的128例NSCLC患者作为研究对象,采用回顾性分析法分析所有患者的临床资料.记录NSCLC患者脑转移发生情况,并观察分析所有患者的一般临床及病理资料、相关血清肿瘤标志物水平、近期疗效和预后情况.研究NSCLC脑转移患者相关血清肿瘤标志物与临床病理、近期疗效和预后的相关性,并通过Cox回归模型研究影响患者预后的相关危险因素.结果 发生脑转移NSCLC患者的癌胚抗原(CEA)水平和腺癌所占比例均明显高于未发生脑转移NSCLC患者(P<0.05).临床治疗有效患者的CEA水平较治疗前明显降低,而治疗进展者则较治疗前明显升高(P<0.05).腺癌患者的CEA水平明显高于鳞癌和其他患者(P<0.05).NSCLC脑转移患者随着肿瘤分期的增加CEA水平也逐渐上升(P<0.05).多因素Cox回归模型分析显示,健康状态评分、脑转移病灶数目、CEA水平以及放疗均为影响NSCLC脑转移患者预后的独立危险因素(P<0.05).结论 CEA与NSCLC脑转移患者的病理特征和近期疗效存在一定的相关性,且为影响NSCLC脑转移患者预后的独立危险因素.