伴区域淋巴结或合并远处转移的放射性碘难治性分化型甲状腺癌125I粒子植入治疗的疗效及安全性

目的:评估125I粒子植入治疗放射性碘难治性分化型甲状腺癌（RAIR-DTC）伴区域淋巴结或远处转移瘤的有效性及安全性，并分析患者肿瘤大小、肿瘤相关标志物Tg值的变化，以及短期疗效与肿瘤体积大小、增强扫描强化程度的相关性。方法:回顾性分析2015年5月至2018年7月42例经由病理与影像证实的RAIR-DTC伴淋巴结或合并远处转移的住院患者，均行CT引导下125I粒子植入治疗。患者术前行CT增强扫描及计算强化程度，并利用计算机三维治疗计划系统（TPS）测量肿瘤体积。术后2、6、12个月参照实体瘤治疗疗效评价标准(RECIST 1.1 标准)联合骨转移瘤MDA疗效评价标准评价治疗效果。结果:42例患者手术顺利，术后2、6、12个月的局部缓解率分别为97.62%（41/42）、88.10%(37/42)、85.71%(36/42)。其中3例声嘶、4例咳嗽的患者症状均较前明显缓解，8例患者术后NRS疼痛评分(2.00±1.07)较术前(4.88±0.83)明显下降（P＜0.001）。治疗后2、6、12个月复查病灶体积分别为（4.44±1.57)cm3、(4.20±1.70)cm3、(4.23±1.77)cm3，均较术前基线水平(6.87±1.67)cm3明显减小(t值:9.466、9.923、7.556，均P＜0.05)。治疗后2、6、12个月复查Tg值水平分别为15.95(5.45,73.93) μg/L、8.90(2.20,39.21)μg/L、6.00(1.93,14.18)μg/L，均较术前基线水平53.50(20.94,222.92)μg/L明显降低（Z值:-5.258、-5.009、-4.987,均P＜0.001）。肿瘤体积、CT强化程度是术后疗效的影响因素。结论:125I粒子组织间植入治疗RAIR-DTC伴区域淋巴结转移或合并远处转移的病灶局部控制效果较好、安全性高，具有较高的临床应用价值,且肿瘤体积小、强化程度高时疗效明显。     

食管鳞癌患者远处转移部位与预后的相关性及生存分析

目的:探讨食管鳞癌患者远处转移部位与预后的相关性及生存分析。方法:从SEER数据库中提取2010年至2015年共439例食管鳞癌伴远处转移患者的临床资料，回顾性分析比较食管鳞癌远处转移部位与预后的相关性，通过χ2检验比较两组变量的差异，采用Kaplan-Meier法绘制生存曲线，Log-rank检验进行单因素分析，COX回归进行多因素分析。结果:肺转移、骨+肺转移、肝+肺转移患者预后较好；骨转移、脑转移、骨+脑转移、骨+脑+肝+肺转移患者预后较差。单因素分析显示:年龄、原发灶部位、T分期、手术情况、多器官转移情况与食管鳞癌远处转移患者的预后有关（P＜0.05）；多因素分析显示:年龄、手术情况与多器官转移情况是影响食管鳞癌远处转移患者总生存时间（OS）的独立危险因素。结论:食管鳞癌伴远处转移的患者整体预后较差，但年龄在60~69岁区间、接受手术治疗与较好的预后相关。仅单器官转移的食管鳞癌患者中，骨转移、脑转移患者预后较差；合并多器官转移的患者中，骨+脑转移、骨+脑+肝+肺转移患者预后较差。     

Angiosarcoma of the oral cavity: a clinicopathological study and a review of the literature

Soft tissue sarcomas are uncommon in the head and neck. Primary angiosarcomas of the oral cavity area are extremely rare, and have mostly been presented as case reports. This paper presents the clinical and histological features of three such cases. All patients were diagnosed based on the presence of rapidly extending masses involving the tongue, maxillary gingiva, or mandibular gingiva; bone destruction was present in two cases. The resected specimens revealed clustered large, pleomorphic, and spindle-shaped cells with a markedly haemorrhagic background. Tumour cells showed expression of vascular endothelial markers, such a CD31, CD34, and factor VIII-related antigen. Despite undergoing radical surgery, distant metastases developed in all three cases. We also studied the clinicopathological features of a series of oral angiosarcomas. This article therefore reports the clinicopathological features of the three new cases and provides a review of the cases of primary oral angiosarcoma reported during the past 20 years.     

Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: Risk factors and patterns

Background. The pathogenesis of frequent intrahepatic recurrence of hepatocellular carcinoma (HCC) after surgical resection or local ablation therapy remains uncertain. Risks and patterns of intrahepatic distant recurrence (IDR) of a single, primary HCC lesion after radiofrequency (RF) ablation were examined. Methods. Ninety patients with a single primary HCC lesion of less than 3 cm who had complete RF ablation were enrolled in the study. Risk factors for IDR and the patterns of IDR after RF ablation were analyzed. Results. The median follow-up was 37.4 months. IDR was observed in 44 (48.9%) patients. The cumulative rate of IDR was 10.4%, 52.5%, and 77.0% at 1, 3, and 5 years, respectively. Univariate analysis revealed that a pretreatment serum α-fetoprotein (AFP) level of ≥50 ng/ml (P = 0.0324), a des-γ-carboxy prothrombin (DCP) level of ≥40 mAu/ml (P = 0.006), an ablative margin of <5 mm of the ablation zone (P = 0.0306), and a prothrombin time of <70% (P = 0.0188) were related to IDR. A multivariate stepwise Cox proportional hazards regression model revealed that pretreatment serum AFP and DCP level and the ablative margin were independent risk factors for IDR pretreatment. Serum DCP level ≥ 40 mAu/ml (P = 0.025), local tumor progression (P = 0.011), and ablative margin < 5 mm (P = 0.024) were related to multiple IDR. Conclusions. HCC patients with high serum AFP or DCP before RF ablation should be carefully followed up to monitor any IDR. A suffi cient ablative margin in RF ablation for HCC is required to prevent IDR.     

Incidence and patterns of late recurrences in colon cancer patients

Long‐term recurrences of colon cancer raised questions about the possible benefit of prolonging the recommended active 5‐year surveillance. The aim of this study was to determine, for the first time, the incidence and patterns of late 10‐year recurrence following curative resection of colon cancer. Data were obtained from two French digestive cancer registries. A total of 3,622 patients under 85 years resected for cure for colon cancer diagnosed between 1985 and 2000 were included. Information regarding recurrences was actively collected. Cumulative failure rates at 10 years were estimated using Kaplan–Meier estimates corrected by cause‐specific hazards, and multivariable analysis was performed using a model for the subdistribution of a competing risk proposed by Fine and Gray. The overall cumulative recurrence rate between 5 and 10 years after initial surgery was 2.9% for local recurrence and 4.3% for distant metastasis. Among men with no recurrence 5 years after diagnosis of colon cancer, 1 in 12 developed a recurrence between 5 and 10 years, and the corresponding cumulative rate was 7.8%. The frequency was 1 in 19 for women, corresponding to a cumulative rate of 5.2%. In the multivariate analysis, non‐emergency diagnostic feature, female sex and age under 75 were associated with a lower risk of recurrence. Stage at diagnosis was not a predictor of late recurrence. Late recurrence after colon cancer resection with curative intent can occur. A regular clinical follow‐up is necessary to detect early signs of possible recurrence.     

Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis?

Purpose

Aim of this study was to investigate for the presence of existing prognostic factors in patients with bone metastases (BMs) from RCC since bone represents an unfavorable site of metastasis for renal cell carcinoma (mRCC).

Materials and methods

Data of patients with BMs from RCC were retrospectively collected. Age, sex, ECOG-Performance Status (PS), MSKCC group, tumor histology, presence of concomitant metastases to other sites, time from nephrectomy to bone metastases (TTBM, classified into three groups: <1 year, between 1 and 5 years and >5 years) and time from BMs to skeletal-related event (SRE) were included in the Cox analysis to investigate their prognostic relevance.

Results

470 patients were enrolled in this analysis. In 19 patients (4%),bone was the only metastatic site; 277 patients had concomitant metastases in other sites. Median time to BMs was 16 months (range 0 − 44y) with Median OS of 17 months. Number of metastatic sites (including bone, p = 0.01), concomitant metastases, high Fuhrman grade (p < 0.001) and non-clear cell histology (p = 0.013) were significantly associated with poor prognosis. Patients with TTBM >5 years had longer OS (22 months) compared to patients with TTBM <1 year (13 months) or between 1 and 5 years (19 months) from nephrectomy (p < 0.001), no difference was found between these two last groups (p = 0.18). At multivariate analysis, ECOG-PS, MSKCC group and concomitant lung or lymph node metastases were independent predictors of OS in patients with BMs.

Conclusions

Our study suggest that age, ECOG-PS, histology, MSKCC score, TTBM and the presence of concomitant metastases should be considered in order to optimize the management of RCC patients with BMs.     

非小细胞肺癌外周血抗Hu抗体水平与远处转移的相关性

目的：检测非小细胞肺癌（non-small cell lung cancer,NSCLC）患者外周血抗Hu抗体水平与健康志愿者抗Hu抗体水平进行比较,并分析其与肿瘤转移部位和多种临床病理变量间的关系。方法： 收集济南军区总医院肿瘤科2013年6月至2013年12月NSCLC患者外周血清标本75例,同时收集成年健康志愿者外周血清标本100例（除外肿瘤及神经系统疾病史）作为阴性对照,按照酶联免疫吸附试验原理,检测175例血清抗Hu抗体表达。纳入研究的变量主要包括：75例NSCLC患者的性别、年龄、组织类型、核分化级别、EGFR突变状态、肿瘤标志物（CEA、CY21-1和NSE）水平及远处转移部位（脑转移、骨转移及其他部位转移）。结果： 肺癌患者外周血抗Hu抗体水平\[（40.00±35.76) ng/ml\]显著高于健康人群\[（16.40±819) ng/ml, P=0.000\]。75例患者中有62.67%（47/75）抗Hu抗体高水平表达,37.33%(28/75)呈低表达。外周血抗Hu抗体水平与患者脑转移（P=0.015）显著相关;81.81%（9/11）的脑转移患者检测到高水平的抗Hu抗体,但仅仅50.00%（32/64）的非脑转移患者检测到高水平的抗Hu抗体;抗Hu抗体水平与患者性别、年龄、组织类型、分期、EGFR突变、CEA水平、CY21-1、NSE、骨转移及其他部位转移无关（P>0.05）。多变量回归分析显示,外周血中抗Hu抗体水平是预测脑转移的独立变量（P=0.015）。结论：非小细胞肺癌患者外周血中抗Hu抗体呈高水平,与脑转移显著相关。抗Hu抗体在非小细胞肺癌脑转移中的作用机制尚需进一步明确。