联合检测suPAR、SccAg在宫颈癌中的意义

目的探讨suPAR、SccAg在宫颈癌中的变化及监测意义。方法采用ELISA方法测定57例宫颈鳞癌患者血清中suPAR、SccAg值,以30例子宫肌瘤的正常宫颈做对照。结果宫颈癌患者治疗前血清中suPAR、SccAg测定值明显高于正常宫颈的血清测定值（P<0.01）,宫颈癌Ⅰ～Ⅱ期血清suPAR、SccAg测定值明显低于Ⅲ～Ⅳ期者,淋巴结无转移者明显低于有转移者（P<0.01）,治疗后无复发者明显低于复发者（P<0.01）,而治疗后复发、术中残留对其影响不显著（P>0.05）。在宫颈癌中,suPAR、SccAg表达的阳性率分别为75.64%、61.69%。结论suPAR、SccAg在宫颈癌呈高表达,提示其可能是宫颈癌发生发展中的特征之一,有待成为术后监测、术后随访及是否追加放疗的参考指标,为判断预后、评估治疗提供帮助。     

原发性肝癌患者血清可溶性细胞间粘附分子-1的测定及其临床意义

目的：探讨血清可溶性细胞间粘附分子－1（sICAM-1)与原发性肝癌发展，转移，疗效及预后的关系。方法：采用ELISA法检测72例原发性肝癌患者治疗前后，12例良性肝肿瘤患者治疗前血清中sICAM-1的水平，再进行比较分析。结果：原发性肝癌患者血清sICAM-1水平高于正常对照组及良性肝肿瘤患者（P＜0．01），且与肿瘤直径，有无腹腔积液，有无肝外转移，临床分期及治疗效果有关。肿瘤越大，血清sICAM-1水平越高（P＜0．01），有腹腔积液者比无腹腔积液者高（P＜0．05），有肝外转移者比无肝外转移者高（P＜0．05），Ⅲ期患者比Ⅱ期者高，Ⅱ期者又比I期者高（P＜0．05或P＜0．01），治疗前比治疗后高（P＜0．01），而正常对照组与良性肝肿瘤患者血清sICAM-1水平无显著性差异（P＞0．05），结论：原发性肝癌患者血清siCAM-1水平在一定程序上可以反映肝癌发展，转移情况及治疗效果，有可能成为预测肝癌转移，复发及疗效的指标。     

动态监测血清VEGF在宫颈鳞癌化疗前后的变化

目的研究宫颈癌化疗前后血管内皮生长因子（vascular endothelial growth factor,VEGF）的改变,探讨VEGF能否作为评判化疗近期疗效的预测指标,为制定合理的治疗方案提供参考。方法采用酶联免疫吸附法（ELlSA）检测60例宫颈鳞癌患者及20例正常健康妇女血清中VEGF水平并进行对照分析。结果宫颈癌患者血清中VEGF水平显著高于正常健康妇女血清中VEGF水平（P〈0．01）,且宫颈癌Ⅰ期血清VEGF值低于Ⅱ期者（P〈0．05）;宫颈癌患者术后血清VEGF表达较术前明显上升（P〈0．01）,术后化疗后血清VEGF水平较术后明显下降（P〈0．01）;宫颈癌Ⅰ期患者术后化疗后血清VEGF水平与术前比较差异无统计学意义（P〉0．05）,宫颈癌Ⅱ。期、Ⅱ。期患者术后化疗后血清VEGF水平均低于术前（P〈0．05）;宫颈癌Ⅱ。期患者新辅助化疗（neoadjuvant chemotherapy,NACT）后血清VEGF浓度较NACT前降低（P〈0．05）。结论VEGF可作为预测宫颈癌化疗近期疗效和判断术后是否需要辅助化疗及化疗疗程数的参考指标。     

血管内皮生长因子在大肠癌诊治中的应用研究

目的 探讨血管内皮生长因子（VEGF）在结直肠癌的诊断、良恶性鉴别以及在复发中的意义。方法 收集85例结直肠癌患者术前（其中13例有术后1周对照）及21例术后半年到4年结直肠癌患者的静脉血,对照组30例,采用酶联免疫夹心法检测血清中VEGF浓度。结果 结直肠癌早期患者（Duke＇sA期）血清VEGF浓度较对照组显著升高（P＜0．01）。Duke＇sA、B期间血清VEGF浓度有显著性差异（P＜0．05）,有淋巴结转移组（Duke＇sC期）较无淋巴结转移组（Duke＇sB期）的血清VEGF浓度显著升高（P＜0．01）,有远处脏器转移组血清VEGF较淋巴结转移5组亦显著升高（P＜0．01）。高分化腺癌组（含Duke＇sA期5例和B期3例）血清VEGF与对照组比较,无显著性差异（P＞0．05）。术后半年到4年的患者,复发组血清VEGF与末复发组比较,有非常显著性差异（P＜0．01）。结论 血清VEGF水平的检测对结直肠癌的诊断有一定的临床意义,可反映疾病的进展对肿瘤恶性程度的判断有一定的帮助。血清VEGF浓度变化还可监测癌症患者术后肿瘤复发和转移。     

微血管计数和血管内皮生长因子在胃癌浸润转移中的作用

目的：研究微血管计数（MVC）和血管内皮生长因子在胃癌组织中的表达情况，探讨其与临床病理特征的关系及在胃癌浸润转移中的作用。方法：应用免疫组织化学ABC法，检测11例正常胃黏膜及253例胃癌组织中MVC，血管内皮生长因子（VEGF），碱性成纤维细胞行政管理茵子（bFGF)的表达。结果：肿瘤组织MVC内明显高于下胃黏膜组织（P＜0．01），肿瘤组织中VEGF和bFGF阳性率分别为67．6％（171／253）和9．5％（24／253），VEGF的表达与分化程度，TNM分期，转移（淋巴结，腹膜，肝等）密切相关（P＜0．01），胃癌组织VEGF阳性组的MVC明显高于阴性组（P＜0．01），VEGF表达阳性者复发转移率明显高于VEGF阴性者（P＜0．01），VEGF阳性患者的预后明显较阴性者差。结论：高MVC及VEGF表达是胃癌的独立预后因子。VEGF可能通过诱导血管生存在胃癌的浸润转移中起重要作用。     

大肠癌患者40例血清血管内皮生长因子测定的临床价值

  目的 探讨大肠癌患者血清血管内皮生长因子（VEGF）测定值在化疗前后变化的临床意义。方法 采用酶联免疫吸附（ELISA）法对40例健康对照组及40例大肠癌治疗组化疗前后进行血清VEGF含量分析。结果 大肠癌组化疗前血清VEGF含量显著高于化疗后（P＜0.001）；化疗有效（CR+PR）患者血清VEGF含量显著低于化疗无效（NC+PD）患者（P＜0.001）。大肠癌组临床分期Ⅰ~Ⅱ期血清VEGF含量显著低于Ⅲ~Ⅳ期（P＜0.001）；侵袭程度低（T1+T2）者血清VEGF含量显著低于侵袭程度高（T3+T4）者（P＜0.001）；高分化者的血清VEGF含量显著低于低分化者（P＜0.001）；有淋巴结转移者VEGF含量显著高于无淋巴结转移者（P＜0.001）。结论 血清VEGF含量在大肠癌的浸润和转移过程中发挥主要作用，可作为判断疗效及预后的敏感指标。     

卵巢肿瘤组织中血管内皮细胞生长因子受体的表达及其与临床病理因素的关系

目的：探讨VEGF受体与卵巢肿瘤发生、发展的关系。方法：采用S－ABC免疫组织化学方法检测54例卵巢恶性肿瘤、14例良性肿瘤及16例正常卵巢组织中VEGF受体Flt-1及KDR蛋白的表达。结果：Flt-1,KDR在恶性肿瘤组织中的表达率分别为59．3％及38．9％，明显高于良性肿瘤及正常组织，均有非常显著性差异（P＜0．01），而良性肿瘤与正常组织比较无显著性差异（P＞0．05），Flt-1,KDP表达与组织分组无关，Ⅲ-Ⅳ期Flt-1表达率明显高于I－Ⅱ期（P＜0．05），腹腔积液≥500ml者Flt-1的表达率明显高于腹腔积液＜500ml者（P＜0．05），KDR表达与临床分期，腹腔积液多少无明显相关性（P＞0．05），有淋巴结转移患者的Flt-1表达率明显高于无淋巴结转移者；有大网膜转移者Flt-1表达率明显高于无大网膜转移者，有显著性差异（P＜0．05），Flt-1和KDR表达与远处转移及术后残留灶大小等均无明显相关性。结论：VEGF受体与卵巢肿瘤的发生，发展有关，可作为判断其预后的指标之一。     

胃癌间质微血管的定量意义

 应用F_Ⅷ相关抗原并采用LSAB法对54例手术切除的胃癌组织微血管进行了定量研究，结果表明，早期胃癌微血管密度明显低于进展期胃癌（P＜0．02）；进展期胃癌中，高分化腺癌微血管数明显低于低分化腺癌和末分化癌（P＜0．02，P＜0．01）；微血管密度和腔面积在有无淋巴结转移两组胃癌中差异亦分别有显著性意义（P＜0．01，P＜0．01）。提示微血管与胃癌细胞分化、浸润及淋巴结转移有关，为临床抗微血管治疗肿瘤提供有价值的指标。     

癌症患者尿激酶型纤溶酶原激活物及其受体检测的临床意义

目的：探讨癌症患者血浆中尿激酶型纤溶酶原激活物（u-PA)及其受体（u-PAR)检测的临床意义。方法：采用ELISA法测定85例癌症患者血浆中u-PA和u-PAP水平，并与正常人进行比较。结果：肝癌、肺癌、大肠癌、胰腺癌和胃癌患者的血浆u-PA和u-PAR水平均同步升高，与对照组比较有显著性差异（P＜0．05或P＜0．01）；胃癌和肺癌患者u-PA和u-PAR水平在术后出现明显回落（P＜0．05或P＜0．01）,复发时又升高；胰腺癌有转移者明显高于无转移者（P＜0．05）；鼻咽癌仅有u-PAR水平高于对照组（P＜0．01）。结论：癌症患者血浆u-PA和u-PAR水平显著异常，可作为评估浸润转移和复发的参考指标。     

血清VEGF水平在乳腺癌诊治中的意义

目的：检测血清VEGF水平在乳腺癌中的临床应用价值。方法：采用ELISA法检测38例初治乳腺癌、6例复发转移乳腺癌、46例定期随访者及30例正常人的血清VEGF水平。以＞125 pg／ml计算VEGF阳性率。结果：血清VEGF的阳性率初治组和复治组分别为52．6％和66．7％，显著高于随访组的4．5％和对照组的3．3％(P＜0．01)，血清VEGF水平随TNM分期升高而逐渐升高，Ⅳ期显著高于Ⅰ、Ⅱ、Ⅲ期(P＜0．05)；有淋巴结转移显著高于无淋巴结转移(P＜0．05)，手术后3个月或复治有效者血清VEGF水平明显下降(P＜0．05)。结论：血清VEGF检测对乳腺癌的诊断、疾病进展情况及监测疗效有一定的临床意义。     

Temozolomide in combination with fotemustine in patients with metastatic melanoma

Purpose  Temozolomide and fotemustine are both active drugs for treating metastatic melanoma. The present study was designed to assess the efficacy and safety of combination therapy with temozolomide + fotemustine in patients with metastatic melanoma. Methods  Forty patients (median age 50.5 and 22 males) with pathologically confirmed, unresectable, AJCO stage IV melanoma were enrolled into the study. The primary endpoints were tumor response and safety. Patients received oral temozolomide 125 mg/m² on days 1–7 and intravenous fotemustine 80 mg/m² on day 3 every 3 weeks. Results  Fourteen (35%) patients achieved an objective response, including 3 (7.5%) complete and 11 (27.5%) partial responses. Median overall survival time was 6.7 months and 6-month survival rate was 57.4%. Myelosupression, particularly thrombocytopenia, was the primary toxicity. Conclusion  The regimen, temozolomide combined with fotemustine, is an active and moderately safe first-line chemotherapy regimen with acceptable and easily manageable toxicities in patients with metastatic melanoma.     

Docetaxel in combination with dacarbazine in patients with advanced melanoma

OBJECTIVES: The number of agents that are active in patients with metastatic melanoma is limited and cure is not a realistic objective for treatment at this stage. The aim of the study was to evaluate the efficacy and safety of new combination regimen cosisting of docetaxel and dacarbazine (DTIC), as first-line chemotherapy, in patients with advanced melanoma. PATIENTS AND METHODS: Patients with advanced melanoma (including cerebral metastases) were eligible. Docetaxel 80 mg/m(2), i.v. over 1 h infusion on day 1, and DTIC 400 mg/m(2), i.v. over 45 min on days 1 and 2, were given every 21 days, for six cycles. All patients were premedicated, prior to each course, with methylprednisolone per os. RESULTS: Forty-one patients entered the study. Thirty-nine were assessable for response and 40 for toxicity. Objective responses were seen in 10 patients (24% of the eligible; 95% CI = 12.4-40.3%, 26% of the assessable and 28% of patients with cerebral metastases were excluded). Three of them achieved a complete response (7%; 95% CI = 1.5-19.9) and 7 a partial response (17%; 95% CI = 7.1-32.0), while 8 patients demonstrated stabilization of their disease (20%; 95% CI = 8.8-34.9). After a median follow-up of 20 months, the median time to progression was 7 months (range 0.5-22) and the median survival was 10 months (1-24+). The main toxicity (G3-4) was neutropenia which occurred in 8/40 (20%) patients. Additional patients had reversible G3-4 toxicities including alopecia, nausea and vomiting and fatigue; 3 of them presented mild to moderate hypersensitivity reactions to docetaxel. No toxic death was noted. CONCLUSIONS: The combination of docetaxel and DTIC is active and well tolerated in patients with advanced melanoma. While this combination is at least as effective as various combination regimens, it does not differ from that reported for single-agent DTIC.     

Preoperative treatment with bevacizumab in combination with chemotherapy in patients with unresectable metastatic colorectal carcinoma

Purpose

This prospective observational study assessed the efficacy of bevacizumab in combination with chemotherapy as preoperative treatment to downsize tumours for radical resection in patients with unresectable metastatic colorectal cancer (mCRC).

Patients/methods

Patients with mCRC initially unresectable according to predefined criteria were included. Preoperative treatment consisted of bevacizumab (5 mg/kg) combined with oxaliplatin- or irinotecan-based chemotherapy, which was followed by surgery in patients showing clinical benefit. Resection rate was the primary endpoint. Response rate (RR) and clinical benefit of preoperative chemotherapy, and overall survival (OS) were secondary endpoints.

Results

A total of 120 eligible patients were included and received preoperative treatment. Chemotherapy was irinotecan-based in 73 (61 %) patients, oxaliplatin-based in 25 (21 %) and 22 (18 %) patients received more than one line. A RR of 30 % and a clinical benefit rate of 73 % were observed with preoperative chemotherapy. Metastatic resection was possible in 61 (51 %) patients. Median OS was 33 months (95 % CI 31–NA months) for patients undergoing surgery, and 15 months (95 % CI 11–25 months) in non-operated patients. Thirty-five patients experienced 59 postoperative complications (morbidity rate 57 %).

Conclusion

Preoperative bevacizumab-based chemotherapy offers a high surgical rescue rate in patients with initially unresectable mCRC.     

Concomitant radiotherapy with chemotherapy in patients with glioblastoma

Glioblastomas are the most frequent and the most aggressive primary brain tumors in adults. Therapeutic strategy is challenging because of radioresistance and chemoresistance explaining the poor prognosis (median survival of 12 months). Standard therapy consisted until recently of surgery and postoperative radiotherapy while the impact of chemotherapy (investigated as adjuvant, neo adjuvant therapy or concomitant with irradiation) was a matter of debate. However a recent phase III study has concluded to the benefit of adjuvant temozolomide administered during and after radiotherapy. This strategy is yet to become a standard.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。