小肠原发性恶性肿瘤54例临床分析

目的 总结小肠原发性恶性肿瘤的诊治及治疗。方法 回顾分析５４例经手术病理证实原发性小肠恶性肿瘤的临床资料。结果 平均发病年龄４１．３岁，３０岁￣６０岁占７０．４％。腺癌中位发病年龄４９岁，十二指肠为其好发部位，占５２．２％（１２／２３）。平滑肌肉瘤为５１岁，空肠占５４．５％（６／１１）。淋巴肉瘤４０岁，回肠占７３．７％（１４／１９）。常见症状为腹痛５１．９％（２８／５４）和腹块４６．２％（２５／５     

小肠肿瘤48例临床分析

探讨小肠肿瘤的临床表现特点及诊治方法，回顾性分析48例小肠肿瘤惠者的临床资料。小肠肿瘤多表现为腹痛、腹块、黑便、腹胀、恶心、呕吐。平滑肌肉瘤中有63．2％（12／19）位于空肠，腺癌75．0％（12／16）位于十二指肠，淋巴瘤66．7％（4／6）位于回肠。54．2％（26／48）的小肠肿瘤位于十二指肠及屈氏韧带以下20cm的空肠。多发性小肠肿瘤为8．3％（4／48）。术后复发的占10．4％（5／48）。根治性切除占70．8％（34／48），姑息性手术占25．0％（12／48），探查活捡术占4。2％（2／48）。对腹痛、腹部肿块、黑便患者如已排除胃结肠病变应高度怀疑小肠肿瘤，特别是平滑肌肉瘤的可能性。小肠肿瘤常多发，术后易复发。根治性切除术是治疗小肠肿瘤最有效的方法。     

肝原发性平滑肌肉瘤(附三例报告及免疫组化分析)

本文报告了3例肝原发性平滑肌肉瘤，男性1例，女性2例。平均年龄38．7岁。占同期肝恶性肿瘤检出率的0．68%（3／436），占同期肝恶性间叶组织肿瘤检出率的25%（3/12）。临床表现为上腹痛、右上腹包块、肝大。本组病例还进行了Masson三色染色及免疫组化染色。本文结合文献对肝原发性平滑肌肉瘤的组织发生、临床病理特点及诊断、鉴别诊断进行了讨论。     

原发性小肠肿瘤20例临床分析

作者报告原发性小肠肿瘤２０例，其中男性１２例，女性８例，年龄４５岁￣７９岁，平均６２．１岁。２０例中良性５例，恶性１５例。肿瘤分布在十二指肠、空肠各６例，回肠８例。恶性肿瘤以腺癌最多，其次为平滑肌肉瘤和淋巴系统恶性肿瘤。腹痛、上消化道出血和肠梗阻是本组小肠肿瘤的主要症状，不同程度的贫血和腹块是常见体征。本组临床诊断与手术及病理对照，误诊率为５５．０％。除１例未手术外，余１９例均作了手术治疗。作者就     

原发性小肠肿瘤122例临床分析

总结１２２例原发性小肠肿瘤的临床资料，并进行回顾性分析。结合文献对原发性小肠肿瘤的性质，发病情况，临床表现，诊断方法进行了讨论。肿瘤位于十二指肠４２例（３４．４％），空肠３６例（２９．５％），回肠４４例（３６．１％）。其中恶性肿瘤９０例（７３．８％），良性肿瘤３２例（２６．５％）。小肠肿瘤因起病隐匿，缺乏特异性症状和体征，术前误诊率高。小肠肿瘤以腹痛、出血、梗阻和腹块为四大临床表现，对诊断不明者，     

肝原发性平滑肌肉瘤（附三例报告及免疫组化分析）

本文报告了３例肝原发性平滑肌肉瘤，男性１例，女性２例，平均年龄３８．７岁，占同期肝恶性肿瘤检出率的０．６８％，占同期肝癌检出率的２５％，临床表现为上腹痛，右上腹包块，肝大。本组病例还进行了Ｍａｓｓｏｎ三色染色及免疫组化染色。本文结合文献对肝原发性平滑肌肉瘤的组织发生，临床病理特点及参数，鉴别诊断进行了讨论。     

原发性小肠肿瘤51例临床分析

小肠占消化道全长的70％，但原发性小肠肿瘤发病率低，症状无特殊，误诊率高。我院1982年1月～1994年12月，共收治原发性小肠肿瘤51例，经手术及病理证实，现报告如下。临床资料本组男30例，女21例。年龄5-81岁，平均38.8岁；30-60岁35人。从出现症状到就诊的病程1天至17年，平均282.7天。消瘦乏力38例，腹痛29例，腹块19例，便秘2例，肠梗阻11例，呕吐8例，长期稀便4例，腹胀4例，肠穿孔9例，便血7例。术前诊断为小肠肿瘤13例，（十二指肠6例、空肠3例、回肠4例）术前确诊率25.5％。本组51例中病变位于十二指肠9例，空肠25例，回肠26例，其…     

原发性小肠肿瘤64例临床分析

目的 探讨原发性小肠肿瘤的临床特点，提高对本病的诊治水平。方法 对我院1985年～2003年手术治疗的64例原发性小肠肿瘤的临床资料进行回顾性分析。结果 64例小肠肿瘤中，良性肿瘤20例(31.2％)，恶性肿瘤44例(68．8％)。良性肿瘤以平滑肌瘤为多，占39％(9／20)；恶性肿瘤以腺癌和淋巴瘤为多，分别占40．9％(18／44)和36．4％(16／44)。腹痛、腹部肿块、肠梗阻、便血及黄疸是小肠肿瘤最常见的临床表现。本组术前确诊23例，仅占35．9％。纤维内镜检查、十二指肠低张造影对十二指肠肿瘤检出率高；小肠分段造影和选择性动脉造影是空、回肠肿瘤的重要诊断方法。结论 原发性小肠肿瘤临床表现无特异性，诊断关键在于提高警惕，并选用合适的影像学检查以确诊。手术是治疗本病的主要方法。     

原发性小肠肿瘤78例分析

目的 提高对原发性小肠肿瘤的诊断水平及鉴别能力.方法 对我院1996年至2006年共10年间收治的经手术和病理证实的原发性小肠肿瘤78例进行回顾性临床分析.结果 原发性小肠肿瘤发病年龄平均56岁.恶性肿瘤占85.9%.恶性中以腺癌多见,良性以平滑肌瘤多见.发病部位以十二指肠多见,占46.2%.腹痛、贫血、消瘦及消化道出血是小肠肿瘤最常见的临床表现,电子内窥镜、B超或CT检查及选择性腹腔血管造影仍是小肠肿瘤的主要检查方法.结论 临床医师对本病的警惕性是诊断此病的关键所在.对反复腹痛、消瘦、腹部包块、肠梗阻、不明原因消化道出血等临床表现患者应高度怀疑小肠肿瘤.     

眼眶原发性恶性肿瘤22例临床分析

目的：探讨眼眶原发性恶性肿瘤的临床病理特点及治疗。方法；对22例眼眶原发性恶性肿瘤患者的性分析。结果：眼球突出和视力障碍为其主要临床特征，病理以横纹肌肉瘤最多见。占27％，其次为恶性淋巴瘤和泪腺腺样囊性癌，分别占18％和14％；3年生存率为72．7％（16／22），5年生存率为41．7％（5／12）。结论：B超，CT等影像检查有助于定位诊断，确诊有赖于病理检查，手术是主要治疗方法，术后辅以放疗和化疗对提高生存率是必要的。     

New strategies are needed in diffuse malignant mesothelioma.

BACKGROUND. Medical records of 50 patients with malignant mesothelioma were reviewed to determine the clinical features and factors influencing survival. METHODS. Charts of all patients whose conditions were diagnosed as malignant mesothelioma were abstracted and analyzed by statistical software. RESULTS. The male-to-female ratio was 4:1. The age distribution was younger than 45 years of age, 10%; 45-54 years of age, 12%; 55-64 years of age, 37%; 65-74 years of age, 33%; and 75 years of age or older, 8%. Both mean and median ages were 58 years. Among the 32 patients in whom asbestos exposure was recorded, 24 had documented exposure. The sites were pleura, 73%; peritoneum, 20%; and both, 6%. The histologic types were epithelial, 51%; sarcomatous, 10%; mixed, 15%; and not specified, 24%. The stage at presentation was Stage I, 37%; II, 39%; III, 12%; IV, 6%; and unknown, 6%. The common symptoms in pleural disease were dyspnea and pain; in peritoneal disease, abdominal distension and pain were common. The median time from first symptom to diagnosis was 3 months (range, 0-23 months). The median survival after the appearance of symptoms, the diagnosis, and the treatment were 13, 10, and 8 months, respectively. CONCLUSIONS. The survival was independent of age, sex, and smoking behavior. It was longer in patients with earlier-stage disease, a good performance status, a longer duration of symptoms, an absence of pain, and who were treated with combined surgery and chemotherapy. Chemotherapy using anthracyclines yielded more remissions (9 of 21) than that using nonanthracyclines (0 of 13). The remission rate after primary chemotherapy with anthracyclines (7 of 16) may be higher than in recurrent tumor (2 of 14). In future trials, stratification into primary chemotherapy and chemotherapy of recurrent cancer is suggested. There is a need for multitechnique trials incorporating primary chemotherapy.     

23例恶性黑色素瘤小肠转移临床病例分析

目的：总结恶性黑色素瘤小肠转移的临床病例特点。方法：我院诊治1例,通过中国知网、万方医学网以及 MEDLINE（或 PUBMED）检索到国内外报道的黑色素瘤小肠转移病例共23例,并进行统计分析。收集一般情况、黑色素瘤原发部位、原发肿瘤至小肠转移间隔时间以及临床症状等。结果：23例（男14例,女9例）,平均年龄54.7岁,初次诊断至发现转移平均时间间隔为6.33年（0-20年）。主要临床表现为腹痛16例（69.6%）,黑便/便血7例（30.4%）,肠梗阻或肠套叠14例（60.9%）。肿瘤最大直径平均为5.82cm（2-15cm）。47.8%为小肠多发转移。结论：恶性黑色素瘤小肠转移主要临床表现为腹痛、黑便,易于发生肠梗阻或肠套叠;肿瘤常多发转移,且发现小肠转移距初次诊断时间间隔较长。     

吉林延边地区551例小儿实体肿瘤临床病理特征分析

[目的]探讨延边地区小儿（0～14岁）实体肿瘤的临床病理特征。[方法]551例经病理证实的小儿肿瘤患者纳入分析,分析小儿实体肿瘤的年龄、性别及良恶性分布情况。[结果]551例中良性500例,恶性51例。良性肿瘤以脉管性肿瘤（28．00％）、骨软骨肿瘤（13．40％）、表皮囊肿（10．60％）和脂肪瘤（10．00％）多见。17例婴儿期（0～1岁）患者均为良性肿瘤（脉管性肿瘤15例,脂肪瘤和畸胎瘤各1例）。恶性肿瘤见于婴儿期后各年龄组,学龄期（7-14岁）最多,占84．62％;以恶性淋巴瘤（21．57％）、恶性胶质瘤（17．65％）和软组织肉瘤（13．73％）多见。[结论]延边地区小儿肿瘤良性居多,不同年龄组肿瘤分布不同,应根据小儿肿瘤的流行特点,制定相应的防治措施。     

Docetaxel monotherapy as a second-line treatment after failure of fluoropyrimidine and platinum in advanced gastric cancer: experience of 154 patients with prognostic factor analysis

OBJECTIVE: To investigate the efficacy and safety of docetaxel monotherapy as salvage chemotherapy for advanced gastric cancer (AGC) in clinical practice and to determine the prognostic factors in these patients. METHODS: We retrospectively reviewed the medical records of patients with AGC for whom fluoropyrimidine and platinum had previously failed and who had received docetaxel salvage monotherapy between December 2000 and March 2006. Docetaxel was administered at a dose of 75 mg/m(2) intravenously every 3 weeks with dexamethasone prophylaxis. RESULTS: A total of 154 patients received 583 cycles of docetaxel with a median of three cycles per patient (range 1-10). The median age was 54 years (range 27-75 years). The objective response rate of 86 patients with measurable lesions was 14%, with 1 complete response and 11 partial responses, with a median response duration of 5.6 months. An additional 25 patients achieved stable disease. The median time to progression (TTP) for all patients was 2.6 months [95% confidence interval (CI), 2.2-2.9] and the median overall survival (OS) from the start of docetaxel chemotherapy was 7.2 months (95% CI, 5.9-8.5). The chemotherapy was generally well tolerated. Multivariate analysis showed that the Eastern Cooperative Oncology Group (ECOG) performance status (0 or 1 versus 2) was an independent prognostic factor for both TTP and OS. Disease status indicative of a relatively small tumor burden (resected metastatic or recurrent tumor) was a predictor for better TTP and good differentiation of the tumor was a predictor for better OS. CONCLUSION: Docetaxel 75 mg/m(2) is relatively active and tolerable as a second-line salvage treatment after failure of fluoropyrimidine and platinum in general clinical practice for AGC.     

三原发恶性肿瘤14例临床分析

目的:分析三原发恶性肿瘤的发病、诊断、治疗及预后情况.方法:回顾性分析14例三原发恶性肿瘤的临床资料,随访患者的生存状态.结果:男性 10 例,中位发病年龄67.5岁,女性4 例,中位发病年龄72岁;合并肿瘤相关家族史2 例,既往吸烟史 5例(全部为男性),中位吸烟指数600;第三原发肿瘤距离第二原发肿瘤间隔时间,7例<7个月,其余均大于24个月,第二原发肿瘤距离第一原发肿瘤间隔时间,3例<7个月,其余均大于15个月;消化系统恶性肿瘤发病部位占全部47.6%,发病率远高于其他部位;上皮性恶性肿瘤占全部发病部位的90.5%;治疗方法中手术为主的治疗比例为61.9%,以化疗、放疗等为主的综合治疗为26.2%,0.07%的病例放弃治疗,且均发生在诊断第三原发恶性肿瘤时;14例三原发恶性肿瘤患者中位生存时间184个月.结论:综合治疗有助于提高患者的总生存时间,早期发现及采用综合治疗手段可改善三原发恶性肿瘤患者的预后.     

Phase II study of a weekly 24-hour infusion with 5-fluorouracil and simultaneous sodium-folinic acid in the first-line treatment of metastatic colorectal cancer.

BACKGROUND: A weekly continuous 24-hour infusion therapy with 5-fluorouracil (5-FU) and calcium - folinic acid (CA-FA) was shown to be an effective first-line treatment in advanced metastatic colorectal cancer. Sodium - folinic acid (S-FA) is a new formulation which, in contrast to CA-FA allows the simultaneous i.v. administration in combination with 5-FU in one pump. PATIENTS AND METHODS: From 1997 to 1998, 51 patients [median age 60 (range 24-77) years; 38 male, 13 female] with metastatic colorectal cancer were recruited in 5 centers to receive weekly 24-hour infusions of 5-FU (2,600 mg/m(2)) and S-FA (500 mg/m(2)) dissolved in one pump for 6 weeks as first-line treatment. The treatment cycle was repeated after a 2-week rest period. RESULTS: 1,178 administrations (median 24, range 3-54) were performed during the study. Out of 51 patients (median follow-up 20.2 months), 2 (3.9%) achieved complete remission (CR), 17 (33.3%) partial remission (PR), and 21 (41.2%) no change (NC). Progressive disease (PD) was observed in 11/51 (21.6%) patients, including 6 patients who did not complete the first cycle. Median time to tumor progression (TTP) was 8.5 months (95% CI: 5.8-11.3). 32/51 (62.7%) patients survived for more than 1 year, the median survival was reached at 16.5 months (95%CI: 10.2-22.8). Among major toxicities, NCICTC grade III/IV diarrhea occurred in 13/51 (25.4%), grade III hand-foot syndrome in 6/51 (11.7%) patients. Grade III/IV stomatitis was observed in 4/51 (7.8%), cardiac toxicity occurred in 2/51 patients (3.9%). CONCLUSION: Similar to conventional 24-hour 5-FU + CA-FA treatment, the combination with S-FA induced 37.2% objective responses with moderate toxicity. However, TTP seems favorable and the administration of S-FA is convenient, while saving costs and time for the patient in outpatient units.     

Medulloblastoma in adults: treatment results and prognostic factors

PURPOSE: To investigate the treatment outcome and prognostic factors of adult medulloblastoma patients who received postoperative craniospinal irradiation (RT). METHODS AND MATERIALS: Between 1983 and 2000, 30 adult patients (17 men and 13 women, age >or=16 years, median 27, range 16-45) underwent postoperative RT. The median duration of symptoms was 2 months (range 1-9). The tumor location was lateral in 16 (53%). A desmoplastic variant was seen in 12 (40%). Tumor resection was complete in 20 (67%) and incomplete in 10 (33%). All patients received craniospinal RT. The median dose to the whole brain was 40 Gy (range 36-51), to the posterior fossa 54 Gy (range 49-56), and to the spinal axis 36 Gy (range 24-40). The median interval between surgery and the start of RT was 31 days (range 12-69), and the median duration of RT was 45 days (range 34-89). Ten patients (33%) received adjuvant chemotherapy. The median follow-up was 51 months (range 5-215). RESULTS: The 5- and 8-year overall survival and disease-free survival rates were 65% and 51% and 63% and 50%, respectively. Twelve patients (40%) developed relapse, with a median follow-up of 51 months. The posterior fossa was the most common site of relapse (6 patients). The median time to relapse was 26 months (range 4-78). Fifty percent of the relapses occurred after 2 years, 17% after 5 years. In univariate analysis, M stage and the interval between surgery and the start of RT were significant prognostic factors for disease-free survival. At 5 years, 70% of M0 patients were estimated to be disease-free, but none of the 3 M3 patients reached 5 years without recurrence (p = 0.0002). The 5-year disease-free survival rate for the patients whose interval between surgery and the start of RT was <3 weeks, between 3 and 6 weeks, and >6 weeks was 0%, 85%, and 75%, respectively (p = 0.002). The 5-year posterior fossa control rate for patients who received >or=54 Gy or <54 Gy to the posterior fossa was 91% and 33%, respectively (p = 0.05). CONCLUSION: The survival results for medulloblastomas in adults compare favorably with those in children. However, late relapses, lateral tumor location, and desmoplastic histologic features are more frequent in adults. Spinal seeding at presentation is a poor prognostic factor for disease-free survival. A minimal dose of 54 Gy to the posterior fossa is essential for adequate tumor control. The interval between surgery and the start of RT, which was found to be a significant prognostic factor, is an interesting issue that requires further study.     

肝脏少见原发恶性肿瘤的临床病理特点

目的:通过研究肝脏少见原发恶性肿瘤临床病理的特点,以提高该类型肿瘤的诊疗水平.方法:收集我院肝胆外科自2003年1月至2012年12月经病理确诊的肝脏少见原发恶性肿瘤24例,其中经外科手术治疗20例,穿刺活检4例,结合文献对其临床及病理特点进行分析总结.结果:此组共24例,占同期全部肝脏恶性肿瘤病例的2.75％ (24/874),涵盖13种病理类型:肝母细胞瘤5例,神经内分泌瘤4例,淋巴瘤3例,胆管黏液腺癌2例,恶性神经鞘瘤2例,恶性神经束膜瘤1例,上皮样血管内皮瘤l例,上皮样血管肌肉脂肪瘤1例,多形肉瘤1例,癌肉瘤1例,平滑肌肉瘤1例,梭形细胞瘤1例,鳞癌1例.男女比例2:1(16:8).平均年龄48.90岁(6～74岁,中位年龄51岁).该组患者术后1年和5年生存率分别为49.0％和26.1％.结论:肝脏少见原发性恶性肿瘤临床诊断和鉴别困难,手术切除或穿刺活检的标本行免疫病理检查是诊断疾病的金标准.治疗尽量根治切除并按照指南辅助有效化疗或进行靶向治疗.     

Craniofacial surgery for malignant skull base tumors: report of an international collaborative study

BACKGROUND: Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group. METHODS: One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1-98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%). RESULTS: Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow-up of 25 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease-specific, and recurrence-free survival on multivariate analysis. CONCLUSIONS: CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome.     

Phase II study of metronomic chemotherapy for recurrent malignant gliomas in adults

Preclinical evidence suggests that continuous low-dose daily (metronomic) chemotherapy may inhibit tumor endothelial cell proliferation (angiogenesis) and prevent tumor growth. This phase II study evaluated the feasibility of this antiangiogenic chemotherapy regimen in adults with recurrent malignant gliomas. The regimen consisted of low-dose etoposide (35 mg/m2 [maximum, 100 mg/day] daily for 21 days), alternating every 21 days with cyclophosphamide (2 mg/kg [maximum, 100 mg/day] daily for 21 days), in combination with daily thalidomide and celecoxib, in adult patients with recurrent malignant gliomas. Serum and urine samples were collected for measurement of angiogenic peptides. Forty-eight patients were enrolled (15 female, 33 male). Twenty-eight patients had glioblastoma multiforme (GBMs), and 20 had anaplastic gliomas (AGs). Median age was 53 years (range, 33-74 years), and median KPS was 70 (range, 60-100). Therapy was reasonably well tolerated in this heavily pretreated population. Two percent of patients had partial response, 9% had a minor response, 59% had stable disease, and 30% had progressive disease. For GBM patients, median progression-free survival (PFS) was 11 weeks, six-month PFS (6M-PFS) was 9%, and median overall survival (OS) was 21 weeks. For AG patients, median PFS was 14 weeks, 6M-PFS was 26%, and median OS was 41.5 weeks. In a limited subset of patients, serum and urine angiogenic peptides did not correlate with response or survival (p > 0.05). Although there were some responders, this four-drug, oral metronomic regimen did not significantly improve OS in this heavily pretreated group of patients who were generally not eligible for conventional protocols. While metronomic chemotherapy may not be useful in patients with advanced disease, further studies using metronomic chemotherapy combined with more potent antiangiogenic agents in patients with less advanced disease may be warranted.