Clnical Study of the Treatment of Patients with a Metastatic Spinal Tumor by Percutaneous Vertebroplasty under the Guidance of DSA

OBJECTIVE To explore the clinical effect in patients with metastatic spinal tumors treated by percutaneous vertebroplasty （PVP） under the guidance of digital subtraction angiography （DSA）. METHODS A total of 110 cases with a metastatic spinal tumor were di- vided into 55 cases in the treatment group （group A ） and 55 cases in the control group （group B ）. The general clinical data were statistically analyzed before treatment with the parameters showing no differences. Group A was treated by PVP and chemotherapy as well. Group B was treated by the regular chemotherapy and regular radiation therapy. The same chemotherapy program was used for the same type of disease. All cases were provided with a follow-up survey for 12 months. During the follow-up survey, changes in the quality of life, in evaluation of bone pain and in vertebral column stability as well as adverse reactions were observed. RESULTS The statistics showed a significant difference between the 2 groups, specifically changes in the quality of life and evaluation of bone pain （P〈0.05, t1=2.74, t2=9.02）. During the follow-up survey, 5 cases in group A died of other organ complilcations, the death rate being 9.1% （5 out of 55）, but all survived more than 3 months following PVP. The vertebral columns of the survivors were kept stable, with no pathological fractures occurring in the vertebral bodies filled with bone cement, there were no obvious adverse reactions, and no paraplegia occurred. Thirteen cases died in group B with a death rate of 23.6% （13 out of 55）. Pathological compression fractures in the vertebral bodies occurred in 30 cases, and 12 cases of complicated paraplegia were noted. The incident rate of paraplegia was 21.8% （12 out of 55）. CONCLUSION PVP is a simple operation causing only small wounds and few complications. It can effectively alleviate pain of metastatic spinal tumors in patients, improve quality of life and reduce the incidence rate of paraplegia.     

Quality of life in cancer patients with pain in Beijing

Objective:To investigate the quality of life(QOL) of cancer pain patients in Beijing,and explore the effect of cancer pain control on patients’ QOL.Methods:Self-developed demographic questionnaire,numeric rating scale and SF-36 questionnaire were used together among 643 cancer pain patients in 28 Grade 2nd to 3rd general hospitals and 2 Grade 3rd cancer hospitals.Results:The SF-36 eight dimensions scores ranged from 31.75 to 57.22 in these cancer pain patients.The t test and Wilcoxon rank sum test were used to compare the QOL between pain controlled(PC) group and pain uncontrolled(PUC) group,and the results showed that patients in PC group had the higher QOL scores in 6 areas of SF-36(P<0.05).Binary logistic regression results found that pain management satisfaction scores(P<0.001),family average personal monthly income(P=0.029),current receiving chemotherapy(P=0.009) and cancer stage(P<0.001) were the predictors to cancer pain controlled results.Conclusion: Cancer patients with pain in Beijing had poor QOL. Pain control will improve the QOL of cancer pain patients.     

Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography （CT）-guided radiofrequency ablation （RFA） and systemic chemotherapy plus hepatic artery infusion of floxuridine （HAI-FUDR）. Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR （ablation group, n=39） or systemic chemotherapy plus HAI-FUDR （FUDR group, n=22）. Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival （OS） rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS （P = 0.001） and survival after metastasis （P = 0.009）. These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.     

Trial of the correlation between cytochrome oxidase CYP3A4 with the susceptibility of paclitaxel-based regimen for advanced gastric cancer

Objective： The aim of the study was to investigate the relationship between susceptibility of paclitaxel-based regimen and gene polymorphisms of cytochrome oxidase CYP3A4 for advanced gastric cancer. Methods： Peripheral venous blood sample of 53 advanced gastric cancer patients were enrolled to test the mutation of CYP3A4 gene by denaturing high performance liquid chromatography（DHPLC） and DNA sequencing. The relation between the efficacy of paclitaxel-based regimen and CYP3A4 gene polymorphisms was further analyzed. Results： DHPLC indicated that among the 53 patients, 21 cases showed biomodal type（mutation） and 32 cases were of unimodal type（wild-type）. Sequencing results showed that the deletion mutation was found at the 27 th basic group of C in exon 10 of CYP3A4 gene. The response rate（RR） and disease control rate（DCR） of wild-type group were 40.6% and 84.4%, while in mutation group they were 33.3% and 85.7%, respectively, with no significances between the two groups（P 0.05）. Of all 53 cases, the median progression-free survival（PFS） was 6.5 months（95% CI： 3.576–9.424 months）, and the median overall survival（OS） was 11.0 months（95% CI： 6.955–15.045 months）. The median PFS and OS in wild-type group had no differences compared with those in mutation group（7.0 months vs. 7.0 months, P 0.05; 10.0 months vs. 14.0 months, P 0.05）. Between wild-type and mutation groups, the median PFS of patients applied with oxaliplatin containing regimen and the median OS in patients applied with/without oxaliplatin had no significant differences（P 0.05）, while the median PFS in patients received non-oxaliplatin regime had statistical differences（P = 0.024）. The median PFS and OS in patients receiving 3-drug or 2-drug regimes had no correlation with CYP3A4 gene polymorphisms. The adverse effects in the two groups were mild, mainly in grades 1–2. The common adverse effects were anorexia, nausea/vomiting and leucopenia. Conclusion： Deletion mutation was located in     

Expression of sIL-2R before and after chemotherapy in patients with breast cancer

Objective:To investigate the difference of peripheral blood sIL-2R before and after chemotherapy in breast cancer patients,and evaluate the clinical value of the sIL-2R in breast cancer's diagnosis and therapy.Methods:The peripheral blood sIL-2R levels of the breast cancer patients with or without chemotherapy were detected by ELISA.The healthy persons were made as the control group.Results:The slL-2R levels of the breast cancer patients were higher than that of the control group(P＜0.05);the slL-2R's levels in Ⅰ～Ⅱ stage breast cancer were lower than that in Ⅲ～Ⅳ stag e breast cancer (P＜0.05);the sIL-2R levels of the patients before chemotherapy were higher than that of the patients undergone chemotherapy(P＜0.05);The level of the patient with chemotherapy was still higher than that of the control group(P＜0.05);the sIL-2R levels of the patients whose chemotherapies were noneffective were higher than that of the patients received effective chemotherapies(P＜0.05).There was no significant difference between the group with ER( )or PR( )and the group with ER(-)or PR(-)(P＞0.05).Conclusion:The breast cancer patients have the high slL-2R levels.There is a close relationship between the cancer incidence and the patients,immune situation.The level of slL-2R could be a clinical index which Can be used for evaluating the cancer degree,because the higher levels of slL-2R can indicate that the immune ability of patient is worse.There is a significant difference between the slL-2R levels of the patients before chemotherapy and that of the patients undergone chemotherapy.     

大剂量维生素 C 在肿瘤患者应用的安全性观察

Objective Dynamic detection of urinary Livin mRNA expression in patients with bladder cancer before and after operation and its clinical value in early diagnosis of bladder cancer. Methods Urine of 30 patients with initially diagnosed BTCC was collected before operation and one week, one month, three months, six months and 18 months after operation. Urine of 30 healthy volunteers and 30 Non-urological cancer patients was collected. Expression of survivin mRNA in urine exfoliated cells was detected by real-time PCR. Results Livin mRNA was highly expressed in the urine of 30 patients before operation, and the relative copy number was (96.33±35.79), and the expression level increased with the clinical stage and grade of the tumor from low to high; 2 of 30 patients in the control group showed high expression, the relative copy number was 43.17 and 47.52, the other was low expression, and the expression level was low. The copy number was (16.25±7.81); 30 cases in normal group were low expression, and the relative copy number was (13.74±1.57). The expression of Livin mRNA in urine of the case group was significantly higher than that of the control group and the normal group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the control group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the normal group (P<0.05); there was no significant difference between the control group and the normal group (P>0.05). Follow-up to 18 months after surgery, 5 patients with recurrence before reoperation (98.27±26.55) and 6 months after the initial operation were significantly different (P<0.05). Conclusion Dynamic detection of urinary Livin mRNA expression with high specificity and sensitivity can be used as an important noninvasive marker for early diagnosis of bladder cancer.     

唑来膦酸注射液治疗恶性肿瘤骨转移疼痛的临床疗效观察

Objective： To evaluate the efficacy and safety of zoledronic acid for the pain caused by metastatic tumor of bone. Methods： 52 patients with metastatic tumor of bone were randomly divided into two groups. The zoledronic acid group received 4 mg zoledronic acid infusion for 30 minutes and the control group received 90 mg pamidronate infusion for 6 hours. Results： The effective rates in zoledronic acid group and control group were 73.08% and 69.23% respectively. No significant difference was observed between the two groups. The median pain relief onset at days 5 and 7, respectively, and no significant difference was observed. The ECOG scores on the 7th day after medication： the differences in the zoledronic acid group before and after medication and between the two groups were both significant （P 〈 0.001 and P = 0.0448）. The adverse reaction was no significant difference between the two groups. Conclusion： Zoledronic acid is efficient and safe in the treatment of pain caused by metastatic tumor of bone and it has low adverse reaction rate and convenient shorter using time.     

Prognostic significance of ERCC1 expression in postoperative patients with gastric cancer

Aim： This study explored the correlation between the expression of excision repair cross-complementation group 1 （ERCC1） and the prognosis of gastric cancer patients. Methods： From January 2005 to December 2008, 605 patients who underwent radical surgery in The First Affiliated Hospital of Nanjing Medical University were enrolled. We conducted the follow-up every 6 months and its contents included a comprehensive medical history, tumor markers and abdominal ultrasound or CT and other imaging findings. Deadline was April 30, 2013 and follow-up time between 51 to 91 months. Survival time is calculated from the date of diagnosis to death or last follow-up date. Immunohistochemistry （IHC） was used to assess the expression of ERCCI in resected samples. The relationship between ERCCI expression and survival of patients was investigated. The comparison of count data were analyzed by Chi-square test. Median survival time （MST） and the 5-year survival rate were calculated by life table analysis. The Kaplan-Meier curves were used for survival analysis. Results： ERCC1 expression was positive in 412 patients （68.1%）. There is no significant difference between ERCCl-positive group and ERCCl-negative group in terms of the MST and 5-year survival rate （P=0.455）. The MST and 5-year survival rate have no significant difference （P=0.162） between group with chemotherapy and group with no chemotherapy in patients with ERCCl-positive expression. However, the MST and 5-year survival rate in patients with ERCCl-negative expression benefited more from with chemotherapy （P=0.019）. The ERCCl-positive patients survived longer than those ERCCl-negative patients （P=0.183） in subgroup with no adjuvant chemotherapy. In the subgroup analysis, ERCC 1 expression had no significant relationship with overall survival in patients with stage II or llI gastric cancer （P〉0.05）. Conclusions： ERCC1 might be a good prognostic factor for the patients of gastric cancer after radical resection. Patients with ERCC     

Studies of Selective Arterial Perfusion plus Chemoembolization on Hepatic Metastasis from Rectal Cancer

OBJECTIVE To develop an effectual method for treating hepatic metas-tasis from rectal cancer. METHODS A randomized control study of celiac artery perfusion plus transcatheter hepatic arterial chemoembolization (TACE) (observation group) and intravenous chemotherapy (control group) for 99 cases with hepatic me-tastasis from rectal cancer was performed. The perfusion was repeated once at 4 weeks after the first treatment of 52 cases in the observation group, and it was subsequently repeated at an interval of 2 or 3 months. Using intrave-nous administration, the perfusion was repeated once every 3 weeks with 47 cases in the control group. RESULTS Three months after treatment, the patients in the observation group who showed a relief or elimination of a former superior abdominal pain amounted to 70.6%, and those with a diminution of their intrahepatic mass reached 55.8%. In the control group, the patients with a relief or disappear-ance of hepatalgia reached 20%, and those with a diminution of their intrahe-patic mass reached 10.6%. The 1, 2 and 3-year survival rates were 80.8%, 46.2% and 25.0% in the cases of the observation group and 61.7%, 19.1% and 4.3% in the control group, respectively. CONCLUSION For the patients who failed to receive a surgical opera-tion on their hepatic metastasis from rectal cancer, celiac artery perfusion plus TACE is a more effective regimen for improvement of the clinical symp-toms and extension of the survival time, compared to intravenous chemo-therapy, and is a better choice for palliative therapy.     

术前口服普瑞巴林对膀胱癌患者行根治性全膀胱切除术后的镇痛效果(英文)

Objective:After the pregabalin has been approved for the treatment of neuropathic pain,preliminary clinical studies suggested a possible role in the perioperative period.To our knowledge,It has never been studied the perioperative analgesic effect of pregabalin in patients with cancer bladder.In this study,we hypothesized that cancer bladder patients undergoing radical cystectomy and received oral pregabalin 75 mg twice daily for ten days preoperatively would get their postoperative pain reduced.Methods:Sixty patients scheduled for elective radical cystectomy were randomly assigned to one of 2 groups(control group or pregabalin group).Patients in the pregabalin group received 75 mg pregabalin twice daily for ten days before surgery.Standard anesthesia protocol was applied to all patients.Pain intensity,opioid consumption,level of sedation and other side effects were regularly assessed for 48h postoperative.Results:Mean time for the first request of analgesia was statistically longer in pregabalin group.Meanwhile,mean morphine consumption,VAS scores at rest(in the first 32h postoperatively),VAS scores during movement(in the first 20h postoperatively) were statistically significant lower in the pregabalin group than those in the control group.Patients in the pregabalin group were statistically more sedated in the first four hours postoperative than the control group.Conclusion:Preoperative pregabalin 75 mg twice daily for ten days resulted in 60% reduction in 24h postoperative morphine requirements in patients undergoing radical cystectomy.     

肺功能中度减退的肺癌患者术后并发症分析

Objective： To analyze the tolerance of lung cancer patients with moderate pulmonary hypofunction to open-chest operation. Methods： The postoperative complications of 31 patients with moderate pulmonary hypofunction （study group） and 62 patients with normal pulmonary function （control group） were reviewed. Statistical t test and χ^2 test were set to examine the data, and logistic regression was performed to find the associated factors. Results： In patients with moderate pulmonary hypofunction, hypoxemia （41.9%）, arrhythmia and cardiac dysfunction （25.8%）, and pulmonary inflammation （25.8%） were common postoperative complications, and respiratory failure and cardiac failure （9.2%） severe complications. In-hospital mortality rate was 3.2%. In the control group, the incidence of the above 4 postoperative complications was 16.1%, 8.1%, 9.6% and 3.2% accordingly, and no case died in hospital. Regression analysis showed that age and resection range were associated with the occurrence of the complications. Conclusion： Common postoperative complications （hypoxemia） in patients with moderate pulmonary hypofunction are remarkably higher than those in control group, but severe complications and in-hospital mortality rate are not significantly high. Patients with older age and larger resection range undergo higher complication rate.     

Clinical significance of serum IL-18 and IL-18BP in patients with benign or malignant primary liver tumors

OBJECTIVE To study the relationship between the serum levels of IL-18 and IL-18BP in the development and growth of primary liver cancer, benign liver tumors and liver cirrhosis and to determine the value of serum IL-18 and IL-18BP in the diagnosis of primary liver cancer. METHODS The serum levels of IL-18 and IL-18BP in 36 patients with primary hepatic carcinoma （PHC） were detected. Eighteen patients were diagnosed with various benign liver tumors and 21 patients with cirrhosis of liver （LC）, determined by using an ELISA assay. The serum levels of AFP in 36 patients with primary liver cancer were examined. The relationship among levels of serum IL-18, IL-18BP and AFP in the primary liver cancer was explored. RESULTS The sIL-18 levels in PHC were significantly lower than in control group, the benign liver tumor group and the LC group. The sIL-18BP in PHC was significantly higher than that in control group, benign liver tumor group and LC group （P 〈 0.001）. There was a close correlation between the levels of IL-18, IL-18BP and clinical stage in PHC： the later clinical stages had lower levels of IL-18 and higher levels of IL-18BP while the earlier clinical stages had higher levels of IL-18 and lower levels of IL-18BP. There was a negative correlation between serum levels of IL-18 and AFP in the PHC group （r = -0.7152, n = 36, P 〈 0.01）, and there was a positive correlation between serum levels of IL-18 BP and AFP in the patients with PHC （r = 0.6315, n = 36, P 〈 0.01）. The IL-18 and IL- 18BP in the patients with various benign liver tumors or LC were significantly higher than those in control group. The differences were statistically significant （P 〈 0.01）. CONCLUSION Serum levels of IL-18 and IL-18BP can reflect the immune function of patients with primary liver cancer, with various benign liver tumors or with LC and can also be indicative of the clinic stage of primary liver cancer. It can be used to assist in making a diagnosis and in determining the clinical stage of PHC. Detecting AFP concurrently can help make the diagnosis of primary liver cancer more precise.     

围手术期应用西米替T对结直肠癌TIL浸润及HLA-DR表达的影响

Objective： It has been shown in our previous study that cimetidine （CIM） can boost the hosts＇ cellular immunity in patients with gastrointestinal cancer. This study was conducted to evaluate CIM＇s effects on tumor infiltrating lymphocytes （TIL） and HLA-DR expression in tumor stroma in colorectal cancer （CRC）, so as to investigate its role in local immune response at the tumor site in CRC. Methods： Forty-nine CRC patients were randomized into treatment group of 25 patients who took CIM 7 days before curative surgery till the operation day, and control group of 24 patients who received similar treatment except for CIM intervention. TIL responses and HLA-DR expression were studied on tumor tissues taken before and after surgical resection. Results： The percentage of significant TIL response was increased from 32% （8/25） to 76% （19/25） （P〈0.005） in the CIM treatment group, whereas there were no significant changes in TIL response in the control group [25% （6/24） at recruitment vs. 33% （8/24） at operation, P〉0.50]. Moreover, the percentages of HLA-DR expression were increased from 36% （9/25） to 72% （18/25） in the CIM treatment group, but there were no significant differences in HLA-DR expression in the control group [41.7% （10/24） before resection vs 45.8% （11/24） after resection, P〉0.50]. Conclusion： CIM used before surgery might promote TIL responses and increase the HLA-DR expression in stroma cells in CRC patients, leading to enhanced host immunity against tumor.     

高聚生联合顺铂心包腔内灌注治疗肺癌致心包液的临床观察

Objective： To evaluate the therapeutic efficacy of injecting highly agglutinative staphylococcin （HASL） and cisplatin into pericardial cavity of lung cancer patients with pericardial effusion. Methods： 81 patients were randomized into two groups： 45 in the experimental group （HASL and Cisplatin） and 36 in the control group （Cisplatin）. At first pericardial effusion was drained out from a intrapericardial catheter and then different drugs were infused, respectively. 24 h after perfusion the draining continued again until drainage quantity was less than 30 mL every day. The draining lasted 10-15 days. Results： The response rate was 91.1% for the experimental group and 80.6% for the control group. There was no significant difference between the two groups （P〉0.05）. The complete remission was 77.8% for the experimental group and 52.8% for the control group, which was statistically significant difference （P〈0.05）. The adverse effects were myelosuppression and nausea and vomiting, which were 35.6% and 40.0% in the experimental group and 72.2% and 66.7% in the control group, respectively （P〈0.01, P〈0.05）. Conclusion： inject- ing HASL and cisplatin into pericardial cavity may be a better way to control pericardial effusion of lung cancer.     

Clinical study of combining chemotherapy of oxaliplatin or 5-fluorouracil/leucovorin with hydroxycamptothecine for advanced colorectal cancer

OBJECTIVE To estimate effects, survival rate after the short-time efficacy, side the treatment of combining chemotherapy of oxaliplatin or 5-fluorouracil/leucovorin with hydroxycamptothecine （HCPT） for the patients with advanced colorectal cancer.
METHODS From January 2002 to November 2005, 59 patients with advanced colorectal cancer confirmed by pathology were enrolled into this study in the department of medical oncology, in the Sixth People＇s Hospital of Shanghai Jiaotong University, Shanghai. Patients＇ characteristics in two groups were similarly confirmed by statistic. All 37 patients in OH group received oxalip21atin （130 mg/m^2 d1） plus hydroxycamptothecine （6 mg/m d1-4）, and all 22 patients in the HLF group received hydroxycamptothecine （6 mg/m^2 d1-4） plus leucovorin （300 mg d1-5） and 5-fluorouracil （0.375 g/m^2 d1-5）. The regimens in both groups were 21-day cycle that was repeated three weeks. The side effects were evaluated. The efficacy was estimated after two cycles of chemotherapy for each patient.
RESULTS The efficacy of the treatment in the OH group with 37 patients and in the HLF group with 22 patients was estimated. The overall response rate （CR ＋ PR） was 32.4% in the OH group and 22.7% in the HLF group. There was no complete response （CR） and there was no statistical significantly difference （%2= 0.876, P = 0.704） in two groups. The 1-year survival rate was 30.98% in the OH group and 15.02% in the HLF group, and it had no significant difference between the two groups. The median PSF and OS were 5.83 months and 11.17 months in the OH group vs. 7.40 months and 10.48 months in the HLF group, and it had no significant differences between the two groups （P 〉 0.05）. The major side effects of grade III and IV in the two groups were myelosuppression and gastrointestinal reactions. The statistically significant difference in side effects appeared in leukopenia （χ^2= 17.173, P = 0.001）, nausea/vomiting （χ^2= 6.426, P = 0.039）, diarrhea （χ^2= 16.245, P = 0.000） and peripheral neuropathy. CONCLUSION The efficacy was almost equal between the OH and the HLF groups, and the two regimens can be used as the second-line treatments for the patients with colorectal cancer. Leucopenia, nausea, diarrhea and peripheral neuropathy appeared more in OH group, and anemia and thrombocytopenia were almost equal between the OH and the HLF groups.     

Radiofrequency ablation or microwave ablation combined with transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma by comparing with radiofrequency ablation alone简

Objective：To compare radiofrequency ablation （RFA） or microwave ablation （MWA） and transcatheter arterial chemoembolization （TACE） with RFA or MWA monotherapy in hepatocellular carcinoma （HCC）.Methods：A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA （combined treatment group） and the RFA-alone or MWA-alone groups （control group）.The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results：Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months （range,29 to 62 months）.The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6％,68.1％ and 61.7％,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months （range,28 to 62 months）.The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1％,59.6％ and 44.7％,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio （HR）,0.526; 95％ confidence interval （95％ CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group （HR,0.582; 95％ CI,0.368-0.895; P=0.008）.Conclusions：RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA.     

盐酸吗啡缓释片直肠给药治疗晚期癌痛临床观察

Objective： To observe the effect of slow-released morphine tablets by rectum in treating the patients of moderate to severe cancer pain with server nausea and vomiting or dysphagia. Methods： 54 cases of cancer patients with server nausea and vomiting symptoms or dysphagia were treated with slow-released morphine tablets by rectum, 30-90 mg/time, once every 12 hours. The drug dose was titrated by degree of pain, and the effects and adverse effects were observed. Results： The total effective rate was 81.48%, complete response rate was 51.85% （28/54）, and the partial response rate was 29.63% （16/54）; there were no obvious toxicities, and the common adverse symptoms included nausea （16.7%） and vomiting （9.3%）. Conclusion： The treatment of slow-released morphine tablet by rectum could effectively control cancer pain, the adverse effects were slight than that by mouth. It is safe and effective to be worthy of the adhibition in clinic.     

Capecitabine maintenance therapy for XT chemotherapy-sensitive patients with metastatic triple-negative breast cancer

Objective： To investigate the efficacy and safety of capecitabine maintenance therapy（MT） after initial capecitabine plus docetaxel（XT） chemotherapy in patients with metastatic triple-negative breast cancer（m TNBC）.
Methods： Fifty-five m TNBC patients treated with XT chemotherapy between May 2007 and June 2013 were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, capecitabine was continued for 32 patients（MT）, while 23 patients remained without any treatment（nonMT）. We compared progression-free survival（PFS） and safety of both groups.
Results： The median PFS of 55 patients was 8.1 months, overall median PFS time of 32 patients in the capecitabine MT group and 23 in the non-MT group was 10.1 vs. 6.7 months（P=0.032）, respectively. When compared PFS time of maintenance treatment, single-agent capecitabine prolonged PFS by 7.1 months, for non-MT patients, the PFS without any treatment was 3.1 months, and this between-group difference was statistically significant（P=0.003）. Adverse events, including of hematologic toxicity, gastrointestinal toxicities, hand-foot syndrome and abnormal liver function were not significantly different between two groups.
Conclusions： After initial disease control was achieved with the XT combination chemotherapy, capecitabine MT can significantly prolong PFS time with a favorable safety profile in m TNBC patients.     

肺癌患者外周血血小板活化标志物水平及其临床意义

Objective： To investigate the relationship between the activation markers of platelets and the lung cancer. Methods： Based on international stages of lung cancer in 1997, lung cancer patients of 120 cases diagnosed by pathology as well as with operation indication were selected as the experimental group. During the process of experiment, 60 cases concluded as healthy in the physical examination were chosen as control group. The activation markers of platelets were detected by FCM method. The experimental result would be processed by SPSS 11.5. Results： The level of activation markers of platelets in peripheral blood of lung cancer patients was significantly higher than those healthy people （P 〈 0.01）. The level of activation markers of platelets in peripheral blood of lung cancer patients on the seventh postoperative day was significantly lower than that before operation and on the first postoperative day （P 〈 0.01）. The level of activation markers of platelets in peripheral blood of lung cancer patients was closely related to the size of the primary tumor, lymph node status and stages, but not to the grade of cell differentiation, type of tumor, age, sex of the patients （P 〉 0.05）. Conclusion： Elevation of the level of activation markers of platelets in peripheral blood exists in lung cancer patients and the levels of activation marker of platelets plays an important role in tumor growth and lymphatic metastasis. The levels of activation markers of platelets maybe a predictor for prognosis.     

Effect of EGFR-TKI retreatment following chemotherapy for advanced non-small cell lung cancer patients who underwent EGFR-TKI

Objective： Non-small cell lung cancer （NSCLC） patients with epidermal growth factor receptor （EGFR）-activating mutations have higher response rate and more prolonged survival following treatment with single-agent EGFR tyrosine kinase inhibitor （EGFR-TKI） compared with patients with wild-type EGFR. However, all patients treated with reversible inhibitors develop acquired resistance over time. The mechanisms of resistance are complicated. The lack of established therapeutic options for patients after a failed EGFR-TKI treatment poses a great challenge to physicians in managing this group of lung cancer patients. This study evaluates the influence of EGFR-TKI retreatment following chemotherapy after failure of initial EGFR-TKI within at least 6 months on NSCLC patients. Methods： ＇i-he data of 27 patients who experienced treatment failure from their initial use of EGFR-TKI within at least 6 months were analyzed. After chemotherapy, the patients were retreated with EGFR-TKI （gefitinib 250 mg qd or erlotinib 150 mg qd）, and the tumor progression was observed. The patients were assessed for adverse events and response to therapy. Targeted tumor lesions were assessed with CT scan. Results： Of the 27 patients who received EGFR-TKI retreatment~ 1 （3.7%） patient was observed in complete response （CR）, 8 （29.6%） patients in partial response （PR）, 14 （51.9%） patients in stable disease （SD）, and 4 （14.8%） patients in progressive disease （PD）. The disease control rate （DCR） was 85.2% （95% CI： 62%-94%）. The median progression-free survival （mPFS） was 6 months （95% CI： 1-29）. Of the 13 patients who received the same EGFR-TKI, 1 patient in CR, 3 patients in PR, 8 patients in SD, and 2 patients in PD were observed. The DCRwas 84.6%, and the mPFS was 5 months. Of the 14 patients who received another EGFR-TKI, no patient in CR~ 6 patients in PR, 6 patients in SD, and 2 patients in PD were observed. The DCRwas 85.7%, and the mPFS was 9.5 months. Significant di