肝细胞癌患者肝移植术后肿瘤复发转移的防治

肝细胞癌(HCC)仍是目前发病率较高的消化道肿瘤,肝移植能从根本上切除肿瘤病灶,是HCC综合治疗方案中的主要手段之一。移植后肿瘤的复发和转移问题,是影响受体长期生存的主要因素。近年来,得益于全球范围的技术改进和经验积累,在HCC的诊疗方面取得了的长足的发展和进步。针对HCC肝移植适应证、复发转移预测、肝移植围手术期干预和术后HCC复发的综合治疗等方面进行探讨。     

鼻咽癌伴咽后淋巴结转移与肿瘤复发、转移及预后的关系

目的探讨鼻咽癌伴咽后淋巴结转移与肿瘤复发、转移及预后的关系。方法选择66例鼻咽非角化性或未分化性癌,分期为T1～4N1～3M0。采用常规根治性放疗或放化综合治疗后,观察患者3年复发率、远处转移率及生存率。结果本组3年复发率15.15%,3年远处转移率33.33%,3年总生存率77.27%。单侧咽后淋巴结转移、双侧咽后淋巴结转移患者的3年远处转移率分别为35.29%、33.33%,3年生存率分别为73.53%、81.25%;N1期、N2～3期患者的3年远处转移率分别为16.67%、42.86%(P<0.05),3年生存率分别为91.67%、69.05%(P<0.05);单纯放疗、放化综合治疗患者的3年远处转移率分别为46.67%、22.22%(P<0.05),3年生存率分别为63.33%、88.89%(P<0.05)。结论鼻咽癌伴咽后淋巴结转移、N分期是影响预后的重要因素,放化综合治疗有提高患者生存率的作用。     

树突状细胞瘤苗对肝癌术后复发和转移的影响

将43例肝癌根治术后患者随机分为治疗组和观察组。治疗组19例,术后行5个周期树突状细胞（DC）瘤苗治疗;对照组24例,术后无辅助治疗。结果发现,DC治疗组患者1、2．3a无瘤生存率明显高于对照组;治疗组和对照组的1、2、3a总体生存率比较无统计学差异。认为DC瘤苗治疗安全可行,在肝癌根治术后能延缓术后肿瘤复发和转移,能成为肝癌术后的一种新辅助治疗手段。     

食管癌术后复发与转移再手术治疗

食管癌术后复发与转移再手术治疗济宁市第一人民医院（２７２１１１）刘炳学李迎新周广华高连方张申我们采用再次手术治疗食管癌术后复发与转移患者５４例，取得满意效果。现分析如下。１资料与方法本组男３９例，女１５例；年龄＜５０岁２７例，５１～６０岁１９例，＞６...     

结直肠癌术后患者血清趋化因子CXCL9变化及其与肿瘤复发、转移的关系

背景:结直肠癌(CRC)术后复发、转移风险的预测为临床研究热点之一。研究发现一些趋化因子和趋化因子受体在CRC组织微环境中表达显著上调,其中抗血管生成趋化因子CXCL9与CRC预后的关系尚不明确。目的:探讨CRC术后患者血清CXCL9水平的变化及其与肿瘤术后复发、转移的关系。方法:收集CRC术后患者60例,50名健康志愿者作为对照组,以ELISA法随访监测血清CXCL9水平,以χ2检验和Logistic回归模型分析其变化与CRC术后复发、转移的关系。结果:CRC组术前血清CXCL9水平显著高于对照组(P<0.05),并随Dukes分期的进展呈升高趋势(P<0.05);术后6个月和12个月,各Dukes分期CRC组血清CXCL9水平均较术前显著降低(P<0.05),其中Dukes C、D期组在术后12个月时虽有所回升,但差异无统计学意义(P>0.05)。按确诊复发/转移时的血清CXCL9水平高低行分组分析,发现复发转移率随CXCL9水平的升高呈上升趋势(P<0.05)。Logistic回归分析显示,Dukes分期和血清CXCL9水平是CRC术后复发、转移的独立危险因素(P<0.05)。结论:CRC患者术后血清CXCL9仍处于相对高水平状态,并与肿瘤术后复发、转移密切相关。血清CXCL9水平监测可能有助于指导CRC的临床治疗和预后评价。     

大肠癌术后复发转移106例临床分析

回顾性分析106例大肠癌手术后复发患者的临床资料。结果术后复发患者以Dukes C期、低分化大肠癌为主;术后2 a复发率最高,临床症状以腹痛、便血最常见,治疗仍以再次根治手术为主;结肠癌肝转移率高,直肠癌盆腔、会阴部转移率高。认为大肠癌Dukes分期、病理类型是术后复发的影响因素。癌胚抗原（CEA）动态变化有助于早期发现复发或转移,尽早采取根治手术为主的治疗方法。     

肝癌的转移与复发

肝癌细胞生长活跃，侵袭性强，周围血窦丰富，极易侵袭包膜和血管，导致局部扩散和远处转移。小肝癌血管内癌栓形成率达30％左右，肝内转移是肝癌最常见的转移途径。尸检发现，肝外癌转移率约达40％～71．6％。     

胸段食管癌术后复发、淋巴结转移部位规律观察

目的：探索胸段食管癌术后复发、淋巴结转移部位的规律,旨在为术后预防性照射的靶区设计提供依据。方法选择食管癌术后复发患者182例,回顾性分析其原发肿瘤部位、术后分期与食管癌术后复发、淋巴结转移部位的关系。结果182例食管癌术后复发患者最常见的复发部位为1区／2区淋巴结（112例）、锁骨上淋巴结（45例）;胸上段、胸中段、胸下段食管癌1区／2区淋巴结转移率分别为64．3％、61．4％、60．0％,锁骨上区淋巴结转移率分别为28．6％、23．6％、25．0％,各段1区／2区、锁骨上区淋巴结转移率比较P均＞0．05。Ⅱa、Ⅱb、Ⅲ期食管癌术后1区／2区淋巴结转移率分别为11．3％、28．6％、49．1％,锁骨上区淋巴结转移率分别为9．4％、26．8％、45．3％,各期1区／2区、锁骨上区淋巴结转移率比较P均＜0．05。结论1区／2区淋巴结及锁骨上区是食管癌术后常见复发、淋巴结转移部位,应将其作为重要的术后预防性照射靶区。     

pN0胸段食管鳞癌术后复发 转移的危险因素探讨

目的探讨p N0胸段食管鳞癌术后复发、转移的高危因素,为术后采取合理辅助治疗提供临床依据,提高患者远期生存率。方法回顾性分析福建省泉州市光前医院肿瘤外科2003-01~2010-12收治的76例p N0胸段食管鳞癌患者的临床资料,应用Cox比例风险回归模型分析术后3年内肿瘤复发、转移的危险因素。结果术后3年内复发转移率为34.2%。单因素分析结果显示,肿瘤部位、p T分期、有无脉管癌栓与术后复发、转移相关(P0.05)。多因素分析结果显示,食管中上段癌、p T3-4a、脉管癌栓是影响p N0胸段食管鳞癌术后复发、转移的独立风险因素。结论胸中上段癌、p T3-4a、脉管癌栓是p N0胸段食管鳞癌术后复发、转移的独立风险因素,术后应给予积极辅助治疗。     

肺癌转移与术后复发患者血清CEA、CA211水平的临床意义

目的探讨CEA、CYFRA21-1两种肿瘤标志物的血清水平对肺癌转移和术后复发的诊断价值。方法应用化学发光免疫检测正常组、复发组、转移组CEA、CYFRA21-1的血清水平和阳性率,并进行统计学分析。结果复发组和转移组血清CEA、CYFRA21-1水平都显著高于正常对照组(P0.05),CEA、CYFRA21-1在复发组中阳性率分别为53.46%、56.67%,在转移组中阳性率分别57.78%、62.22%,两种标志物联检复发组和转移组的阳性率分别为83.33%、88.89%。结论CEA、CYFRA21-1具有诊断肺癌复发和转移的临床价值,两者联检可以提高诊断的准确性。     

淋巴管新生与肿瘤转移

肿瘤患者的肿瘤细胞可以通过血液和淋巴管发生远处转移,肿瘤患者淋巴管新生明显增加。淋巴管新生受许多生长因子的调控,如VEGF-C、VEGF-D及其受体VEGFR-3等。对于淋巴管新生的生理及分子学机制的研究将为恶性肿瘤的治疗以及淋巴水肿等疾病的治疗提供新的、更有效的方法。     

变异型CD44分子和癌细胞的侵袭及转移

变异型CD44（CD44v）对癌细胞侵袭及转移有着密切的关系,本文拟从侵袭、转移癌组织中CD44v的表达情况和CD44v在癌细胞侵袭、转移中的机理两个方面,结合国内外有关研究的结果对CD44v和癌细胞侵袭、转移的关系作进一步综述。     

肺癌微环境中免疫细胞与肿瘤免疫逃逸相关研究进展

肺癌肿瘤局部浸润的免疫细胞、间质细胞及所分泌的活性介质等与肺癌细胞共同构成的局部内环境又被称之为肺癌微环境。肺癌微环境中浸润的免疫细胞参与了肺癌的疾病进展和免疫逃逸。本文对这一群细胞的浸润特征、功能和相互关系进行阐述,探讨其在肺癌发生发展过程中的作用。     

Monoclonal immunoscintigraphy for detection of metastasis and recurrence of colorectal cancer

AIM:To assess the clinical role of monoclonal immunoscintigraphy for the detection of metastasis and recurrence of colorectal cancer.METHODS:Monoclonal immunoscintigraphy was performed in patients operated on for colorectal adenocar-cinoma suspected of local recurrence and metastatic disease.The results were compared with conventional diagnostics.RESULTS:Immunoscintigraphic investigation was done in 53 patients.Tumor recurrence occurred in 38 patients,and was confirmed by other diagnostic modalities in 35.I...     

Mechanisms of tumor metastasis: cell biological aspects and clinical implications

The clinical course – and hence the prognosis – of patients suffering from malignant tumors are essentially determined by the capability of tumor cells to metastasize. During the past decade knowledge about genetic aberrations, as well as molecular and cell biological mechanisms which are involved in the regulation of tumor metastasis, has dramatically increased and consequently led to the development of new theoretical and experimental strategies in cancer treatment. The objective of this review is not only to give an overview about the principal cell biological and molecular mechanisms of tumor metastasis, but also to discuss potential therapeutical options resulting from this knowledge. Received: 9 March 2000 / Accepted: 6 April 2000     

Colonic metastasis of Klatskin tumor： Case report and discussion of the current literature

INTRODUCTIONBile duct tumors are rare neoplasms with an incidence of 0.5-1/100 000[1]. Predisposing factors include mainly PSC with a thirty-fold increased risk as well as choledochal cysts and parasitic infections (clonarchis sinensis, opisthordis viverr…     

Adalimumab in prevention of postoperative recurrence of Crohn's disease in high-risk patients

AIM: To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn’s disease in high-risk patients.METHODS: A multicenter, prospective, observational study was conducted from June 2009 until June 2010. We consecutively included high-risk Crohn’s disease patients who had undergone an ileal/ileocolonic resection. High-risk patients were defined as two or more criteria: smokers, penetrating pattern, one or more previous surgical resections or prior extensive resection. Subcutaneous adalimumab was administered 2 wk (± 5 d) after surgery at a dose of 40 mg eow, with an initial induction dose of 160/80 mg at weeks 0 and 2. Demographic data, previous and concomitant treatments (antibiotics, 5-aminosalicylates, corticosteroids, immunomodulators or biologic therapies), smoking status at the time of diagnosis and after the index operation and number of previous resections (type and reason for surgery) were all recorded. Biological status was assessed with C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin. One year (± 3 mo) after surgery, an ileocolonoscopy and/or magnetic resonance enterography was performed. Endoscopic recurrence was defined as Rutgeerts score ≥ i2. Morphological recurrence was based on magnetic resonance (MR) score ≥ MR1.RESULTS: Twenty-nine patients (55.2% males, 48.3% smokers at diagnosis and 13.8% after the index operation), mean age 42.3 years and mean duration of the disease 13.8 years were included in the study. A mean of 1.76 (range: 1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection. 51.7% had previously received infliximab. Immunomodulators were given concomitantly to 17.2% of patients. Four of the 29 (13.7%) developed clinical recurrence, 6/29 (20.7%) endoscopic recurrence and 7/19 (36.8%) morphological recurrence after 1-year. All patients with clinical recurrence showed endoscopic and morphological recurrence. A high degree of concordance was found between clinical-endoscopic recurrence (κ = 0.76, P < 0.001) and clinical-morphological recurrence (κ = 0.63, P = 0.003). Correlation between endoscopic and radiological findings was good (comparing the 5-point Rutgeerts score with the 4-point MR score, a score of i4 was classified as MR3, i3 as MR2, and i2-i1 as MR1) (P < 0.001, r_s = 0.825). During follow-up, five (17.2%) patients needed adalimumab dose intensification (40 mg/wk); Mean time to intensification after the introduction of adalimumab treatment was 8 mo (range: 5 to 11 mo). In three cases (10.3%), a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk. One patient suffered an adverse event.CONCLUSION: Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.     

Recent progress in molecular mechanisms of postoperative recurrence and metastasis of hepatocellular carcinoma

Hepatectomy is currently considered the most effective option for treating patients with early and intermediate hepatocellular carcinoma (HCC). Unfortunately, the postoperative prognosis of patients with HCC remains unsatisfactory, predominantly because of high postoperative metastasis and recurrence rates. Therefore, research on the molecular mechanisms of postoperative HCC metastasis and recurrence will help develop effective intervention measures to prevent or delay HCC metastasis and recurrence and to improve the long-term survival of HCC patients. Herein, we review the latest research progress on the molecular mechanisms underlying postoperative HCC metastasis and recurrence to lay a foundation for improving the understanding of HCC metastasis and recurrence and for developing more precise prevention and intervention strategies.     

养胃抗瘤冲剂对小鼠前胃癌抗复发和转移的作用

[目的]观察养胃抗瘤冲剂对实验性手术后小鼠前胃癌局部复发和转移的作用。[方法]以小鼠前胃癌高转移肿瘤模型为对象,用养胃抗瘤冲剂进行实验性治疗,与化疗组和对照组抑瘤率和抑制转移率进行对比观察。[结果]养胃抗瘤冲剂对局部肿瘤复发抑制率为68．07％,与对照组比较差异有统计学意义（P〈0．05）;对淋巴结转移抑制率和肺转移抑制率分别为16．67％和33．33％,与对照组比较差异均有统计学意义（均P〈0．05）。[结论]养胃抗瘤冲剂对实验性手术后小鼠胃癌局部复发及术后转移有显著的抑制作用。