A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer

BACKGROUND: Though the outcome of resection for locally invasive pancreatic cancer is still poor, it has gradually improved in Japan, and the 5-year survival is now about 10%. However, the advantage of resection over radiochemotherapy has not yet been confirmed by a randomized trial. We conducted this study to compare surgical resection alone versus radiochemotherapy without resection for locally invasive pancreatic cancer using a multicenter randomized design. METHODS: Patients with pancreatic cancer who met our preoperative criteria for inclusion (pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric artery or the common hepatic artery, or without distant metastasis) underwent laparotomy. Patients with operative findings consistent with our criteria were randomized into a radical resection group and a radiochemotherapy group (200 mg/m(2)/day of intravenous 5-fluorouracil and 5040 cGy of radiotherapy) without resection. The 2 groups were compared for mean survival, hazard ratio, 1-year survival, quality of life scores, and hematologic and blood chemical data. RESULTS: Twenty patients were assigned to the resection group and 22 to the radiochemotherapy group. There was 1 operative death. The surgical resection group had better results than the radiochemotherapy group as measured by 1-year survival (62% vs 32 %, P=.05), mean survival time (>17 vs 11 months, P < .03), and hazard ratio (0.46, P=.04). There were no differences in the quality of life score or laboratory data apart from increased diarrhea after surgical resection. CONCLUSIONS: Locally invasive pancreatic cancer without distant metastases and major arterial invasion appears to be best treated by surgical resection.     

7-Year Survival Results of Perioperative Chemotherapy with Epidoxorubicin,Etoposide, and Cisplatin (EEP) in Locally Advanced Resectable Gastric Cancer: Up-to-date Analysis of a Phase-II Study

Background  Perioperative chemotherapy is considered an effective treatment option for patients with gastric carcinoma. We report the results after a 7-year follow-up of a study aimed at evaluating a perioperative chemotherapy protocol in a group of patients with locally advanced gastric cancer (LAGC). Methods  Between February 1996 and May 2000, 24 patients with LAGC underwent D2-gastrectomy after three preoperative cycles of chemotherapy (Epidoxorubicin, Etoposide, Cisplatinum). Three further cycles were planned after surgery. Differences among groups were evaluated using the chi-square test. Survival rate was calculated after a 7-year follow-up, and differences were assessed using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. Results  A total of 24 patients received preoperative chemotherapy and underwent surgical resection. Of these, 17 (71%) received postoperative treatment. The main toxicity was grade 3–4 neutropenia. Curative resection (R0) was achieved in 83.3% of patients. No pathologic complete responses were documented, but tumor downstaging was obtained in 10 of 24 patients (41.7%). Overall median survival was 40 months, and 7-year survival rate was 46%. At univariate and multivariate analysis, R0 resection and tumor diameter were the most important prognostic factors. Conclusion  Long-term results in our series show a survival benefit for LAGC patients treated by perioperative chemotherapy and D2-gastrectomy when compared with previously studied controls who had surgery with postoperative chemotherapy alone. The high rate and prognostic impact of R0 resection in this study stressed the role of the therapy during the preoperative phase.     

保留膀胱联合髂内动脉化疗治疗浸润性膀胱癌46例报告

目的：评价保留膀胱手术后联合髂内动脉介入化疗治疗浸润性膀胱癌的临床疗效。方法：2003年6月～2009年2月对46例浸润性膀胱移行细胞癌患者采用经尿道膀胱肿瘤电切或膀胱部分切除术联合顺铂＋吡喃阿霉素方案髂内动脉化疗进行治疗。结果：46例患者均获得随访,平均随访38（9～68）个月。33例无瘤生存,2例带瘤生存,11例死于肿瘤转移,5年生存率为75．76％;29例保留膀胱生存,10例行挽救性全膀胱切除,其中全膀胱切除术后死亡4例,5年膀胱保存率为73．32％;其中33例T2期患者5年生存率为83．21％;5年膀胱保留率为81．82％。全部患者对动脉化疗耐受良好,无严重全身和局部不良反应。结论：保留有功能的膀胱手术加髂内动脉灌注化疗为治疗浸润性膀胱移行细胞癌的有效方法之一,尤其是早期浸润性膀胱癌（T2期）患者,是保留膀胱治疗的最佳适应证。     

First-line chemotherapy improves the resection rate and long-term survival of locally advanced (T4, any N, M0) squamous cell carcinoma of the thoracic esophagus: final report on 163 consecutive patients with 5-year follow-up.

OBJECTIVE: The objective of this prospective, nonrandomized study was to evaluate the immediate and long-term results of first-line chemotherapy and possible surgery in locally advanced, presumably T4 squamous cell esophageal cancer. SUMMARY BACKGROUND DATA: Locally advanced esophageal cancer is rarely operable and has a dismal prognosis. For this reason, neoadjuvant cytoreductive treatments are more and more frequently used with the aim of downstaging the tumor, increasing the resection rate, and possibly improving survival. Methods: From January 1983 to December 1991, 163 consecutive patients with a presumedly T4 squamous cell carcinoma of the thoracic esophagus (group A) received on average 2.5 cycles (range, 1-6) of first-line chemotherapy with cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2 per day, in continuous infusion from day 1 through day 5). Chemotherapy was followed by surgery when adequate downstaging of the tumor was obtained. RESULTS: Chemotherapy toxicity was WHO grade 0 to 2 in 80% of cases, but 3 toxic deaths (1.9%) occurred. Restaging suggested a downstaging of the tumor in 101 of 163 patients (62%), but only 85 patients (52%) underwent resection surgery; it was complete or R0 in 52 (32%) and incomplete or R1-2 in 33. Overall postoperative mortality was 11.7% (10 of 85), morbidity 41% (35 of 85). Complete pathologic response was documented in 6 patients, and significant downstaging to pStage I, IIA, or IIB occurred in 25 more patients. The overall 5-year survival was 11 % (median, 11 months). After resection surgery, the 5-year survival was 20% (median, 16 months); none of the nonresponders survived 4 years after palliative treatments without resection (median survival, 5 months). The 5-year survival rate of the 52 patients undergoing an R0 resection was 29% (median, 23 months). Stratifying patients according to the R, pT, pN, and pStage classifications, the survival curves were comparable to the corresponding data obtained in the 587 group B patients with "potentially resectable" esophageal cancer who underwent surgery alone during the same period. Furthermore, the results were improved in comparison with 136 previous or subsequent patients with a locally advanced tumor who did not undergo neoadjuvant treatments (group C). In these patients, the R0 resection rate was 7%, and the overall 5-year survival was 3% (median, 5 months). CONCLUSION: Although nonrandomized, these results suggest that in locally advanced esophageal carcinoma, first-line chemotherapy increases the resection rate and improves the overall long-term survival. In responding patients who undergo R0 resection surgery, the prognosis depends on the final pathologic stage and not on the initial pretreatment stage.     

胃癌异时性肝转移的治疗及预后因素分析

目的探讨胃癌异时性肝转移的治疗方式及影响预后的相关因素。方法回顾性分析1996年1月至2008年12月天津医科大学肿瘤医院收治的102例胃癌异时性肝转移患者的临床病理资料。其中行单纯化疗64例,化疗联合TACE19例,化疗联合肝转移癌切除19例。患者在术后3年内,每3个月来院随访复查1次,3年后每6个月1次,5年后每年1次。复查内容包括体格检查、实验室检查和影像学检查等。随访时间截至2013年10月。采用Kaplan—Meier法绘制生存曲线,Log—rank法进行显著性检验,COX模型进行预后因素分析。结果102例中行单纯化疗的64例患者,部分缓解15例、稳定22例、进展27例;化疗联合TACE的19例患者,部分缓解6例、稳定9例、进展4例;化疗联合肝转移癌切除的19例患者,术后发生切口感染1例,围手术期无死亡。胃癌复发死亡者16例,其中局部复发10例、多灶复发6例。102例患者中有8例失访,随访时间9～149个月。总体中位生存时间为8个月（2～70个月）,1、3、5年生存率分别为40．2％、17．7％、6．8％。其中64例单纯化疗者中位生存时间为5个月（2—37个月）,1、3、5年生存率分别为15．6％、3．5％、0;19例行化疗联合TACE者中位生存时间为6个月（3～36个月）,1、3、5年生存率分别为26．1％、6．5％、0;19例行化疗联合肝转移癌切除者中位生存时间为15个月（5～70个月）,1、3、5年生存率分别为63．2％、31．6％、16．8％。联合肝转移癌切除者与单纯化疗和联合TACE者累积生存率比较,差异有统计学意义（X2=23．900,P〈0．05）。单因素分析结果显示：原发癌直径、分化程度、是否存在肝外转移、肝转移癌类型、肝转移癌数目和治疗方式与胃癌异时性肝转移的预后相关（,=6．307,7．908,4．375,45．188,18．234,23．900,P〈0．05）。多因素分析结果显示：肝转移癌类型和肝转移癌数目是影响胃癌异时性肝转移预后的独立因素（OR=5．217,3．292,95％CI：1．428～2．882,1．054～2．514,P〈0．05）。结论手术切除肝转移癌仍然是提高患者生存率的关键。在选择治疗方式时应考虑肝转移癌数目和转移癌类型这两个影响患者预后的独立因素。     

Total pancreatectomy for pancreatic remnant carcinoma five years after pancreaticoduodenectomy: Report a case

Introduction and importanceThe prognosis of non-invasive intraductal papillary mucinous neoplasma (IPMN) is better than that of pancreatic cancer. However, if the first surgical finding revealed an invasive IPMC, the risk of recurrence was found to be 7–21%.Case presentationA 76-year-old Japanese man had undergone subtotal stomach-preserving pancreaticoduodenectomy for intraductal papillary mucinous carcinoma non-invasive type at our hospital. No signs of adenocarcinoma at the resection margin were found by pathological examination of frozen sections. Five years later, a blood analysis showed increased serum CA19-9 level. A contrast-enhanced computed tomography scan of the abdomen revealed a mass adjacent to the pancreaticogastrostomy anastomosis. The patient underwent a total pancreatectomy. The tumor was identified as a recurrent IPMC with subserosal invasion, but without nodal involvement. The resection margins were negative. The patient’s postoperative course was uneventful, and he was discharged after 12 days. He is being followed up without adjuvant chemotherapy.DiscussionThe prognosis of IPMN is better than that of pancreatic cancer. However the risk of recurrence in invasive IPMC was found to be 7–21%. Therefore, IPMC must be surveilled every three months using tumor markers and imaging. Local recurrence in remnant pancreas is usually treated with systemic therapy. The median long-term survival after total pancreatectomy (range 7–24 months) was shown to be better than when chemotherapy alone was used (range 10–13 months).ConclusionWe chose secondary surgery in term of survival time although there are quality of life drawbacks that currently make total pancreatectomy more inappropriate in patients than chemotherapy.     

Perioperative Intra-Arterial and Systemic Chemotherapy for Pancreatic Cancer

Background

Even after curative resection of pancreatic cancer, there is a high probability of systemic recurrence. This indicates that subclinical metastases are already present at the time of operation. The purpose of this study was to assess the feasibility and outcomes of patients who received a novel multimodality therapy combining pancreatic resection and intraoperative radiation therapy (IORT) with pre- and postoperative chemotherapy for pancreatic cancer.

Methods

For eligible patients with pancreatic cancer, 5-FU was administered at a dose of 125 mg/m²/day on days 1–5 every week as a continuous pancreatic and hepatic arterial infusion, and gemcitabine was infused intravenously at a dose of 800 mg/m² per day once per week for 2 weeks for preoperative chemotherapy. Pancreatic resection combined with IORT was performed 1 week after preoperative chemotherapy. Postoperative chemotherapy was performed in the same way as preoperative chemotherapy. We performed an intention-to-treat analysis for all enrolled patients.

Results

This study enrolled 44 patients. The most common toxicities were hematological and gastrointestinal events. Grade 3/4 hematological toxicities were observed during preoperative chemotherapy, although there were no grade 3/4 nonhematological events. Postoperative chemotherapy-related toxicities were more critical and frequent than preoperative ones. There were no pre- or postoperative chemotherapy-associated deaths. Median overall survival was 36.5 months with 30.5% overall 5-year survival.

Conclusions

This multimodality therapy is feasible and promises to contribute to survival. It should be evaluated in a phase III setting.     

从胰腺癌患者的长期生存看预后因素及治疗模式

Pancreatic cancer has the characteristics of high malignancy, early dissemination within the pancreas,extrapancreatic nerve plexus invasion, lymph node metastasis and vascular invasion. The 5-year survival rate of pancreatic cancer patients was under 5% even for those who had undergone surgical resection. Based on the review of the literatures including 42 pancreatic cancer patients who survived for 5-20 years after the operation, we concluded that curative resection of pancreatic cancer was still a reliable means in achieving long-term survival; factors influencing the results of resection of pancreatic cancer were lymph nodes involvement, poor differentiated tumor, extrapancreatic nerve plexus invasion, tumor size, residual tumor, curative resection and adjuvant chemotherapy; early diagnosis, aggressive surgery for patients with indications of resection, appropriate surgical procedure and postoperative adjuvant chemotherapy are essential factors to ensure a long term survival of patients with pancreatic cancer.     

从胰腺癌患者的长期生存看预后因素及治疗模式

胰腺癌恶性程度高,具有早期胰腺内播散,胰腺外神经丛侵犯,淋巴结转移与血管侵犯的特点.即使外科切除,大部分患者5年生存率仍<5%. 1长期生存的特征     

动脉置泵化疗在晚期胃肠道肿瘤治疗中的应用

目的　评价术中动脉内置泵、术后皮下泵内区域灌注化疗晚期胃肠道肿瘤的疗效。方法　随访观察 79例手术证实不能切除的晚期胃肠道肿瘤患者 ,经术中肿瘤供血动脉内置泵 ,术后泵内灌注化疗后的疗效。其中胃癌 4 2例 ,直肠癌 2 6例 ,结肠癌 11例。结果　化疗后 ,完全缓解者(CR) 1例 ;部分缓解者 (PR) 6 9例 ,其中 11例行二次根治性癌肿切除术 ;稳定者 (NC) 9例 ;无 1例恶化者 (PD)。有效率 88.6 % (70 / 79)。置泵术后生存满 1、2、3年者分别为 83.5 (6 6 / 79)、2 7.8(2 2 / 79)、8.9% (7/ 79) ,平均生存期为 2 0 .6个月。结论　术中动脉内置泵 ,术后泵内区域灌注化疗是治疗晚期胃肠道肿瘤的有效方法 ,可以延长患者的生存期 ,提高手术切除率。     

Feasibility of Induction Chemotherapy Using Bronchial Arterial Infusion for Locally Advanced Non-Small Cell Lung Cancer: A Pilot Study

Purpose: We examined the feasibility and effectiveness of bronchial arterial infusion (BAI) as induction chemotherapy before surgery for locally advanced non-small cell lung cancer (NSCLC). Methods: Eighteen patients with locally advanced NSCLC were given BAI consisting of cis-diamminedichloroplatinum (CDDP) (50–100 mg/m²) as induction chemotherapy before surgery (induction BAI). Six patients with clinical stage IIIA cancer had bulky N2 metastatic lymph nodes, and 12 patients with clinical stage IIIB cancer had T4 disease. Results: Of the 18 patients, 12 (67%) showed a partial response to the BAI therapy. Standard pulmonary resection was performed in 5 patients, pulmonary resection with the combined resection of adjacent organs was performed in 10 patients, and pulmonary resection with carinal resection and reconstruction was performed in 3 patients. Complete resection was possible in 14 patients (78%). There were no serious BAI therapy-related complications or postoperative deaths. The 5-year survival rate of the 18 patients was 35.7% and the median survival time (MST) was 19.4 months. Survival was better when complete resection was achieved after the induction BAI, especially in patients with stage IIIB (T4) disease. Conclusion: Based on our preliminary findings, BAI with CDDP as induction chemotherapy is feasible and may be an effective therapeutic modality for locally advanced NSCLC. Received: July 26, 2001 / Accepted: March 5, 2002     

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目的探讨胰腺癌的早期诊断、手术治疗的效果以及微创外科技术带来的新问题。方法回顾性分析1991年1月至2003年12月148例胰腺癌的外科治疗及随诊情况。结果施行手术148例,手术切除率38.5%,根治性切除率28.4%,姑息性切除率10.1%。根治性切除组1、3、5年存活率分别是52.6%、18.4%、7.9%;姑息性切除组1、3、5年存活率分别是23.1%、0、0。术后采取全身化疗。对复发或原发病变进行热疗,姑息旁路引流组1、3年存活率达到16.7%、3.3%。结论重视高危人群的监测,胰腺癌应采取以手术为主的综合治疗模式。     

Indications for and postoperative problems of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer

To treat locally advanced cancer of the pancreatic body involving the common hepatic artery and/or celiac axis with perineural invasion in the nerve plexus surrounding these arteries, we have employed distal pancreatectomy with en bloc celiac axis resection (DP-CAR) without arterial reconstruction. DP-CAR has been performed in patients in whom the gastroduodenal artery and superior mesenteric artery could be preserved. Between April 1998 and December 2007, 37 patients underwent DP-CAR in our institution. The surgical margins were histologically clear (R0) in 35 (95%) patients. The postoperative morbidity rate was 59%. The primary complications were pancreatic fistula occurring in 19 patients and ischemic gastropathy in 5. Estimated overall 1- and 5-year survival rates were 72% and 17%, respectively, and the median survival was 21 months. The most common site of recurrence was the liver, where recurrence appeared significantly earlier than in other metastatic sites. DP-CAR, with its potential to achieve complete local control, has been confirmed to be advantageous only in cases that are unlikely to develop hepatic metastasis. In principle, since 2006 patients who have undergone DP-CAR also receive postoperative adjuvant chemotherapy. Patients must achieve feasible general status within 3 months after DP-CAR to be able to start adjuvant chemotherapy.     

T4期结直肠癌根治术后早期腹腔热灌注化疗的临床研究

目的:探讨T4期结直肠癌患者根治术后早期行腹腔热灌注化疗(HIPEC)的可行性、安全性及短期临床疗效。方法:回顾性分析2011年1月—2013年6月收治的96例T4期结直肠癌患者资料,其中48例于术后第5~6天开始行HIPEC(1次/d,共3次),术后1个月内行第1次m FOLFOX6方案全身静脉化疗,共6疗程(HIPEC组);另48例仅行相同方案的全身静脉化疗(对照组)。比较两组患者的不良反应、并发症、术后1、2年复发率、生存率及生存质量情况。结果:HIPEC及全身静脉化疗均顺利完成;两组均无手术相关死亡,均未出现切口感染、吻合口瘘、粘连性肠梗阻等并发症。两组患者骨髓抑制、恶心呕吐、肝功能损害差异均无统计学意义(均P0.05);HIPEC组术后1、2年复发率均低于对照组(2.1%vs.20.8%;6.3%vs.31.3%,均P0.05);两组术后1年生存率差异无统计学意义(P0.05);HIPEC组术后2年生存率高于对照组(81.3%vs.58.3%,P0.05);HIPEC组生存质量评分升高比例明显高于对照组(75.0%vs.25.0%,P0.05)。HIPEC组中,结肠癌患者的中位生存时间长于直肠癌患者(32个月vs.18个月,P0.05)。结论:T4期结直肠癌患者根治术后早期行HIPEC可有效控制腹腔复发、转移,提高患者近期生存率及生存质量,无明显毒副作用,安全可行。     

局部切除胰体尾联合血管切除重建治疗晚期胰腺癌的疗效分析

目的:探讨局部切除胰体尾联合血管切除重建手术治疗晚期胰腺癌的效果。方法:将2010年—2012年收治的58例胰腺体部及体尾部晚期胰腺癌患者分为观察组和对照组,观察组患者采用局部切除胰体尾联合血管切除重建手术治疗后配合化疗,对照组仅接受化疗,比较两组患者的临床治疗效果与生存情况并分析预后因素。结果:两组患者的一般资料具有可比性;与对照组比较,观察组的客观有效率(44.9%vs.6.9%)、疾病控制率(82.8%vs.55.2%)明显升高(均P0.05);半年生存率(79.3%vs.48.3%)、1年生存率(55.2%vs.17.2%)、平均生存时间(17.6个月vs.10.3个月)、总生存率和无进展生存率均明显增加(均P0.05);两组患者的不良反应发生率差异无统计学差异(P0.05);单因素分析结果显示,肿瘤分期、有无淋巴/血管转移是胰腺癌患者无进展生存的影响因素(均P0.05)。结论:对于可以采取手术治疗的晚期胰腺癌患者而言,采用局部切除胰体尾联合血管切除重建手术疗效良好,可推荐应用。     

Intraarterial Adjuvant Chemotherapy after Pancreaticoduodenectomy for Pancreatic Cancer: Significant Reduction in Occurrence of Liver Metastasis

The clinical benefit of adjuvant chemotherapy in pancreatic cancer patients is still questionable. Phase II studies using radiochemotherapy based on 5-fluorouracil (5-FU) provided evidence of an increase in median survival times. Because palliative chemotherapy by celiac artery infusion (CAI) led to an increase in survival in pancreatic cancer, we treated 24 patients with adjuvant CAI following resection of the head of the pancreas for pancreatic cancer (21 patients with Union Internationale contre le Cancer (UICC) stage III, 2 with UICC stage II, 1 with UICC stage I). Catheters were placed angiographically into the celiac artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5-FU, folinic acid, and cisplatinum. This treatment was repeated five times at monthly intervals. CAI was well tolerated, and World Health Organization (WHO) grade III toxicities were observed in 8%; WHO grade IV was seen in none of the treatment cycles. Furthermore, we observed pain reduction in nearly all patients under CAI. Median survival times in patients who received CAI were 23 months for all patients, whereas in patients who did not receive adjuvant treatment the median survival was 10.5 months. With Kaplan-Meier regression analysis of the patients who were curatively resected (R0 resection) and received CAI, the overall 4-year survival was 54%, whereas in patients without CAI the 4-year survival was 9.5%. The occurrence of liver metastases in the CAI group went down to 17%. These results demonstrate that CAI is well tolerated, reduces the risk of liver metastasis, and increases the survival time of pancreatic cancer patients.     

Adjuvant treatment of pancreatic cancer

The prognosis of pancreatic cancer is poor at any stage. The complete resection of the tumour offers the only chance of cure, but 10-25 % of the patients at most present with operable disease, and median survival following surgery with curative intention is 18 months. Local recurrence is often accompanied or rapidly followed by distant metastasis. Studies of postoperative (adjuvant) treatment have yielded contradictory results. Combined radiochemotherapy resulted in improved survival in a few studies while others failed to demonstrate any survival benefit. Intraoperative radiation therapy given in addition to percutaneous irradiation may improve local tumour control at best. At present only few data support the benefit of adjuvant systemic chemotherapy alone. Unfortunately, the recently completed ESPAC-1 study was not very helpful in settling this issue due to its problematic design. Therefore, the results of ongoing studies of adjuvant chemotherapy are eagerly awaited. These studies have also included arms with gemcitabine, the current standard for palliative treatment of pancreatic cancer, and will hopefully allow firm conclusions as to the role of postoperative chemotherapy.     

血管内皮生长因子C与胰腺癌根治术后复发的相关性研究

目的 探讨血管内皮生长因子C(VEGF-C)表达及多种临床病理因素在预测胰腺癌根治术后复发的价值.方法 应用Envision免疫组化法测定47例胰腺癌根治性切除标本中胰腺癌组织和自身胰腺正常组织中VEGF-C的表达.通过Kaplan-Meier生存分析和Cox风险比例模型,评估VEGF-C和各临床病理因素对胰腺癌根治术后复发的影响.结果 VEGF-C在胰腺癌组织中的表达比例及其在自身正常胰腺组织中的表达比例分别为29例(61.7%)、7例(14.9%),VEGF-C在胰腺癌组织中的表达比例明显高于其在自身正常胰腺组织中的表达(P=0.018).胰腺癌根治术后患者无病中位生存期为11.9个月,平均为(18.4±2.4)个月.1年、2年、3年累计无病生存率分别为46.8%、23.4%和14.4%.VEGF-C的表达与淋巴结转移有显著的相关性(P=0.036).单因素生存分析显示VEGF-C(P=0.020)、肿瘤直径(P=0.013)、年龄(P=0.057)、术后辅助化疗(P=0.017)与无病生存期明显相关.Cox回归多因素分析显示,VEGF-C(P=0.009),肿瘤直径(P=0.010)、术后辅助化疗(P=0.017)是胰腺癌根治术后患者无病生存期独立的预后因素.结论 VEGF-C在胰腺癌组织中表达明显增高,VEGF-C的表达与淋巴结转移有显著的相关性,VEGF-C可作为判断胰腺癌根治术后患者无病生存期的独立指标.

Abstract：

Objective To investigate the prognostic value of vascular endothelial growth factor C (VEGF-C) and clinicopathologic indexes in predicting recurrence following curative resection of pancreatic cancer. Methods The expressions of VEGF-C of 47 patients who underwent curative resection for curative pancreatic cancer resection were detected by Envision immunohistochemical methods. The effects of VEGF-C and clinicopathologic indexes on recurrence were assessed by the Kaplan-Meier and Cox proportional hazards model. Results The positive rates of VEGF-C were 61. 7% in = 29) and 14. 9%(n = 7), respectively, in pancreatic cancer and normal pancreatic tissues. The positive expression of VEGF-C in pancreatic carcinoma was obviously higher than the normal pancreatic tissues (P = 0. 018). The median disease-free survival time was 11. 9 months, the average disease-free survival time was 18. 4 + 2. 4 months, and the cumulative 1-year, 2-year and 3-year actuarial recurrence free survival rates were 46. 8%, 23. 4%, 14. 4%, respectively. There was a significant correlation between the VEGF-C expression and lymph node metastasis in pancreatic cancer (P = 0. 036). On Kaplan-Meier analysis, VEGF-C (P = 0. 020), tumor diameter (P = 0. 013), age (P = 0. 057) and adjuvant chemotherapy (P=0. 017) were associated with disease-free survival time. Multivariate analysis showed VEGF-C (P = 0. 009), tumor diameter (P = 0. 010) and adjuvant chemotherapy (P = 0. 017)were independent prognostic factors of disease-free survival after surgery for pancreatic cancer.Conclusion The expression of VEGF-C was higher in pancreatic cancer, and VEGF-C was correlated with lymph node metastasis. VEGF-C was the biomarker that independently predicted disease-free survival after surgery for pancreatic cancer.     

进展期结直肠癌根治术后腹腔热灌注化疗联合全身化疗的临床相关性研究

目的评估进展期结直肠癌患者在行腹腔镜下根治性切除术后采取腹腔热灌注化疗联合全身化疗的临床疗效及安全性。方法选择两组在我院收治的78例进展期结直肠癌患者,一组为联合化疗组(39例),在行腹腔镜下结直肠癌根治性切除术后,首先行腹腔热灌注化疗(IHIPC)3次,然后再采用全身化疗,方案为(XELOX);另一组为单一化疗组(39例),在行腹腔镜下结直肠癌根治性切除术后,单纯采用全身化疗,方案为(XELOX)。对两组患者的临床疗效及安全性进行对比分析。结果联合化疗组患者在化疗后,其KPS评分升高率为53.85%,单一化疗组在化疗后,其KPS评分升高率为25.64%,两者差异存在统计学意义(P0.05);两组患者的各种不良反应发生率无明显差异(P0.05);对两组患者术后随访5年,联合化疗组的患者在第1、3、5年的生存率分别为94.87%、84.62%、69.23%,单一化疗组分别为92.31%、64.10%、46.15%,两组患者在第3、5年的生存率进行比较,其差异存在统计学意义(P0.05)。结论进展期结直肠癌患者在行腹腔镜下根治性切除术后采取腹腔热灌注化疗联合全身化疗,可能提高了患者的术后生存质量及生存率,且不良反应也无明显增加。     

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目的 探讨胰腺癌术后介入化疗的作用。方法 对1999～2003年行根治性手术48例和姑息性手术82例胰腺癌病人在术后进行介入化疗，观察介入化疗后病人生存率、肿瘤大小的改变、疼痛缓解率和血清肿瘤标志物的变化。结果 胰腺癌介入化疗后血清肿瘤标志物水平显著降低，病人疼痛明显缓解，肿瘤缓解率为41.5％。根治性切除组1年、2年、3年生存率为74.1％、32.3％和9.8％；姑息性手术组1年、2年、3年生存率为53.0％、7．2％和1．4％。结论 术后介入化疗能抑制胰腺癌肿瘤细胞生长，有助于延长生存期和改善疾病相关症状，是胰腺癌手术后有效的辅助治疗手段。