上消化道双原发癌的诊断与治疗

目的 探讨上消化道双原发癌的诊断问题和手术治疗方法,以提高对本病的认识诊疗水平。方法 1985年6月-1999年6月我们共收治上消化道双原发部16例,占同期食管贲门癌病例的1.23%。其中食管双原发癌8例,食管癌并贲门癌5例,食管癌并胃癌3例,9例术前确诊,5例术中发现,2例术后诊断,8例行食管胃吻合,6例行结（空）肠移植重建消化道,2例行姑息切除术。结果 全组无手术死亡及严惩并发症,12例术后随访生存1年以上者8例,3年以上者4例,5年以上者1例。结论 上消化道双原发癌的诊断要从术前、术中、术后三方面着手,治疗首选根治性手术,术中上消化道的重建非常重要。     

合并肺癌的多原发癌诊治进展

多原发癌（MPC）也称重复癌,是指一个患者同时或先后发生两个或两个以上彼此无关的原发癌,可发生在同一器官或同一系统的不同部位,也可发生于不同器官或不同系统。而肺重复癌是指同一患者存在肺MPC或肺与其他器官MPC。随着癌症患者生存时间延长及肿瘤诊断水平的提高,MPC的发病率也逐渐增高。因此正确及时地诊断MPC,有利于提高患者的治愈率、降低医疗成本及病死率。文章就合并肺癌的MPC的流行病学特点、诊断标准、发病机制、好发部位、治疗及预后作一综述。     

消化系多原发癌116例临床分析

目的 探讨消化系多原发癌的发病特点、诊治原则及预后。方法 通过计算机病案管理系统,检索10年间收治的全部消化系恶性肿瘤病例,对检出的116例多原发癌患者的临床资料进行回顾性分析。结果 消化系多原发癌116例,其中双原发癌111例,三原发癌5例,总发病率为1．7％,男女之比为2．7：1。其中同时性多原发癌62例,异时性多原发癌54例。全部癌灶中受累及次数为：结肠＞胃＞直肠＞肝,结肠病灶中又以右半结肠最多。以1990－1995年有完整随访记录的47例计算生存率,同时性多原发癌1,3,5年生存率分别为42．3％、23．1％和11．5％,,异时性者为95．2％、85．7％和76．2％。结论 消化系多原发癌好发于结肠系,以右半结肠为著;异时性癌预后好于同时性癌,两癌间隔时间越长则预后越好;均发生于结肠系者预后较好。提高疗效的关键在于早诊早治,提倡尽量根治与免疫支持并重的治疗原则。     

多原发癌2例报道

我科自１９９８年２月至１９９９年４月收治多原发癌２例,现报告如下。１临床资料例１邓××,男性,６７岁。入院前半年因反复右侧胸痛胸片示“右上肺炎变”,两度以结核收入传染科治疗。入院前４天右胸痛加重,胸片示“右上中心型肺癌”,于１９９８年２月２３日收我科。经纤支镜检查,病理检验报告为“右上支气管低分化癌”,于１９９８年３月４日转某肿瘤医院,４月７日全麻下行右肺上叶切除术,术后病理诊断为鳞癌Ⅲ级。随访中１９９９年６月右肺癌术后肝转移。既往史:１９９５年１月１６日因患鼻咽癌伴左颈淋巴结转移,左颅底骨质受侵,病理诊断…     

多原发癌的研究进展

近年来,肿瘤患者的生存期不断延长,肿瘤病灶常常控制在长期稳定的状态,甚至达到完全缓解。因此,在对肿瘤患者进行治疗及随访的过程中,越来越多的研究发现了第二原发癌(SPC)的存在。多原发癌(MPC)由基因因素、生活环境因素、医源性因素等多种因素引发,根据两癌间隔时间的不同其可以分为同时性MPC和异时性MPC,由于MPC患者的个体差异较大,因而其诊治过程相对复杂。目前,临床对MPC的认识仍不足,对MPC的治疗尚缺乏统一标准。本文就MPC患者的临床特征、发病机制、治疗及预后情况作一综述,旨在为临床工作带来启发。     

大肠多原发癌1例报告

患者男,64岁,因右上腹隐痛3个月,大便带血20天来院。检查:体温、脉搏、呼吸、血压正常。全身浅表淋巴结未触及肿大。腹平坦,右上腹及左下腹有深压痛,无反跳痛,未扪及明显包块,肝脾未触及,肠鸣音正常。直肠指诊:膝胸位进指约10cm于11点处可扪及一不规则分叶状肿物约4×4×3cm大小,质硬不光滑,活动,手套带血迹。前列腺质韧、光滑、中央沟变平、无触痛。入院后经钡灌肠检查诊断为直肠癌、结肠癌(肝曲)。经术前准备后在双管硬膜外麻醉下行肿瘤根治性切除术。术中见肝胆胰脾正     

上消化道双原发癌的诊断与治疗

目的　探讨上消化道双原发癌的诊断问题和手术治疗方法 ,以提高对本病的认识及诊疗水平。方法　 1985年 6月～ 1999年 6月我们共收治上消化道双原发癌 16例 ,占同期食管贲门癌病例的 1 2 3 %。其中食管双原发癌 8例 ,食管癌并贲门癌 5例 ,食管癌并胃癌 3例。 9例术前确诊 ,5例术中发现 ,2例术后诊断。 8例行食管胃吻合 ,6例行结 (空 )肠移植重建消化道 ,2例行姑息切除术。结果　全组无手术死亡及严重并发症 ,12例术后随访 ,生存 1年以上者 8例 ,3年以上者 4例 ,5年以上者 1例。结论　上消化道双原发癌的诊断要从术前、术中、术后三方面着手 ,治疗首选根治性手术 ,术中上消化道的重建非常重要。     

食管癌相关多原发癌的研究进展

近年来,随着食管癌患者生存期不断延长,长期随访中发现相关多原发性恶性肿瘤(multiple primary malignant neoplasms,MPMNs)的发生率逐渐上升.食管癌相关MPMNs好发于头颈部、胃部及肺部,且多见同时性多原发癌;可能由生活环境、基因和医源性等因素作用诱发;可能的发病机制可用"区域癌化"...     

原发性胃肠道恶性淋巴瘤的诊断与治疗

目的 :探讨原发性胃肠道恶性淋巴瘤的诊断及治疗。方法 :分析我院近12年来收治的69例原发性胃肠道恶性淋巴瘤的临床资料 ,其生存率由寿命表法计算获得。结果 :本组术前确诊率为27.5 % ,其2年、5年和10年生存率分别是 :Ⅰ期91.7%、83.3%和25 % ,Ⅱ期52 %、32%和20 %。结论 :掌握本病钡餐造影的特点和内镜取材深度 ,可望提高本病的术前诊断率 ,争取手术切除 ,术后辅助化疗、放疗 ,以提高本病生存率。     

Multiple primary squamous cell carcinomas in the upper digestive tract

Multiple squamous cell carcinomas are common and patients carry a constant and excessive risk of developing a new cancer at any time (13-21 X the normal). Among 6,203 cases of primary squamous carcinoma of the upper digestive tract, 648 patients (10.4%) developed two or more independent tumors. Altogether, 761 additional malignancies were observed, with up to five cancers being seen in individual patients. There were 279 patients with a prior or synchronous cancer and 409 patients who developed 462 metachronous tumors. There was a substantial risk for developing a second primary cancer in the upper aerodigestive tract. Overall the observed to expected ratio was 2.48, specifically 2.32 for males and 2.89 for females.     

胃肠道癌患者外周血癌胚抗原信使核糖核酸的检测及其临床意义

目的：应用RT—PCR法检测胃肠道癌患者外周静脉血CEAmRNA，探讨与不同临床病理指标之间的关系，评估对临床治疗和预后的指导意义。方法：应用RT—PCR技术，选择特异性CEAmRNA引物，检测41例胃癌、大肠癌患者外周血CEAmRNA，同时定量检测外周血CEA和CA19—9糖蛋白。另抽取12例健康志愿者外周血标本作为对照。结果：41例胃肠癌患者外周血中CEAmRNA、CEA、CA19—9阳性率分别为26．8％、19．5％、14．6％。12例对照外周血中CEAmRNA、CEA、CA19—9均阴性。有淋巴结转移者外周血CEAmRNA阳性率（40％，10／25）高于无淋巴结转移者（6．25％，1／16），P=0．000。TNM分期Ⅳ期中外周血CEAmRNA阳性率63．6％（7／11），Ⅲ期21．4％（3／14），Ⅰ、Ⅱ期6．3％（1／16），P=0．004。外周血CEAmRNA表达在不同年龄、性别、病理类型中无统计学差异（P〉0．05）。结论：CEAmRNA、CEA和CA19—9在胃肠道癌患者中的阳性率，以CEAmRNA阳性率最高，随淋巴结转移数目、病期进展，阳性率更高，可能预后不良。     

原发胃肠道非霍奇金淋巴瘤的研究现状

胃肠道是原发结外非霍奇金淋巴瘤（non-Hodgkin's lymphoma,NHL）最常见的发病部位,发病率逐年上升。虽然结内非霍奇金淋巴瘤的治疗模式已标准化,但是对于原发胃肠道非霍奇金淋巴瘤的治疗仍存在争议。手术、化疗、放疗等治疗方式可单独应用,或以不同组合联合应用,最佳治疗模式目前尚无定论,且影响原发胃肠道非霍奇金淋巴瘤预后的因素较多。现对原发胃肠道非霍奇金淋巴瘤的发病率、临床特点、组织学分类、治疗方案及预后进行综述,重点探讨该病的治疗及预后。     

Immune status in advanced upper gastrointestinal cancers

Thirty-eight cases of advanced upper gastrointestinal cancer were assessed for their immune status prior to any form of therapy. Cell-mediated immunity, as tested by absolute lymphocyte count, T-cell count and delayed cutaneous hypersensitivity reactions to purified protein derivative and phytohemagglutinin showed severe depression. Immunoglobulins A and M were elevated, while immunoglobulin G reduced. No correlation could be established between the immune status and the site of cancer or its extent, the performance status of the patients, or their response to chemotherapy.     

Genetic susceptibility to multiple primary neoplasms in the upper aero-digestive tract: Genotype Score and phenotype correlation

Early detection and treatment of head and neck cancer has led to increased patient survival. However such patients are at a high risk for multiple primary neoplasm(s) (MPN). In order to study the genetic susceptibility to MPN, 22 candidate SNPs were genotyped based on which a distinctive Genotype Score was created using Additive, Dominant and Recessive models. Using lymphoblastoid cell lines (LCLs) generated from these individuals, the Genotype Score was correlated with carcinogen sensitivity in vitro. LCLs from MPN patients exhibited significantly higher Genotype Score and showed resistance to genotoxic agents compared to matched controls. This report demonstrates quantitative assessment of cumulative effect of gene polymorphisms and its correlation with carcinogen sensitivity for predicting susceptibility to MPN.     

41例可手术多原发肺癌临床分析

背景与目的：多原发肺癌(multiple primary lung cancers,MPLC)是原发性肺癌中的一种少见类型,但近年临床检出率呈逐渐升高的趋势。本研究对41例MPLC的临床资料进行总结分析,进一步探讨MPLC的诊断、治疗和预后。方法：参照Martini-Melamed诊断标准,对41例MPLC的临床病理资料进行回顾性分析。结果：41例患者中三原发肺癌3例,双原发肺癌38例。同时性MPLC13例,异时性MPLC26例,同时性MPLC+异时性MPLC2例。手术方式以肺叶切除为主(78.8%,67/85),病灶好发于右上叶(41.2%,35/85),病理以腺癌多见(70.6%,60/85),其次为鳞癌(17.6%,15/85)。腺癌亚组中以乳头状为主的病理亚型比率较高(50%,30/60)。分期以I期为主(80%,68/85)。组织病理类型相同的MPLC比例(68.3%,28/41)高于不同病理类型(31.7%,13/41),其中腺癌-腺癌多见(82.1%,23/28)。病灶位于同侧不同肺叶者4例(9.8%),位于双侧肺者37例(90.2%)。MPLC2年总生存(overall survival,OS)率为87.8%(36/41),生存分析显示病理类型相同组较不同组预后好(P=0.037),无淋巴结转移的MPLC较有淋巴结转移组预后好(P=0.02)。结论：MPLC病灶好发于右上叶,病理以腺癌最常见,乳头状为主的病理亚型多见。其早期检出率越来越高,采取积极的手术治疗可获得较为理想的预后。     

Photodynamic Therapy for Upper Gastrointestinal Cancers during Past 25 Years in China

Objective: To evaluate the status of photodynamic therapy (PDT) for upper gastrointestinal cancers, and then discuss how to solve the problems that hinder the development of PDT. Methods: A total of 30 pertinent literatures about PDT for upper gastrointestinal cancers during past 25 years were collected through the retrieval of several related medical databases (Chinese Medical Current Contents, China Bio-Medical Bibliographic Database, China Journal Fulltext Database). The data, including the gender, age of patients, tumor position, pathologic findings, treatment efficacy, adverse effects and the applied laser and photosensitizer, were statistically analyzed. Results: For all the 1687 cases with upper gastrointestinal cancers, the excellent-effective rate (complete remission or prominent remission) and effective rate (complete remission or prominent remission or minor remission) were 53.2% and 87%, respectively. The therapeutic effect of combined treatment (PDT with other methods) was superior to that of PDT (u=4.456, P<0.01). All the involved pathological types were sensitive to PDT. Different photosensitizers and lasers were used by different authors, but all of them were effective without any serious side effect. Conclusion: PDT shows a radical effect on the tumors of early stage and a favorable palliative effect on the tumors of advanced stage, so it is one of the optional strategies for the treatment of upper gastrointestinal cancers.     

Preoperative and adjuvant therapies for upper gastrointestinal cancers

Survival of esophageal, gastrointestinal junction and gastric cancers is poor given that they frequently present with locally advanced or metastatic disease. The incidence of gastrointestinal junction adenocarcinoma is increasing whereas that of squamous cell carcinoma of the esophagus is decreasing. The accuracy of staging has improved with newer diagnostic techniques, including positron emission tomography, endoscopic ultrasound and laparoscopy, and this should be integrated in prospective Phase III clinical trials evaluating neoadjuvant and adjuvant therapies for some esophageal and all gastric carcinomas. For esophageal cancer (except for one trial by Walsh and colleagues), four randomized Phase III trials comparing preoperative chemoradiation followed by surgery versus surgery alone have not shown a survival benefit. Neither have the trials, where preoperative chemoradiation followed by surgery, is compared with definitive chemoradiation. Nevertheless, it is commonly practiced in the USA and has become a preferred combined modality approach. Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more than Stage IA). The UK–MAGIC trial results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, probably has an impact on the treatment practice of these cancers in Europe and Asia. Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer (pathologic complete response of 20–30%) need to be further evaluated in a Phase III setting and compared with postoperative chemoradiation. Active ongoing research will help us clarify the role of preoperative and adjuvant therapies in esophageal and gastric cancers. The role of molecular profiling is evolving and will help us differentiate the responders from the nonresponders.