同步新辅助放化疗联合全直肠系膜切除术治疗中低位局部进展期直肠癌的临床研究

目的:探讨同步新辅助放化疗联合全直肠系膜切除术(total mesorectal excision,TME)治疗中低位局部进展期直肠癌的疗效及安全性。方法:2009年9月-2011年2月30例中低位局部进展期直肠癌患者[Ⅱ期(T3-4N0M0)14例,Ⅲ期(T1-4N1-2M0)16例]接受了术前同步新辅助放化疗(术前放疗总剂量为45～50Gy,1.8Gy/次;化疗方案为FOLFOX4,化疗2个周期)。同步新辅助放化疗结束后4～6周行手术治疗,遵循TME原则。结果:全部患者均完成同步新辅助放化疗,CR5例、PR18例、SD7例,有23例(76.7%)患者的临床TNM分期下降。同步新辅助放化疗结束后4～6周,除1例CR患者拒绝手术外,29例患者均行手术治疗,其中23例行低位或超低位前切除术(Dixon术),6例行腹会阴联合切除术(Miles术),保肛率为80.0%(24/30)。无一例发生围手术期死亡,术后并发症的总发生率为20.7%(6/29)。结论:同步新辅助放化疗联合TME治疗中低位局部进展期直肠癌安全而有效,可以降低肿瘤分期、提高肿瘤切除率和保肛率,改善患者的生活质量。     

新辅助同步放化疗联合TME及术后辅助化疗对中低位局部进展期直肠癌的疗效研究

目的探讨新辅助同步放化疗联合全直肠系膜切除（TME）加术后辅助化疗三联疗法治疗中低位局部进展期直肠癌的疗效及安全性.方法选择局部进展期中低位直肠癌Ⅱ、Ⅲ期（T2N＋M0,T3-4N0-2M0期）65例,术前放疗总剂量50～54Gy,术前采用Xelox方案化疗3个疗程,放化疗结束后6～8周根据TME原则行直肠癌根治术.术后采用Forfox4方案辅助化疗6个疗程.结果65例均完成新辅助同步放化疗、手术治疗及术后辅助化疗.其中48例行Dix-on’s手术,17例行mile’s手术,保肛率73.85%,术后并发症发生率23.08%,其中伤口感染延期愈合6例,吻合口瘘4例,吻合口狭窄5例,手术后病理完全缓解（pCR）11例,占16.92%.结论新辅助放化疗＋TME手术治疗＋术后辅助化疗三联疗法治疗中低位进展期直肠癌安全有效,可以降低肿瘤分期,减少局部复发及远处转移,中远期疗效好.     

新辅助同步放化疗联合全系膜切除对局部进展期中低位直肠癌的治疗价值

目的探讨新辅助同步放化疗联合直肠全系膜切除术(total mesorectal excision,TME)用于局部进展期中低位直肠癌治疗的可行性与临床价值。方法111例局部进展期(T3～4 N0～2 M0)中低位直肠癌术前接受同步放化疗,放疗剂量50 Gy,化疗包括奥沙利铂+卡培他滨的联合化疗方案及不含铂类药物的单药化疗方案。共105例患者同步放化疗结束后2～10周内完成了肿瘤根治性(R0)手术,可进行疗效的病理学评价。结果105例患者获得根治性切除,切缘均阴性,42例(37.8%,42/111)患者成功实施保肛手术;18例临床-影像分期为T4期患者中,15例(83.3%)新辅助放化疗后获得根治性切除(R0)。所有患者手术及术后恢复顺利,无严重手术并发症;术后病理示肿瘤完全消退15例(14.3%),重度消退26例(24.8%),中度消退40例(38.1%),轻度及无消退24 例(22.8%)。结论新辅助同步放化疗联合TME手术安全可行,可提高局部进展期中低位直肠癌的根治性切除率与保肛率,不增加手术并发症,是局部进展期中低位直肠癌的优选治疗模式。     

中低位进展期直肠癌患者全直肠系膜切除术前应用同步新辅助放化疗效果分析

目的：分析中低位进展期直肠癌患者全直肠系膜切除术前同步新辅助放化疗应用疗效。方法选取45例中低位进展期直肠癌患者为研究对象,将其随机分为联合组（23例）与对照组（22例）,对照组患者行单纯全直肠系膜切除术,联合组患者在行全直肠系膜切除术前同步新辅助放化疗,比较联合组新辅助放化疗前后肿瘤分期（TNM）情况,两组患者治疗前后肿瘤标志物水平变化情况及术后3个月保肛率、复发率、转移率、术后并发症发生情况。结果新辅助治疗后联合组TNM分期较治疗前降低,差异具有统计学意义（P﹤0.05）;治疗前两组患者癌胚抗原（CEA）、糖链抗原19-9（CA19-9）、糖链抗原242（CA242）水平差异无统计学意义（P﹥0.05）,治疗后均降低（P﹤0.05）,且联合组低于对照组（P﹤0.05）;两组患者术后3个月转移率及并发症发生率差异无统计学意义（P﹥0.05）,联合组保肛率高于对照组,复发率低于对照组（P﹤0.05）。结论采用全直肠系膜切除术前同步新辅助放化疗,可以有效提高中低位进展期直肠癌患者保肛率,降低复发率,改善肿瘤TNM分期,降低CEA、CA19-9、CA242水平,具有良好的应用前景。     

直肠癌非手术治疗的新策略

术前同步放化疗联合全直肠系膜切除术是目前局部进展期直肠癌的标准治疗方式。术前同步放化疗可使肿瘤退缩、降期,增加低位直肠癌的保肛率,术后少部分患者可达病理完全缓解。手术相关的前切除综合征引起的功能损害、风险及并发症,使以“器官保留”、“等待观察”为代表的非手术治疗策略逐渐引发研究与探讨,从而为提高和改善患者的生活质量带来了新希望。     

术前放疗和化疗在低位直肠癌保肛治疗中的作用

低位直肠癌是指肿瘤距离肛缘(或齿线)小于6 cm的直肠癌[1,2]。低位直肠癌的治疗虽有人工肛门术式的改进,但就生活质量而言,仍不如保肛手术。现在低位直肠癌的手术治疗上已有了改进的方法,如全直肠系膜切除(TME)和吻合器的应用等。但对部分局部进展期直肠癌患者,因肿瘤位置偏低和侵犯范围偏大而暂时不能够作保肛手术的患者,则需寻求新的术前治疗方法,为保肛手术做准备,以使患者获得最佳的治愈机会而伴随最小的功能丧失和较高的生活质量。术前的放疗和化疗是目前常用的治疗方法,并取得了很好的疗效。1术前放化疗的方法1.1术前放疗的方法低位…     

局部中晚期直肠癌术前新辅助同期加量IMRT联合术前化疗的Ⅱ期临床研究

目的 观察评估局部中晚期直肠癌术前SIB-IMRT联合1周期卡培他滨诱导化疗联合全直肠系膜切除术治疗方案的可行性、安全性及疗效。方法 2015-2016年入组37例局部中晚期直肠癌患者接受术前放疗,直肠病变及阳性淋巴结给予58.75 Gy分25次,盆腔淋巴引流区给予50.00 Gy分25次,同步卡培他滨化疗。同步放化疗结束后休息1周继续行1周期卡培他滨诱导化疗。同步放化疗结束后6~8周接受直肠癌根治术。研究主要终点为pCR,次要终点为TN降期率、保肛手术率、不良反应等。结果 37例患者顺利完成术前同步放化疗,32例行手术治疗,4例因症状缓解拒绝手术,1例患者因肛周水肿手术延迟。pCR率为34%(11/32),TN降期率为91%(29/32),R₀切除率为100%,保肛手术率为75%(24/32)。放化疗期间大部分为1、2级急性不良反应,3、4级不良反应共3例。术后并发症为输尿管损伤(1例)和肠梗阻(1例),围手术期内未见死亡。结论 局部中晚期直肠癌行术前SIB-IMRT联合1周期卡培他滨术前化疗及全直肠系膜切除术方案的初步结果表明其近期疗效好、安全可行、急性不良反应轻。     

直肠癌新辅助放化疗临床效果的评估

直肠癌是常见的恶性肿瘤，直肠癌发病率近年有上升趋势。全直肠系膜切除术（total mesorectal excision ，TME ）是直肠癌的最主要治疗手段，但局部进展期直肠癌患者术后局部复发率高、保肛率低，新辅助放化疗成为局部晚期直肠癌的优选治疗手段。直肠癌新辅助治疗后的临床效果是临床医生关注的焦点。直肠癌新辅助治疗效果的预测及评估关系到后续治疗方案的选择，影响患者的生存期及生活质量。      

全直肠系膜切除在低位直肠癌保肛手术中的应用

目前，手术治疗仍是直肠癌治疗中的首选。随着人们对直肠癌生物学特性的重新认识，以及20世纪60年代吻合器的发明应用，越来越多的低位直肠癌得以进行保肛治疗，但术后局部复发是导致手术失败的原因之一。80年代Heald提出直肠癌全直肠系膜切除(total mesorector excision，TME)能明显降低直肠癌术后的局部复发率。现在，TME作为直肠癌手术的金标准正被越来越多的人接受。我院从2000年1月至2002年5月采用TME方法对75例患者行直肠癌低位前切除术疗效满意，现报告如下。     

术前同步放化疗联合全直肠系膜切除术治疗Ⅱ/Ⅲ期中、低位直肠癌的临床疗效

目的:探讨术前同步放化疗联合全直肠系膜切除术治疗Ⅱ/Ⅲ期中低位直肠癌的临床疗效和安全性.方法:回顾性收集新疆医科大学附属肿瘤医院2008年1月1日至2014年12月31日收治的181例接受术前同步放化疗的Ⅱ/Ⅲ期中低位直肠癌患者的临床资料,术前放疗为50 Gy/(25 f·35 d),共5周完成,同步化疗方案包括XELOX、FOLFOX及单药卡培他滨等,术前化疗2～5周期,所有患者在同步放化疗治疗结束6～8周后手术,遵循全直肠系膜切除术(total mesorectal excision,TME)原则.147例患者行术后辅助化疗.用Kaplan-Meier法计算总生存率(overall survival,OS),局部复发率(local recurrence rate,LRR),远处转移率(distant metastasis rate,DMR),并用Cox模型对预后的影响因素进行多因素分析.结果:181例患者均完成同步放化疗,行经腹直肠癌切除、近端造口、远端封闭手术(Hartmann)2例,低位前切除术(Dxion) 108例、腹会阴联合切除术(Mile's)71例.原发肿瘤T分期、N分期及TNM分期的降期率分别为49.7％、82.9％、54.1％.病理完全缓解率为10.5％(19/181).术前同步放化疗Ⅲ级不良反应为6.8％,术后累计并发症发生率为22.7％.同步XELOX、FOLFOX及单药卡培他滨5年OS分别为69.66％、62.75％、63.41％,差异有统计学意义(P =0.000).5年DMR分别为17.1％、32.7％、24.5％,差异有统计学意义(P=0.000).5年LRR分别为3.9％、5.8％、3.8％,差异无统计学意义(P=0.108).肿瘤占肠周值及术后病理分期是预后影响因素.结论:术前同步放化疗能提高R0切除率和保肛率,肿瘤降期明显,治疗相关的急性不良反应及术后并发症的发生率较低.同步XELOX方案化疗5年OS要高于FOLFOX及单药卡培他滨,且5年DMR率要低于同步FOLFOX及单药卡培他滨.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.