原发性肺癌胸部CT表现与手术切除的关系探讨

目的探讨原发性肺癌胸部ＣＴ表现与手术切除的关系。方法将９５例经手术和病理证实为原发性肺癌的患者分为３组：根治性切除组、姑息性切除组、探查组。分别测量３组ＣＴ肿瘤直径、纵隔肺门淋巴结受侵ＣＴ纵向厚度,记录纵隔、肺门及胸内结构改变。结果根治性切除组、姑息性切除组、探查组肿瘤直径分别为４．１０±１．７５,３．９０±１．２０,５．２０±３．６６（ｃｍ,ｘ±ｓ,Ｐ＞０．０５）。纵隔肺门淋巴结受侵ＣＴ扫描纵向厚度分别为２．６８±１．６０,４．０２±１．５６,４．８５±３．２８（Ｐ＜０．０１,Ｐ＜０．０５）。手术探查组ＣＴ特征主要表现为纵隔、肺门结构变形。结论肿瘤直径大小与手术切除无明显直接关系,纵隔肺门淋巴结受侵厚度是影响手术切除的重要因素。当纵隔肺门淋巴结受侵、胸部ＣＴ纵向厚度≤２．６８±１．６０ｃｍ时,临床上可行根治性肺切除。明显纵隔、肺门结构变形可视为手术禁忌症。     

食管癌组织及其区域淋巴结中树突细胞CD1a、CD80、CD86的表达

背景与目的:树突细胞(dendriticcell,DC)是重要的抗原提呈细胞,参与抗肿瘤免疫。本研究通过检测人食管癌组织及其区域淋巴结中树突细胞CD1a(特异性标志)、CD80、CD86(共刺激分子)的表达,探讨食管癌发生及其免疫逃逸的机制。方法:采用流式细胞术检测58例食管癌病例(Ⅰ-Ⅱ期27例,Ⅲ-Ⅳ期31例;G1-237例,G321例;鳞癌49例,腺癌9例;有淋巴结癌转移者37例,无淋巴结癌转移者21例)的癌组织及癌旁组织、11例食管炎性组织、12例正常食管组织、31枚有癌转移的区域淋巴结、34枚无癌转移的区域淋巴结中树突细胞CD1a及CD80、CD86的表达。结果:(1)树突细胞CD1a、CD80、CD86的表达在食管癌组织中(6.18±1.47,5.37±1.13,37.35±7.42)明显低于正常食管组织(10.28±2.11,9.67±1.94,48.76±10.23)、食管炎性组织(11.89±2.65,10.46±1.79,51.55±10.60)及癌旁组织(11.79±2.41,10.49±1.89,9.78±12.31)中的表达(P<0.01);(2)树突细胞CD1a、CD80、CD86的表达在食管癌患者有癌转移的区域淋巴结中的表达(8.34±1.66,6.78±1.42,41.70±8.71)明显低于无癌转移的淋巴结中的表达(12.23±2.14,10.82±2.11,59.63±12.52)(P<0.01);(3)癌旁组织及食管炎性组织中树突细胞CD1a、CD80、CD86的表达与正常食管组织中的表达的差异无统计学     

Effect of intravenous administration of FT-207 for gastric cancer

FT-207, 800mg per day, was administered intravenously 2 hours per day for 6 days to 15 patients with gastric cancer. By chemical assay, FT-207 and 5-FU concentrations in the blood and tissues were determined. The FT-207 levels in cancerous tissue, metastatic lymph nodes and normal gastric mucosa were almost equal. The mean 5-FU level in cancerous lesions was 0.110 +/- 0.075mcg/g, and was 0.124 +/- 0.080mcg/g in lymph nodes, and 0.043 +/- 0.021mcg/g in normal mucosa. This showed that 5-FU levels were significantly higher in tumors and lymph nodes than in normal mucosa. (p less than 0.05, p less than 0.01 respectively). The mean blood level of 5-FU was low at 4 hours after FT-207 infusion. In conclusion, intravenous drip administration of FT-207 was considered to be effective for gastric cancer because of the high tumor affinity of 5-FU.     

脂质体的局部淋巴结靶向富集

目的 探讨脂质体的局部淋巴结靶向性和富集性.方法 18只兔分为3组,每组6只.在兔双侧第一趾蹼皮下注射99mTc-氟尿嘧啶脂质体(99mTc-FL)各18.5 MBq,然后在注射后不同时间(第1组3 h,第2组6 h,第3组8 h)检测局部淋巴结、非引流淋巴结、血、尿、肝、脾、肺、肾、心、肠等组织的放射性.结果3、6和8 h组的每克局部淋巴结摄取率分别为(2.32±0.75)%、(5.37±1.73)%和(8.61±1.89)%(P＜0.05);3 h组每克局部淋巴结与非引流淋巴结、血、尿、肝、脾、肺、肾、心、肠等组织摄取率的均数比分别为232.00、16.57、23.20、29.00、19.33、25.78、46.40、46.40和25.78,6 h组分别为89.50、41.31、18.52、67.13、41.31、25.57、134.25、59.67和59.67,8 h组分别为86.10、61.50、16.56、53.81、57.40、10.01、107.63、107.63和86.10,差异有统计学意义(P＜0.01).结论 FL可经淋巴途径缓慢流向局部淋巴结,并不直接进入血液循环,造成局部淋巴结靶向富集.脂质体的淋巴结靶向富集提示胸部恶性肿瘤局部淋巴靶向化疗的可行性.     

胃癌细胞增殖活性与脉管转移及预后关系的探讨

目的探讨胃癌细胞溴化脱氧脲嘧啶核苷（BrdUrd）标记指数（LI）、G2／M期细胞比率（G2／MPF）、DNA含量与胃癌淋巴管侵袭、淋巴结转移、静脉侵袭及预后之间的关系。方法用BrdUrd／DNA双参数流式细胞术（FCM）检测60例胃癌新鲜标本。碘化丙啶（PI）用于检测细胞DNA的荧光探针,抗BrdUrd单克隆抗体用于掺入DNA中的BrdUrd探针。荧光标记的羊抗鼠抗体用于第二抗体。用体外标记BrdUrd法检测S期比率,同时检测DNA倍体和G2／MPF。结果淋巴管侵袭阳性者BrdUrd LI和G2／MPF均明显高于阴性者（P〈0．01）,二者5年生存率差异有统计学意义（P〈0．01）。淋巴结转移阳性者BrdUrd LI和G2／MPF较阴性者明显增高（P〈0．01）,二者5年生存率差异有统计学意义（P〈0．01）。异倍体癌淋巴结转移阳性者明显增高（P〈0．05）,二倍体癌的5年生存率较异倍体癌明显增高（P〈0．05）。淋巴结多数转移者（〉5个）的BrdUrd LI较无转移者（P〈0．01）和少数转移者（1～4个）明显增高（P〈0．05）,G2／MPF较无转移者明显增高（P〈0．01）;淋巴结少数转移者较无转移者的G2／MPF明显增高（P〈0．05）,淋巴无结转移、少数转移和多数转移者之间比较,其5年生存率差异有统计学意义（P〈0．01）;异倍体癌淋巴结多数转移者明显增高（P〈0．01）。静脉侵袭阳性的G2／MPF较阴性者明显增高（P〈0．01）。结论胃癌细胞BrdUrd LI、G2／MPF、DNA含量和脉管侵袭与胃癌预后有一定的关系。     

小鼠肝癌细胞淋巴结转移的基质金属蛋白酶谱

背景与目的:肿瘤转移是恶性肿瘤致死的主要因素之一,淋巴结转移是癌早期最常见的转移方式,且淋巴结转移灶可以成为进一步血道转移的桥头堡,但癌淋巴道转移的分子机制尚不清楚。本实验旨在探讨小鼠肝癌细胞分泌基质金属蛋白酶(MMPs)及表达Fas-L与其淋巴结转移的关系。方法:采用酶谱法检测具有不同转移能力的小鼠肝癌细胞Hca-F(高转移)和Hca-P(低转移)分别在淋巴结匀浆、肝组织匀浆或脾组织匀浆存在的情况下分泌的基质金属蛋白酶谱;以流式细胞仪检测荷瘤鼠淋巴细胞的生长分数;以TUNEL检测淋巴结内淋巴细胞的凋亡情况;以免疫组化法检测Hca-F和Hca-P细胞表达Fas-L的情况。结果:在淋巴结匀浆存在下Hca-F和Hca-P细胞分泌MMP-9显著增多(P<0.01):RPMI-1640培养基中,Hca-F和Hca-P细胞分泌MMP-9分别为1256±157、2642±385;加入淋巴结匀浆后,则分别为12403±894、9086±686,同时分泌大量的MMP-2(Hca-F为7364±2001,Hca-P为2997±1990)和MMP-9的活性型(Hca-F为7297±1657,Hca-P为3914±1253),且Hca-F细胞分泌量多于Hca-P(P<0.05)。而在肝组织或脾组织匀浆存在下,Hca-F和Hca-P细胞均不分泌基质金属蛋白酶。Hca-F组荷瘤鼠引流淋巴结内的淋巴细胞的增殖高峰出现于荷瘤后第14日,并迅速下降,而Hca-P组荷瘤鼠引流淋巴结内     

Endoscopic injection of liposomal adriamycin targeting lymph node metastasis of gastric cancer

Gastric submucosal injection of 5 mg liposomal adriamycin (L-ADM) close to the main gastric cancer tumor was done in 15 patients by endoscopy. This approach was based on the idea that preoperative adjuvant chemotherapy targeting lymph node metastasis in patients with gastric cancer may be effective for prevention of lymph node recurrence. ADM concentrations in the regional lymph nodes were assessed and compared with those in patients who were administered 5 mg of free adriamycin (F-ADM) i.v. preoperatively. ADM concentrations in Group 7 lymph nodes (according to the General Rules for Gastric Cancer Study) were: After 2 days; 7.21 +/- 5.98 micrograms/g (n = 2) in the L-ADM group and 0.59 +/- 0.23 micrograms/g (n = 3) in the F-ADM group. After 4 days; 4.93 +/- 3.93 micrograms/g (n = 2) in the L-ADM group and 0.36 +/- 0.0 micrograms/g (n = 2) in the F-ADM group. After 6 days; 2.08 +/- 0.49 micrograms/g (n = 2) in the L-ADM group and 0.05 +/- 0.05 micrograms/g (n = 3) in the F-ADM group. L-ADM group: those who had L-ADM injected into the side of the lesser curvature of the stomach. F-ADM group: those who had F-ADM administered i.v. These data demonstrate that gastric submucosal injection of L-ADM is well suited for specific delivery to the regional lymph nodes, suggesting that this type of administration may prevent lymph node recurrence of gastric cancer by targeting lymph node metastasis.     

乳腺癌淋巴化疗与静脉化疗后腋窝淋巴结药物浓度的比较

背景和目的:淋巴结状态是乳腺癌重要的预后因素之一,区域淋巴组织靶向化疗是近几年出现的针对高淋巴转移倾向肿瘤的治疗方法。本研究检测乳腺癌患者淋巴化疗(lymphaticchemotherapy,LC)后腋窝淋巴结内的药物浓度,并与静脉化疗(intravenouschemotherapy,VC)作对比,以确定LC能否有效提高区域淋巴结内抗癌药物的聚积。方法:60例乳腺癌患者随机分为LC组和VC组,每组30例,所有患者均于术前穿刺活检明确诊断。LC组在癌灶周围皮下注射卡铂鄄活性炭混悬液5mg/ml,VC组给予同等剂量卡铂水溶液静脉化疗。给药后1、12、24、36、48h分别行乳腺癌改良根治术,每组每个时间点各6例患者。术中常规清扫腋窝淋巴结并送病理检查,原子吸收光谱法(AAS)测定淋巴结内卡铂浓度。结果:术中共切除淋巴结275枚,其中LC组154枚,VC组121枚。共有23例(38.3%)患者的146枚(53.1%)淋巴结发现癌转移。LC组给药后1、12、24、36、48h腋窝淋巴结中卡铂浓度分别为(11.82±3.50)、(23.58±7.34)、(18.22±4.93)、(16.70±5.15)、(14.62±4.29)μg/g,VC组在给药后1、12、24、36h分别为(0.06±0.02)、(0.11±0.05)、(0.10±0.02)、(0.05±0.02)μg/g,给药后48h淋巴结内未检测出卡铂,两组间差异有极显著性(P<0.001)。淋巴结药物浓度与癌转移之间无明显     

The concentration of bleomycin labeled with Co-57 in primary and metastatic tumors

The concentration over time of bleomycin labeled with Co-57 was measured in 39 primary and metastatic tumor sites in 16 patients using a newly developed and validated single photon emission computed tomography (SPECT) method. There were nine primary tumors, 15 metastatic tumors, and five multifocal lymphomas. Co-bleomycin concentrations also were measured in primary and metastatic B-16 melanoma tumors in mice. In humans, metastases to lymph nodes (1.58 +/- 0.51 %ID/ml X minutes) showed significantly higher (P less than 0.01) tumor cumulative concentrations of Co-bleomycin than metastases to liver, bone, lung, and brain (0.76 +/- 0.20 %ID/ml X minutes). The cumulative concentrations of Co-bleomycin in human lymphomas (1.1 +/- 0.25 %ID/ml X minutes) also were significantly higher (P less than 0.01) than the concentrations in human metastases other than lymph nodes. The cumulative concentration in cerebral metastases (0.65 +/- 0.18 %ID/ml X minutes) was significantly lower (P less than 0.05) than in noncerebral metastases (1.22 +/- 0.53 %ID/ml X minutes). Primary tumors in humans showed higher concentrations of Co-bleomycin than metastases, except for lymph nodes. In contrast with humans, murine metastases showed higher concentrations of Co-bleomycin (6.20 +/- 2.65 %ID/g) than primary tumors (2.94 +/- 0.90 %ID/g) (P less than 0.001). The concentrations of Co-bleomycin in murine tumors that were affected by bleomycin were about three orders of magnitude higher than in human tumors. The results of this in vivo study document the differences in drug delivery of Co-57-labeled bleomycin to human primary and metastatic tumors and show differences in drug delivery between human and murine tumors.     

非小细胞肺癌患者引流区淋巴结中CD4+CD25+调节性T细胞的检测及临床意义

目的分析非小细胞肺癌(NSCLC)患者引流区淋巴结中CD4 CD25 调节性T细胞在淋巴结局部免疫抑制状态的形成以及在肺癌发生发展中的作用。方法手术切除53例NSCLC患者引流区淋巴结,采用双标记的间接免疫荧光法检测CD4 CD25 调节性T细胞数量,实时荧光定量逆转录-聚合酶链反应(RT-PCR)法检测细胞因子TGF-β1、IL-10的表达水平,常规免疫组化方法检测CD8 T细胞的数量。结果NSCLC患者引流区转移淋巴结中,CD4 CD25 调节性T细胞(28.80%±8.06%)明显高于未转移淋巴结(15.48%±4.66%,P<0.01)。随肺癌的进展,引流区淋巴结中CD4 CD25 调节性T细胞数量增多。在转移的纵隔淋巴结(N2)和肺内淋巴结(N1)中,CD4 CD25 调节性T细胞数量分别为32.58%±7.52%和22.76%±4.67%(P<0.01)。在进展期(Ⅲ)和早期(Ⅰ Ⅱ)NSCLC患者引流区淋巴结中,CD4 CD25 调节性T细胞数量分别为30.42%±7.47%和16.22%±4.88%(P< 0.01)。NSCLC患者引流区淋巴结中的CD4 CD25 调节性T细胞数量与其自身的CD8 T细胞的数量呈负相关(r=-0.756,P<0.001)。在NSCLC患者引流区淋巴结中,CD4 CD25 调节性T细胞数量与抑制性细胞因子TGF-β1和IL-10的表达水平呈正相关(TGF-β1:r=0.645,P<0.001;IL-10:r=0.769,P<0.001)。结论NSGLC患者引流区淋巴结的CD4 CD25 调节性T细胞数量与肺癌的发展密切相关。一方面,检测肺癌患者引流区淋巴结的免疫状况为评价NSCLC患者疾病的进展程度和预后提供了一个新的免疫学指标;另一方面,在NSCLC的生物治疗中,控制CD4 CD25 调节性T细胞数量,阻断其发挥免疫抑制作用,具有广阔的临床应用前景。     

Gastric cancer with p53 overexpression has high potential for metastasising to lymph nodes.

Overexpression of the tumour suppressor gene p53 was investigated immunohistochemically in 96 primary gastric carcinomas and 26 corresponding metastatic perigastric lymph nodes. Abnormalities in p53 expression were found in 52 (54%) of the 96 primary carcinomas. Tumours stained positively for p53 frequently metastasised to lymph nodes (the metastatic rate: 85%) compared to findings in those with negative p53 staining (64%, P < 0.05). Ninety-two percent (24/26) of the malignant cells in the lymph nodes stained positively for p53. When the DNA ploidy pattern of the tumour was determined by flow cytometry, the aneuploid tumours in p53 positive and negative groups accounted for 69% and 45%, respectively (P < 0.05). Proliferative activity of the tumour, as measured by Ki-67 labelling, was significantly higher (30.6 +/- 12.0%) in the p53 positive group than that (25.1 +/- 10.7%) in the p53 negative group (P < 0.05). Thus, gastric cancer with a mutant p53 has high proliferative activity and metastasis to lymph nodes will probably occur.     

胃癌淋巴结微转移的多种抗体联合检测及其临床价值

免疫组化法检测胃癌淋巴结中的微转移灶方法简便,但敏感性差。同时应用多种抗体联合检测淋巴结的微转移情况,是否能提高其敏感性,克服免疫组化法的弱点尚有一些争议。本研究应用细胞角蛋白20(CK20)、上皮膜抗原(EMA)及肿瘤相关糖蛋白72-4(CA72-4)抗体对胃癌阴性淋巴结的微转移情况进行联合检测,旨在评价多种抗体联合检测微转移的应用价值。     

Neoadjuvant therapy changes the lymphocyte composition of tumor-draining lymph nodes in cervical carcinoma

BACKGROUND: The objective of the current study was to illustrate the influence of neoadjuvant therapy on the local immune response in patients with cervical carcinoma. METHODS: Uninvolved tumor-draining lymph nodes (TDLN) (n=158 lymph nodes), including internal, external, and common iliac lymph nodes as well as obturator, presacral, and aortic lymph nodes from 15 nontreated (NT) patients, 4 chemotherapy (CT)-treated patients, and 19 chemoradiation (CR)-treated patients, were analyzed for lymphocyte subset distribution and for the proliferative response of T cells to polyclonal activation and interferon-gamma (IFN-gamma) production. Lymphocyte subsets in peripheral blood also were assessed. RESULTS: TDLNs from CR-treated patients contained higher proportions of CD8+ cells and natural killer cells than NT and CT-treated patients (P values ranged from <0.05 to <0.01). TDLNs from CR-treated patients were enriched in activated-type CD4+ cells (HLA-DR+, CD134+, CD62L-, and CD25+ at an intermediate expression level; P values ranged from <0.05 to <0.01) and activated-type CD8+ cells (CD62L-, P<0.001) compared with NT patients. Concomitantly, there was a reduction in the proportion of na?ve-type CD4+ and CD8+ cells (CD45RA+/CD62L+) (P<0.01 and <0.05, respectively). CR treatment increased the proportion of both CD4+ and CD8+ cells prone to produce IFN-gamma. All TDLNs contained suppressive CD4+ T regulatory (Treg) cells (CD25+ and CD152+ at a high expression level) whose frequency and suppressive activity was not influenced by the treatment. Therapy-induced changes in TDLN were mirrored only in part by respective alterations in peripheral blood. CONCLUSIONS: To our knowledge, the current study is the first to show that neoadjuvant therapy produces an enhancing effect on the immune competency of TDLNs from patients with cervical carcinoma.     

术前淋巴化疗对乳腺癌复发转移的影响及其机制

背景与目的:有报道认为淋巴化疗可以增加消化道肿瘤引流区域淋巴结中抗癌药物的浓度,改善预后,关于乳腺癌淋巴化疗的研究尚少见报道。本研究探讨术前淋巴化疗对乳腺癌复发转移的影响及其作用机制。方法:将60例Ⅱ～Ⅲ期乳腺癌患者随机分为两组,淋巴化疗组40例,对照组20例。在改良根治术前72h,淋巴化疗组于肿瘤周围或瘤床注射表阿霉素-活性炭混悬液10mg;对照组注射表阿霉素水溶液10mg,注射部位和方法同淋巴化疗组。用末端转移酶标记法检测腋窝转移淋巴结癌细胞凋亡指数(apoptoticindex,AI);用免疫组化SP法检测Fas/Fas-L蛋白的表达。观察两组患者局部和全身反应,比较复发转移率。结果:淋巴化疗组转移癌细胞AI平均为(9.5±2.7)%,对照组平均(3.8±1.4)%,前者明显高于后者(P﹤0.01);淋巴化疗组Fas蛋白表达比对照组明显上升(P﹤0.05),而Fas-L蛋白表达无明显改变(P﹥0.05)。对照组中有5例患者出现注射部位皮肤红肿发热,两组均无与化疗有关的局部和全身不良反应。淋巴化疗组患者的2年复发转移率为10.34%,低于对照组的38.46%(P﹤0.05)。结论:乳腺癌术前应用活性炭-表阿霉素混悬液淋巴化疗,可能会降低乳腺癌的复发转移率,其作用可能是通过上调Fas蛋白表达、诱导腋窝转移淋巴结癌细胞凋亡实现的。     

Current trends in the surgical treatment of esophageal and cardia adenocarcinoma

Since adenocarcinoma of the esophagus and cardia is increasing at an alarming rate, major efforts are currently oriented to identify patients who may benefit from extensive resection. Between November 1992 and May 1998, 218 patients with histologically proven adenocarcinoma of the distal esophagus or cardia were referred to our Department. In six patients (10.2%) with Barrett's adenocarcinoma, cancer was discovered during endoscopic surveillance program for Barrett's metaplasia. Overall, one hundred-forty-seven patients (67%) underwent resection. Fifty-one underwent an extended mediastinal lymphadenectomy. Median cumulative survival was 25.9+/-3.1 months in patients undergoing resection, and 7+/-1.3 months in patients having palliation (p<0.01). Survival was significantly longer in patients with negative nodes than in those with lymph node metastases (54+/-12.9 versus 17+/-2.8 months, p<0.01). Six of the 51 patients (11.8%) undergoing extended lymphadenectomy had metastatic upper mediastinal nodes. Additional serial sections and immunohistochemistry were performed in 46 patients. In 6 of 18 patients (33.3%) with negative nodes at conventional hematoxylin-eosin examination, immunohistochemistry demonstrated micrometastases in the lesser curve, paracardial, peripancreatic, or lower mediastinal nodes. Early diagnosis remains the prerequisite for curative treatment of adenocarcinoma of the esophagus and cardia. When a curative resection is attempted, extended lymphadenectomy improves tumor staging and may prevent local recurrences. Serial sections and immunohistochemistry provide additional accuracy in the staging of the disease and may prove useful to select patients for adjuvant therapy.     

Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy

PURPOSE: Curative radiotherapy (RT) for carcinoma of the cervix requires adequate irradiation of regional lymph node groups. The best nonsurgical method of defining lymph node anatomy in the pelvis remains the lymphangiogram (LAG). This study was designed to determine if bony landmarks could accurately substitute for LAG as a means of determining lymph node position for the purpose of pelvic RT treatment planning. METHODS AND MATERIALS: The post-LAG simulation films of 22 patients treated at the Fox Chase Cancer Center for cervical cancer were examined. On anterior/posterior (A/P) simulation films, the distance of lymph nodes was determined from the top, middle, and bottom of the sacroiliac joint, and at the pelvic rim, 1 and 2 cm above the acetabulum. On lateral (LAT) simulation films, lymph node position was measured at points 0, 4, and 8 cm along a line from the bottom of L5 to the anterior aspect of the pubic symphysis. Positive values represent lateral and anterior distances relative to the reference point on A/P and LAT films, respectively. Negative values represent distances in the opposite direction. The adequacy of standard pelvic fields as defined by the Gynecologic Oncology Group (GOG) (A/P: 1.5 cm margin on the pelvic rim; LAT field edge is a vertical line anterior to the pubic symphysis) was also examined. Data are expressed as the mean +/- two standard deviations, (i.e. 95% confidence level). RESULTS: On A/P simulation films, the distance of visualized lymph nodes had mean values of -1.6 +/- 1.7 cm (range -4.1 to -0.4 cm), -1.3 +/- 1.5 cm (range -3.4 to 0.0 cm), and 1.2 +/- 1.8 cm (range -1.0 to 2.6 cm) from the sacro-iliac (SI) joint at the superior, middle, and inferior points, respectively. The mean distance of the nodes from the pelvic rim at points 1 and 2 cm above the acetabulum was 0.3 +/- 1.2 cm (range -0.6 to 1.8 cm) and 0.2 +/- 1.8 cm (range -1.6 to 2.1 cm), respectively. On LAT simulation films, the distance of lymph nodes from points 0, 4, and 8 cm from the previously described reference line had mean values of 2.0 +/- 1.0 cm (range 1.3 to 3.0 cm), 0.9 +/- 3.9 cm (range -1.9 to 5.1 cm), and 1.8 +/- 2.1 cm (range -0.8 to 3.5 cm), respectively. Ten of 22 (45%) patients would have had inadequate nodal irradiation if their fields had been designed according to standard GOG parameters. In all cases, these incompletely irradiated lymph nodes were from the lowest of the lateral external iliac group. CONCLUSION: Great variability in pelvic lymph node location is demonstrated when LAG is used to directly visualize their location. Bony structures are inaccurate landmarks for pelvic lymph node position. The GOG standard pelvic fields are not consistently adequate to cover all lateral external iliac lymph nodes, although the clinical significance of this subgroup of lymph nodes is not known. At this time, LAG remains the ideal radiographic modality to define anatomic location of regional lymph nodes for pelvic RT treatment planning. The clinical importance of the most lateral group of external iliac lymph nodes in various stages of cervical cancer represents a potential area of future research.     

Clinical study on concentration of FT-207 and 5-FU in serum, lymph nodes and tissues after rectal administration of FT-207 suppositories for malignant diseases of the liver, biliary tract and pancreas

In order to study the antitumor effect of FT-207 in a solid tumor, it is necessary to determine the concentration of 5-FU and FT-207 in a tissue. This has only been done so far for gastric cancer and colon cancer, but these has been practically no research carried out regarding cancers of the liver, biliary tract and pancreas. A study was therefore made of lymph nodes and tissues after rectal administration of FT-207 suppositories to 12 patients with cancers of the liver, biliary tract and pancreas. These included 7 cases of pancreatic cancer, 2 cases of gall bladder cancer with infiltration to the liver, and 3 cases of hepatoma. In serum, the concentration of 5-FU reached 0.018 +/- 0.006 micrograms/ml at one hour after administration, 0.019 +/- 0.004 micrograms/ml at three hours after administration, and 0.023 +/- 0.008 micrograms/ml at six hours after administration. These concentrations would be expected to maintain a clinically sufficient dose. The concentration of 5-FU in metastatic lymph nodes was high compared with normal lymph nodes (p less than 0.05), its concentration in liver tumors was high while compared with normal liver tissues (p less than 0.05).     

FDG uptake and glucose transporter type 1 expression in lymph nodes of non-small cell lung cancer.

AIMS: FDG uptake in NSCLC is related to glucose transporter type 1 (Glut-1) expression. Here, we investigated the direct causal relationship between FDG uptake and Glut-1 expression to determine the role of Glut-1 in FDG uptake by malignant and benign lymph nodes (LNs). METHODS: Fifty-five curative lung resections in 53 NSCLC patients (male:female=36:17, age=62.0+/-11.8 years) were included. Maximum standardized uptake values (maxSUVs) of LNs in preoperative whole body FDG-PET and Glut-1 immunostaining results were compared. RESULTS: Of 316 pathologically confirmed LNs, 12.3% (39/316) were malignant, and in malignant LNs, FDG positive LNs were no different from FDG negative LNs in terms of size (15.0+/-6.7 mm vs 10.0+/-6.1mm, p>0.05), or in terms of the proportion of LNs occupied by tumor (60.0+/-28.8% vs 39.2+/-38.4%, p>0.05), but had greater percentages of Glut-1 positive cells in tumors (74.1+/-31.8% vs 22.7+/-18.7%, p<0.01), and Glut-1 staining intensities (3.4+/-0.9 vs 1.8+/-1.3, p<0.01). FDG negative malignant LNs featured cytoplasmic Glut-1 expression and adenocarcinoma. Glut-1 staining intensities were found to be significantly correlated with the maxSUVs of malignant LNs (rho=0.516, p<0.05), but the percentages of Glut-1 positive cells in tumors were not (r=0.2072, p>0.05). Analysis of FDG positive benign LNs showed that maxSUV was not correlated with degree of follicular hyperplasia, or Glut-1 expression (p>0.05). CONCLUSIONS: Intense Glut-1 immunoreactivity was found to be proportionally related to the degree of FDG uptake by malignant LNs in NSCLC. However, the finding that Glut-1 expression in lymphoid hyperplasia showed no correlation with FDG uptake in benign LNs requires further investigation.     

肝癌荷瘤小鼠调节性T细胞数量的改变及其与肿瘤生长的关系

目的研究肝癌荷瘤小鼠调节性T细胞数量的改变及其与肿瘤生长的关系。方法采用小鼠肝癌细胞系H22接种BALB／c小鼠,建立肝癌模型;采用流式细胞术方法检测CD4^＋ CD25^＋T／CD4^＋T细胞的比例;以RT-PCR和流式细胞术检测Foxp3基因的表达。以免疫磁珠分选法纯化CD4^＋CD25^＋T和CD4^＋CD25^-T细胞;在体外,用3H-TdR掺入法检测T细胞的增殖情况;在体内,观察荷瘤小鼠来源的CD4^＋CD25^＋T细胞对肿瘤生长的作用。结果（1）荷瘤小鼠在引流淋巴结中,CD4^＋CD25^＋T细胞占CD4＋T细胞（18．80％±0．06％）比例增高,与对照组（9．50％±0．03％）相比,差异有统计学意义（P〈0．01）;在非引流淋巴结（LN）和脾脏（SP）中,荷瘤小鼠CD4^＋CD25^＋T／CD4^＋T比例分别为16．28％±0．02％和17．28％±0．06％,与对照组9．50％±0．03％和11．08％±0．04％相比,差异有统计学意义（P〈0．01,P〈0．05）;同时,调节性T细胞特异性标志Foxp3 mRNA的表达也升高。在同一只荷瘤小鼠中,引流淋巴结中CD4^＋CD25^＋T细胞数量（18．8％±0．06％）较对侧非引流淋巴结（16．28％±0．02％）略有升高,但差异无统计学意义（P〉0．05）。（2）从荷瘤小鼠中纯化的CD4^＋CD25^＋T细胞,在体外对抗CD3单抗的刺激无反应,但能抑制CD4^＋CD25^-T细胞的增殖。（3）CD4^＋CD25^＋T／CD4＋T比例与肿瘤大小呈正相关,并且可以抑制CD4^＋CD25^-T细胞的抗肿瘤效应。结论肝癌细胞在小鼠体内的生长可以提高调节性T细胞的数量,其数量的高低与肿瘤的大小呈正相关,提示清除调节性T细胞将是肿瘤免疫治疗的策略之一。     

卵巢癌内血管生成与区域淋巴结微转移的关系

背景及目的:癌组织内微血管密度与患者预后有关。本研究旨在探讨卵巢上皮性肿瘤内微血管密度与区域淋巴结内微小转移间的关系,及其对预后的意义。方法:39例卵巢上皮癌组织切片用细胞角蛋白(cytokeratin,CK)及Ⅷ因子相关抗原(factorⅧ-relatedantigen,F8-RA)作免疫组化染色,后者经计算机图像分析系统计数切片中微血管数(40倍视野下);另将这些病例的212个淋巴结同时行HE及CK染色,检测淋巴结转移及微转移。结果:39例中7例HE染色诊断有淋巴结转移,CK染色发现12例存在淋巴结微转移,HE阳性组平均微血管密度(intratumormicrovesseldensity,IMD)为48.86±16.60,阴性组为29.16±10.02(P<0.01);CK阳性组IMD为41.67±21.69,亦较阴性组高(28.70±10.77,P<0.05);高IMD组(IMD≥30)16例中8例(50%)发现微转移,低IMD组(IMD<30)23例中仅4例(17.4%)有微转移(P<0.05)。经Cox比例风险模型分析,IMD(P=0.03)和淋巴结微转移(P=0.04)是影响生存最有意义的因素,且IMD(P=0.0008)和临床分期(P=0.03)又是预示复发的最重要的因素。结论:CK免疫组化染色可检出上皮性卵巢癌HE阴性的盆腔淋巴结中的微小转移,且癌组织内IMD与微转移密切相关,两者均与卵巢癌预后有关,可作为独立的预示生存时间的参数。