非肌层浸润性膀胱癌预后相关分子标志物的研究进展

膀胱癌是我国最常见的泌尿系肿瘤之一,在初次诊断的患者中约75％是非肌层浸润性膀胱癌（ NMIBC ）［1］。目前以临床病理因素为基础的EORTC评分系统［2］被广泛用于判断西方国家NMI-BC的复发及进展风险。但是EORTC评分系统并不能完全反映NMIBC 的高度异质性。有研究［3,4］表明, NMIBC 分子标志物的预后预测价值要优于EORTC评分系统。寻找有效的分子标志物来早期、精确预测术后复发或进展是当前NMIBC面临的重要挑战。现就NMIBC预后相关分子标志物的研究进展进行综述。     

电切治疗老年非肌层浸润性膀胱癌合并后尿道癌的疗效

膀胱癌是一种泌尿系统的常见的恶性肿瘤,早期诊断以及治疗有助于提高其临床预后[1].Alkhateeb[2]等对非肌层浸润性膀胱癌主要采用经尿道膀胱肿瘤电切术进行治疗,但对于非肌层浸润性膀胱癌合并后尿道肿瘤的治疗研究较少.本文就我院对收治的非肌层浸润性膀胱癌合并后尿道肿瘤患者采用经尿道膀胱肿瘤电切术进行治疗的临床疗效进行临床评价.     

膀胱肿瘤复发和进展评分对非肌层浸润性膀胱肿瘤预后的判断价值

目的探讨非肌层浸润性膀胱肿瘤术后复发和进展评分对预测其患者预后的临床价值。方法依据非肌层浸润性膀胱肿瘤术后复发和进展危险评分系统(EORTC)对2005年4月至2009年9月该院收治的131例非肌层浸润性膀胱肿瘤患者术后进行评分,并计算各评分等级组术后患者的1、3、5年复发率和进展率。结果依据复发评分计算后分为0分组、1~4分组、5~9分组和10~17分组,其中患者术后1、3、5年复发率与欧洲膀胱治疗研究组织(EORTC)评分预测的参照复发比较无显著差异(P>0.05);依据进展评分计算后分为0分组、2~6分组、7~13分组、14~23分组,其中患者术后1、3、5年进展率与EORTC评分预测的进展率比较无显著差异(P>0.05)。结论根据非肌层浸润性膀胱肿瘤患者术后评分实际情况将其分为不同评分等级,对患者预测1~5年的预后具有重要的临床意义,但目前有待多中心、大样本临床试验进一步验证。     

绿激光汽化术联合吡柔比星灌注化疗治疗非肌层浸润性膀胱癌临床观察

目的探讨经尿道绿激光汽化术联合吡柔比星膀胱灌注化疗治疗非肌层浸润性膀胱癌的安全性及疗效。方法非肌层浸润性膀胱癌患者31例,所有患者行尿道绿激光汽化术,术后即刻给予吡柔比星30 mg+注射用水30 m L膀胱灌注化疗,出院后规律膀胱灌注,每周1次,持续8周,以后每月1次,持续10个月,总持续时间为1年。术后定期行膀胱镜检查。结果 31例患者均手术成功,手术时间25~85 min、平均41 min。无术中、术后大出血,未发生闭孔神经反射、膀胱穿孔等严重并发症。术后随访11~30个月、平均13个月,发生肿瘤复发7例,复发率为22.5%,均为异位复发。结论绿激光汽化术联合吡柔比星灌注化疗治疗非肌层浸润性膀胱癌疗效确切、并发症少、术后复发率低。     

非肌层浸润性膀胱癌经尿道电切术后不同的灌注化疗方案的临床观察

目的对比非肌层浸润性膀胱癌(NMIBC)经尿道膀胱肿瘤切除术(TURBT)后膀胱灌注羟喜树碱和吡柔比星的疗效和安全性。方法选择该院2012-01~2015-12收治的膀胱癌患者76例,采用随机数字表法将TURBT术后的NMIBC患者分为羟喜树碱组和吡柔比星组,各38例,于术后1周进行膀胱灌注化疗,比较两组复发率、不良反应发生率以及化疗费用。结果随访时间12~60个月,羟喜树碱组1年内复发率高于吡柔比星组(P0.05),但两组2年内、5年内复发率差异无统计学意义(P0.05)。吡柔比星组灌注后膀胱刺激征发生率高于羟喜树碱组(P0.05)。结论羟喜树碱和吡柔比星均可有效预防NMIBC术后复发,吡柔比星对预防术后短期内复发疗效较好,但不良反应多且价格较贵,而羟喜树碱不良反应少且价格有优势。     

吉西他滨联合卡介苗膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的效果

目的探讨经尿道膀胱肿瘤切除(TUR-BT)术后吉西他滨(GEM)联合卡介苗(BCG)膀胱灌注预防非肌层浸润性膀胱癌(NMIBC)复发的临床效果及不良反应。方法选取行TUR-BT术并经术后病理确认的高危NMIBC患者126例,随机分为3组:GEM组、BCG组及GEM+BCG组; 3组患者均随访至2018年1月,随访期间每3个月行膀胱尿道镜检查;观察随访患者复发及生存情况,收集患者有无发热、咳嗽、尿频、尿急、尿痛、血尿、皮疹、肺结核或泌尿系结核及尿道狭窄等不良反应,每6个月复查血尿常规、胸部透视、泌尿系彩色超声、生化等检查。结果 GEM组复发率为26. 1%(11/42),BCG组复发率为复发率为16. 7%(7/42); GEM+BCG组复发率为9. 5%(4/42); 3组复发率之间差异均有统计学意义(P<0. 05); GEM+BCG组复发率明显低于GEM组及BCG组(P<0. 05); GEM组无复发生存时间为(25. 36±1. 18)个月; BCG组无复发生存时间为(32. 28±1. 21)个月; GEM+BCG组无复发生存时间为(41. 24±2. 01)个月; 3组无复发生存时间差异均有统计学意义(P<0. 05),GEM+BCG组无复发生存时间明显长于GEM组及BCG组(P<0. 05); GEM组不良反应率为9. 5%(4/42),BCG组不良反应率为40. 4%(17/42),GEM+BCG组不良反应率为38. 1%(16/42),BCG组与GEM+BCG组不良反应率差异无统计学意义(P>0. 05),GEM组不良反应率明显低于BCG组与GEM+BCG组(P<0. 05)。结论 GEM联合BCG预防高危NMIBC复发较单用GEM或BCG效果好,不良反应较单用BCG无明显差异,可作为高危NMIBC术后膀胱灌注的推荐方案。     

免疫检查点抑制剂在肌层浸润性膀胱癌新辅助免疫治疗中的应用研究进展

目前肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的标准治疗方式为新辅助化疗(neoadju-vant chemotherapy,NAC)后膀胱癌根治性切除术(radical cystectomy,RC).基于免疫检查点抑制剂(immune check-point inhib...     

消痔灵联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的临床疗效

目的探讨消痔灵联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的临床效果和安全性。方法将86例行膀胱肿瘤部分切除术的初发非肌层浸润性膀胱癌患者随机分为观察组和对照组各43例。观察组患者术后6 d内采用消痔灵联合羟喜树碱行膀胱灌注化疗,对照组单用羟喜树碱行膀胱灌注化疗。每次化疗后记录患者全身反应,并定期进行膀胱镜复查,观察两组患者术后肿瘤复发情况和不良反应情况。结果 86例患者术后随访2年,除对照组中1例患者因经济原因只用药1年外,其余患者均坚持用药。观察组(43例)中5例复发,复发率为11.6%,对照组(42例)中复发10例,复发率为23.8%,两组相比差异显著(P<0.05);两组患者KPS评分比较差异不显著(P>0.05),但与灌注化疗前相比,KPS评分均显著提高;两组术后治疗的不良反应主要包括发热、膀胱刺激症状、呕吐等,观察组不良反应发生率为30.2%,对照组为38.1%,两组相比差异不显著(P>0.05)。结论消痔灵联合羟喜树碱术后膀胱灌注可降低初发非肌层浸润性膀胱癌术后复发率,且毒副作用小,可有效提高患者的生活质量,值得推广。     

二次TURBt联合THP膀胱灌注治疗非肌层浸润膀胱癌临床观察

目的观察二次经尿道膀胱肿瘤电切术(TURBt)联合吡喃阿霉素(THP)膀胱灌注治疗非肌层浸润膀胱癌的疗效。方法 60例T1期膀胱尿路上皮癌患者,连续行两次TURBt,中间间隔4～6周,术后予THP膀胱灌注化疗。结果手术均成功。第2次TURBt手术时间15～30 min,平均20 min;术中出血10～45 mL,平均25 mL。第2次TURBt时发现残存肿瘤19例,总阳性率31.5%。THP膀胱灌注时所有病例均有程度不同的尿路刺激症状,均未发生全身严重不良反应。1 a内复发9例,其中4例再次行电切后治愈,另外5例根据病理情况3例行膀胱部分切除,2例行全膀胱切除+回肠代膀胱术后治愈。结论二次TURBt联合THP膀胱灌注是治疗非肌层浸润性膀胱癌的有效的方法。     

非肌层浸润性膀胱癌组织Ki-67、p53和CK-20表达变化及其临床意义

目的 探讨非肌层浸润性膀胱癌（NMIBC）组织Ki-67、p53、细胞角蛋白20(CK-20)表达变化及其临床意义。方法 选择NMIBC患者105例,取手术切除的NMIBC组织及其配对的癌旁正常组织,采用免疫组化法检测Ki-67、p53、CK-20表达。比较NMIBC组织与癌旁正常组织Ki-67、p53、CK-20阳性表达,分析NMIBC组织Ki-67、p53、CK-20表达与患者临床病理特征的关系以及三者表达的关系。结果 NMIBC组织Ki-67、p53、CK-20阳性表达率均显著高于癌旁正常组织（χ2分别为40.485、40.752、42.091,P均<0.01）。NMIBC组织Ki-67、p53、CK-20表达与病理分级、浸润深度、术后复发有关（P均<0.05）,而与性别、年龄、肿瘤数目、肿瘤最大径无关（P均>0.05）。NMIBC组织Ki-67阳性表达与p53、CK-20阳性表达均呈正相关关系（r分别为0.642、0.669,P均<0.01）,p53阳性表达与CK-20阳性表达亦呈正相关关系（r=0.706,P<0.01）。结论 NMIBC组织Ki...     

Current status and progress of pancreatic cancer in China

Cancer is currently one of the most important public health problems in the world. Pancreatic cancer is a fatal disease with poor prognosis. As in most other countries, the health burden of pancreatic cancer in China is increasing, with annual mortality rates almost equal to incidence rates. The increasing trend of pancreatic cancer incidence is more significant in the rural areas than in the urban areas. Annual diagnoses and deaths of pancreatic cancer in China are now beyond the number of cases in the United States. GLOBOCAN 2012 estimates that cases in China account for 19.45% (65727/337872) of all newly diagnosed pancreatic cancer and 19.27% (63662/330391) of all deaths from pancreatic cancer worldwide. The population’s growing socioeconomic status contributes to the rapid increase of China’s proportional contribution to global rates. Here, we present an overview of control programs for pancreatic cancer in China focusing on prevention, early diagnosis and treatment. In addition, we describe key epidemiological, demographic, and socioeconomic differences between China and developed countries. Facts including no nationwide screening program for pancreatic cancer, delay in early detection resulting in a late stage at presentation, lack of awareness of pancreatic cancer in the Chinese population, and low investment compared with other cancer types by government have led to backwardness in China’s pancreatic cancer diagnosis and treatment. Finally, we suggest measures to improve health outcomes of pancreatic cancer patients in China.     

大肠癌预防的现状及研究进展

2003年初将上市某应用基因公司研制的一种基于粪便DNA多项指标分析筛查大肠腺瘤和癌的检测技术。该项检测技术的上市名称是PreGen-Plus，可以检测5种不同的DNA异常，其中包括APC，k-ras，p53和BAT-26(一种微卫星不稳定性标志物)以及DNA片段完整性分析。该检测技术将用于拒绝大肠镜检查的普通人群。目前，美国正在进行两个多中心、大样本的筛查验证。     

缩窄性心包炎诊治现状及进展

缩窄性心包炎是不同原因造成的心包慢性炎症,表现为心包丧失弹性,心脏舒张受限,进而全身血液循环障碍。部分患者发病隐匿,缺乏典型临床表现。临床医师需通过详细的超声心动图、CT、核磁共振和右心导管检查来识别特征性的影像表现,外科手术剥离心包是有效治疗方法。该病误诊漏诊率高,为此本文综述了该病的诊治现状及进展。     

革袋胃诊治现状及进展

革袋胃是一种特殊型胃癌,呈弥漫性生长,恶性度高、进展快,通常预后差,属于弥漫浸润型(Borrmann Ⅳ型)胃癌,好发于女性。随着诊疗技术的提高,为部分革袋胃患者的诊治提供了新的希望。革袋胃的具体发病机制及疾病进展尚未完全明确,该文就近年来的革袋胃的诊治现状及进展进行综述。     

Current status of esophageal cancer treatment in Asia

Esophageal cancer is becoming a different disease in Asian and Western countries. The rapidly rising incidence of adenocarcinoma of the lower esophagus and cardia has replaced squamous cell cancers as the predominant cell type in the west. The different cell type and tumor location to some extent influence how the disease is treated; other factors are cultural and the way health care is financed. The goals of treatment, however, are the same; to provide long-term cure with minimal morbidity and mortality and to preserve patients quality of life. Surgical resection has remained the mainstay treatment in Asia. Improvement in surgical outcome has taken place in many centers throughout Asia in the past two decades. Emphasis has been centered on epidemiology of the disease, reducing morbidity and mortality of esophagectomy, and identifying effective surgical or nonsurgical methods of treatments. Randomized controlled trials are also increasingly employed to test many unresolved problems. The Asian contributions are elaborated with specific examples from Japan, Hong Kong, and China.This lecture was presented during the international session at the 58th Annual Meeting of the Japan Esophageal Society.     

Current status of laparoscopy for the treatment of rectal cancer

Surgery for rectal cancer in complex and entails many challenges. While the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe, it is still a debatable topic for rectal cancer. The attempt to benefit rectal cancer patients with the known advantages of the laparoscopic approach while not compromising their oncologic outcome has led to the conduction of many studies during the past decade. Herein we describe our technique for laparoscopic proctectomy and assess the current literature dealing with short term outcomes, immediate oncologic measures (such as lymph node yield and specimen quality) and long term oncologic outcomes of laparoscopic rectal cancer surgery. We also briefly evaluate the evolving issues of robotic assisted rectal cancer surgery and the current innovations and trends in the minimally invasive approach to rectal cancer surgery.     

Current status of immunotherapy for the treatment of lung cancer

Immunotherapy is a novel approach for the treatment of systemic malignancies. Passive and adaptive immunotherapy have been applied to the treatment of a wide variety of solid tumors such as malignant melanoma (1), renal cell carcinoma (2) and ovarian cancer (3). Several early clinical trials of immune based therapy for both non-small (NSCLC) and small cell lung cancer (SCLC) have demonstrated limited or no success (3),(4) but recent trials of antigen-specific cancer immunotherapy have shown early therapeutic potential and are now being rigorously evaluated on a larger scale (5). In this communication we briefly review the historic aspects of immune based therapy for solid cancer, describe therapeutic strategies aimed at targeting lung cancer, and discuss limitations of current therapy and future directions of this field.     

Anal cancer treatment:Current status and future perspectives

Anal cancers(AC)are relatively rare tumors.Their incidence is increasing,particularly among men who have sex with other men due to widespread infection by human papilloma virus.The majority of anal cancers are squamous cell carcinomas,and they are treated according to stage.In local and locally advanced AC,concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil(5-FU)is the current best treatment,while metastatic AC,chemotherapy with 5-FU and cisplatin remains the gold standard.There are no indications for induction or maintenance therapies in locally advanced tumors.Many novel strategies,such as targeted therapies,vaccination,immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC,with promising results in some indications.