Risk of adenocarcinomas of the oesophagus and gastric cardia in patients hospitalized for asthma.

In the first cohort study of the question we followed 92 986 (42 663 men and 50 323 women) adult patients hospitalized for asthma in Sweden from 1965 to 1994 for an average of 8.5 years to evaluate their risk of oesophageal and gastric cardia adenocarcinoma. Standardized incidence ratio (SIR) adjusted for gender, age and calendar year was used to estimate relative risk, using the Swedish nationwide cancer incidence rates as reference. Asthmatic patients overall had a moderately elevated risk for oesophageal adenocarcinoma (SIR = 1.5, 95% confidence interval CI, 0.9-2.5) and gastric cardia cancer (SIR = 1.4, 95% CI, 1.0-1.9). However, the excess risks were largely confined to asthmatic patients who also had a discharge record of gastro-oesophageal reflux (SIR = 7.5, 95% CI, 1.6-22.0 and SIR = 7.1, 95% CI, 3.1-14.0, respectively). No significant excess risk for oesophageal squamous-cell carcinoma or distal stomach cancer was observed. In conclusion, asthma is associated with a moderately elevated risk of developing oesophageal or gastric cardia adenocarcinoma. Special clinical vigilance vis-à-vis gastro-esophageal cancers seems unwarranted in asthmatic patients, but may be appropriate in those with clinically manifest gastro-oesophageal reflux.     

贲门癌手术径路与疗效的关系研究

目的：探讨贲门癌手术径路的选择与外科治疗效果的关系。方法：随机抽取天津市肿瘤医院资料完整的贲门癌手术切除病例217例，回顾性分析其手术径路与疗效之间的关系，判定各径路的优劣。结果：腹部径路创伤小、失血少、手术时间短，易于术后恢复，但较难以切除足够长的食管及行下纵隔的淋巴结清扫。左胸径路可切除足够长的食管，有利于纵隔淋巴结的清扫，但腹腔暴露差，施行全胃切除、联合胰脾切除及5、6、8、9、12、13、14等组淋巴结的清扫有一定的难度。胸腹联合径路腹腔暴露好，便于行全胃切除及脏器联合切除，能切除足够长的食管和施行彻底的下纵隔淋巴结清扫并能进行D2淋巴结清扫，对肿瘤不能切除的患者避免了开胸探查，但是创伤大，可能引起较多的并发症和较高的死亡率。结论：3种手术径路各有其优缺点。手术径路的选择需根据病变部位、病变大小、疾病分期、患者体质以及医生的经验和技术水平等因素综合考虑而决定。单一的手术径路并非是影响预后的独立因素。     

Prognosis in adenocarcinomas of lower oesophagus, gastro-oesophageal junction and cardia evaluated by uPAR-immunohistochemistry

Adenocarcinomas of lower oesophagus, gastro-oesophageal junction and cardia in humans are highly invasive tumours with poor prognosis. The localisation of urokinase-type plasminogen activator receptor (uPAR) was determined in 66 patients; 60 with adenocarcinomas and six cases with Barrett's oesophagus. uPAR was expressed in nearly all cases of invasive adenocarcinomas by populations of cancer cells, macrophages and myofibroblasts at both the invasion front and the tumour core. In areas with high-grade dysplasia or with Barrett's metaplasia adjacent to the tumour tissue, no uPAR-immunoreactivity was found. High local expression of uPAR, therefore, appears to be a characteristic marker for invasive behaviour in this tumour, suggesting that uPAR's contribution to matrix degradation during invasive growth is a late event in carcinogenesis. Using a scoring system for semiquantitative estimation of uPAR-positivity on immmunohistochemically stained specimens, a significant association was found between poor overall survival and high uPAR-score for cancer cells in the tumour core and for macrophages peripherally at the tumour invasion zone. In multivariate analysis, these two uPAR-scores were confirmed as highly significant prognostic parameters independent of Tumour, Node, Metastasis (TNM)-stage and World Health Organization (WHO) classification. The proteolytic action of these malignant and nonmalignant accessory cells thus seemed to follow two main patterns: one dominated by uPAR positive cancer cells and one by uPAR-positive macrophages. Scoring of uPAR-positivity might be a useful parameter for onset of invasion and prognosis in these adenocarcinomas.     

Differential depression of lymphocyte subsets according to stage in stomach cancer

Lymphocyte surface markers were determined in the peripheral blood lymphocytes (PBL) in 31 stomach cancer patients (15 males and 16 females) and 47 controls (20 males and 27 females) using an indirect immunofluorescence technique. The monoclonal antibodies used were Leu 2a (CD8, suppressor/cytotoxic T cells), Leu 3a (CD4, inducer/helper T cells), Leu 4 (CD3, pan T reagent), Leu 11 (CD16, natural killer cells) and Leu 12 (CD19, B cells). The numbers of PBL, CD3+, CD4+, CD8+, CD16+ and CD19+ cells significantly decreased and the CD4:CD8 value increased in patients with stomach cancer compared to those in healthy volunteers. In stage I, PBL, none of the PBL subsets nor the CD4:CD8 value were significantly different from those of the controls. In stage II, the numbers of PBL, CD3+, CD4+ and CD8+ cells decreased. In stage III, the CD19+ cells decreased in addition to the decreased subsets in stage II. In stage IV, PBL and all subsets measured decreased. The CD4:CD8 value showed significant increases in stages II, III and IV, because the CD8+ cells decreased to a greater extent than did the CD4+ cells. Changes in the subsets were analyzed with regard to age, sex, performance status and smoking history, no significant relation being observed between these factors and lymphocyte subsets. From the present study, we have demonstrated that lymphocyte subsets were differentially depressed in the order of T cells, B cells and natural killer cells, with progression of the stage of disease.     

Trends in the incidence of adenocarcinoma of the oesophagus and cardia in the Netherlands 1989-2003

Over the 15-year period 1989-2003, the incidence of oesophagus-cardia adenocarcinoma in the Netherlands rose annually by 2.6% for males and 1.2% for females. This was the net outcome of annual increases in the incidence of adenocarcinoma of the oesophagus (ACO) of 7.2% for males and 3.5% for females and annual declines in the incidence of adenocarcinoma of the gastric cardia (AGC) of more than 1% for both genders. Nonlinear cohort patterns were found in females with ACO and for both genders in AGC; a nonlinear period pattern was observed only in males with AGC. These differing epidemiological patterns for ACO and AGC do not support a common aetiology. Proposed underlying factors for the rise in ACO incidence appear to have little effect on AGC incidence. This and the secular decline in smoking among males may have led to the decline in AGC incidence.     

高龄贲门癌手术径路选择的探讨

目的探讨高龄贲门癌手术径路的合理选择对术后恢复疗效的影响。方法回顾性分析114例高龄贲门癌病例的临床资料,进行统计分析,比较经胸、经腹两种手术径路的切端残留率、心脏并发症发生率、呼吸系统并发症发生率的差异。结果两组间切端残留率无明显差异(P>0.05),经胸组心脏并发症发生率、呼吸系统并发症发生率、术后平均住院时间与经腹组相比有统计学意义(P<0.05)。结论高龄贲门癌术前应充分评估分析病情,选择合适的手术径路,以利于恢复。     

恶性血液病患者化疗前后淋巴细胞亚群测定及其意义

 目的 研究恶性血液病患者化疗前后淋巴细胞亚群的变化及其意义。方法 采用流式细胞术对21例急性淋巴细胞白血病（ALL）／非霍奇金淋巴瘤（NHL）患者和23例急性髓系白血病（AML）患者化疗前后淋巴细胞亚群（包括CD+4细胞、CD+8细胞、CD+4／CD+8比值、NK细胞）进行检测。结果 CR组白血病、淋巴瘤的CD+4／CD+8与NK细胞比例均明显高于初诊组和化疗后未缓解组白血病、淋巴瘤（P＜0.05）;CR组ALL／NHL的CD+4／CD+8明显低于CR组AML（P＜0.05）。结论 CD+4／CD+8与NK细胞比例可以作为判断恶性血液病患者病情严重程度和预后的指标,与AML相比,ALL／NHL的细胞免疫功能受损更为严重。     

Study of the Value of Combined Multiorgan Resection in Surgical Treatment of Carcinoma of the Gastric Cardia

OBJECTIVE:To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS:We retrospectively analyzed 217 random patients with car- cinoma of the gastric cardia who underwent a gastric cardiac resection.The patients had been treated as fol ows:186 with partial gastrectomy,31 with total gastrectomy,97 with a combined-visceral resection,of which 82 under- went a splenectomy plus partial pancreatectomy,10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS:The total patients were divided into 3 groups:128 with a gas- trectomy alone,10 with gastrectomy and splenectomy,and 82 with gastrec- tomy and splenectomy plus pancreatectomy.The operating times for these 3 groups were respectively 3.0 h,3.1 h and 3.8 h.The hospitalization times were respectively 23.8 d,31.2 d and 25.9 d.No differences in post-operative complications were found between these 3 groups.There were 92 patients who underwent a gastrectomy combined with a splenectomy and(or)the pancreatectomy,in which 92 No.10 lymph nodes were eliminated,with an average of one in each patient.Among the 125 patients not receiving a sple- nectomy but with elimination of lymph nodes,82 underwent a gastrectomy combined with partial pancreatectomy,of which 107 lymph nodes were elimi- nated for the No.11 group,with an average of 1.3 in each patient.There was a statisticaly significant difference between the 2 groups.The overal survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage III patients with a combined resection of multi- organs.For patients in the Stage IV without resection of multi-organs,the survival rate was higher,but there was no significant difference between the 2 groups. CONCLUSION:It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation.Combining a sple- nectomy with a pancreatectomy does not increase the post-operative compli- cations following surgical treatment for carcinoma of the gastric cardia.The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11,especially for patients in Stage III.In the applica- tion of a resection combining multi-organs,the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.     

PFC方案化疗对进展期胃癌患者外周血淋巴细胞表型的影响

目的探讨紫杉醇(paclitaxel)联合氟尿嘧啶(5-Fu)及顺铂(CDDP)的治疗方案(简称PFC方案)对进展期胃癌患者外周血淋巴细胞表型的影响.方法 47例经病理学或细胞学确诊的进展期胃癌患者,采用PFC方案化疗(紫杉醇50 mg/m2,静滴3 h, 第1,8,15天;5-Fu 750 mg/m2,用便携式微量输液泵持续静脉输注,第1～5天;CDDP 20 mg/m2,静滴,第1～5天;每4周重复).应用流式细胞仪检测CD3 、CD4 、CD8 、CD16 56 、CD19 细胞的百分率.结果进展期胃癌患者经PFC方案化疗后CD4 、CD4 /CD8 、CD16 56 较化疗前显著升高(P＜0.05);CD3 、CD8 、CD19 化疗前后差异无显著性(P＞0.05).结论 PFC方案化疗可改善进展期胃癌患者机体的免疫功能.     

The clinical trial research of preoperative induced hypertension chemotherapy on the III staging cardia or fundus of stomach carcinoma

Objective: To observation the therapeutic effect and the adverse reaction of preoperative induced hypertension chemotherapy (IHC) on the III staging cardia or fundus of stomach carcinoma. Methods: 49 cases of the III staging cardia or fundus of stomach carcinoma were divided into two groups at random. The observation group included 19 cases and the control group included 30 cases. Every case used one cycle chemotherapy. The observation group (IHC group) used chemotherapy and AT II. The control group (simple chemotherapy group) used simple chemotherapy. All cases of the two groups operated after 3 weeks rest. The specimen’s DNA was analyzed by flow cytometry. Results: The effective power of observation group was 63.2% (12/19), exairesis ratio was 84.2% (16/19). The effective power of control group was 30% (9/30), exairesis ratio was 63.3% (19/30). DNA ploid determination: 13 cases were diploid and 5 cases were heteroploid in the observation group, 9 cases were diploid and 16 cases were heteroploid in the control group. The operative complications and risks of the two groups did not increase. Conclusion: IHC can increase the therapeutic effect of III staging cardia or fundus of stomach carcinoma obviously. IHC is one of the chemotherapy methods that have good future. It has good value of clinic enlarge trial.     

Ⅲ期贲门胃底癌患者术前药物诱导性高压化疗的临床试验研究

Objective:To observation the therapeutic effect and the adverse reaction of preoperative induced hypertension chemotherapy (IHC) on the Ⅲ staging cardia or fundus of stomach carcinoma. Methods:49 cases of the Ⅲ staging cardia or fundus of stomach carcinoma were divided into two groups at random. The observation group included 19 cases and the control group included 30 cases. Every case used one cycle chemotherapy. The observation group (IHC group) used chemotherapy and AT Ⅱ. The control group (simple chemotherapy group) used simple chemotherapy. All cases of the two groups operated after 3 weeks rest. The specimen's DNA was analyzed by flow cytometry. Results:The effective power of observation group was 63.2% (12/19), exairesis ratio was 84.2% (16/19). The effective power of control group was 30% (9/30), exairesis ratio was 63.3% (19/30). DNA ploid determination:13 cases were diploid and 5 cases were heteroploid in the observation group, 9 cases were diploid and 16 cases were heteroploid in the control group. The operative complications and risks of the two groups did not increase. Conclusion:IHC can increase the therapeutic effect of Ⅲ staging cardia or fundus of stomach carcinoma obviously. IHC is one of the chemotherapy methods that have good future. It has good value of clinic enlarge trial.     

Changes of peripheral blood lymphocyte subsets in a long-term survivor with advanced renal cell carcinoma

We present the case of an 11-year survivor with advanced renal cell carcinoma (T4N2M1). This patient received long-term interferon-alpha (IFN-α)-based immunotherapy. Measurement of peripheral blood lymphocyte subsets suggested that reduction of the IFN-α dose might be associated with a marked increase of cytotoxic T cells, suppressor T cells, activated suppressor/cytotoxic T cells, and natural killer cells among the peripheral blood lymphocytes.     

Effects of radiofrequency ablation on lymphocyte subsets and type 1/type 2 T cell subpopulations in patients with hepatocellular carcinoma

Objective  

To evaluate whether radiofrequency ablation (RFA) might have an influence on immune status in hepatocellular carcinoma (HCC) patients.     

贲门癌患者肿瘤细胞与外周血淋巴细胞体外药敏试验的相关性研究

目的:探讨贲门癌患者外周血淋巴细胞能否代替肿瘤细胞进行体外药敏试验,以指导不能行肿瘤细胞化疗药敏检测患者的临床化疗。方法:采用MTT法体外药敏试验,检测28例贲门癌患者外周血淋巴细胞和肿瘤细胞对9种临床常用抗癌药物的敏感性。结果:贲门癌患者外周血淋巴细胞与其肿瘤细胞的体外药敏试验对9种抗癌药物的敏感性差异无统计学意义,P值为0·500~1·000。两种细胞药敏试验对5-FU、DDP、CBP、MTX、Vp-16、CTX和THP敏感,对ADM不敏感。结论:贲门癌患者外周血淋巴细胞与其肿瘤细胞对化疗药物的敏感性具有良好的正相关性,外周血淋巴细胞化疗药敏检测对临床选择化疗药物具有重要参考价值。     

头颈部鳞癌同步放化疗患者外周血淋巴细胞亚群变化的研究

目的:分析头颈部鳞癌患者放化综合治疗前、后细胞的免疫功能变化,探讨放化综合治疗对头颈部鳞癌患者免疫功能的影响。方法:应用FACS Calibur流式细胞仪对46例头颈部鳞癌患者外周血T淋巴细胞亚群进行检测,并将放射疗前、中、后检测结果进行比较。结果:头颈部鳞癌患者治疗前、中、后的CD3+、CD4+、CD8+、NK细胞无明显变化,B细胞、CD4+/CD8+比值在放射治疗前后明显变化(P<0.05,P<0.05)。结论:头颈部鳞癌患者治疗前后T、B细胞亚群的检测对判断患者的免疫功能及疗效有参考作用,在同步放化疗期间应用增强免疫治疗有积极意义。     

头颈部鳞癌同步放化疗患者外周血淋巴细胞亚群变化的研究

目的：分析头颈部鳞癌患者放化综合治疗前、后细胞的免疫功能变化,探讨放化综合治疗对头颈部鳞癌患者免疫功能的影响。方法：应用FACS Calibur流式细胞仪对46例头颈部鳞癌患者外周血T淋巴细胞亚群进行检测,并将放射疗前、中、后检测结果进行比较。结果：头颈部鳞癌患者治疗前、中、后的CD3＋、CD4＋、CD8＋、NK细胞无明显变化,B细胞、CD4＋/CD8＋比值在放射治疗前后明显变化（P〈0.05,P〈0.05）。结论：头颈部鳞癌患者治疗前后T、B细胞亚群的检测对判断患者的免疫功能及疗效有参考作用,在同步放化疗期间应用增强免疫治疗有积极意义。     

贲门癌miRNA-145的表达

目的:探讨贲门癌中miRNA-145的表达特征。方法:采用Microarray流体芯片技术及荧光定量聚合酶链反应（qRT-PCR）技术检测贲门癌癌组织及癌旁组织中miRNA-145表达,分析二者差异。结果:贲门癌癌组织中miRNA-145表达水平显著低于癌旁组织（P＜0.05）。伴淋巴结转移组贲门癌癌组织的miRNA-145表达水平低于无淋巴结转移组（P＜0.05）。结论:miRNA-145可能与贲门癌的发生和转移相关。     

Prognostic factors in patients with submucosal carcinoma of the oesophagus

To clarify the prognostic factors in patients with submucosal carcinoma of the oesophagus, we examined the results of surgical treatment for 78 cases over the last decade. The clinicopathological factors including age, sex, location of the tumour, length of the tumour, histological differentiation, subclassification of depth, lymphatic or blood vessel invasion, intramural metastasis and lymph node metastasis were all analysed. Then the correlation between these factors and prognosis was investigated. As a result, significant differences were observed in the survival rates between the groups regarding lymphatic vessel invasion (P = 0.0003), intramural metastasis (P = 0.0051) and lymph node metastasis (P = 0.0026). According to a multivariate analysis, intramural metastasis (P = 0.0038, relative risk 9.17), vessel invasion (P = 0.0033, relative risk 6.25) and lymph node metastasis (P = 0.0187, relative risk 3.62) were found to be independent prognostic factors. The prognosis of the patients with at least one of these factors was significantly poorer than that without. The five-year survival rate of the patients without these factors was as good as that with mucosal carcinoma of the oesophagus. Based on our findings, vessel invasion, intramural metastasis and lymph node metastasis are thus considered to be significant prognostic factors in patients with submucosal carcinoma of the oesophagus.     

慢性淋巴细胞白血病外周血T细胞亚群及免疫球蛋白研究

 目的　分析慢性淋巴细胞白血病（CLL）患者的免疫状态及其与疾病分期的关系。方法　应用流式细胞术（FCM）分析60例B-CLL患者外周血T淋巴细胞亚群的变化，用免疫速率比浊法分析其中37例患者血清中IgG、IgA和IgM的变化，比较各Binet分期患者免疫功能的变化。结果　与正常对照组相比，60例B-CLL患者外周血中CD+3、CD+4和CD+8细胞比率均明显降低（P＜0.01），Binet B、C期组患者CD+4／CD+8比值也明显低于Binet A和正常对照组（P＜0.01）。37例B-CLL患者中有21例患者（56.8 %）出现有免疫球蛋白（Ig）减低的情况。Binet C期组Ig减低发生率高于Binet A和B期（P＜0.05），Binet C期组IgG、IgA、IgM的平均水平明显低于Binet A和B期组（P＜0.05）。结论　CLL患者存在细胞免疫和体液免疫功能的低下，与CLL病程密切相关。检测CLL患者外周血T细胞亚群及Ig水平的变化，对了解CLL免疫功能状态，从而判断病情具有重要作用。     

紫杉醇联合顺铂化疗对非小细胞肺癌患者外周血淋巴细胞表型的影响

目的：探讨紫杉醇联合顺铂化疗对非小细胞肺癌（ｎｏｎ－ｓｍａｌｌ ｃｅｌｌ ｌｕｎｇ ｃａｎｃｅｒ,ＮＳＣＬＣ）患者机体免疫功能的影响。方法：４５例经病理学或细胞学确诊的ＮＳＣＬＣ患者,采用紫杉醇、顺铂联合化疗方案,应用流式细胞仪检测ＣＤ３、ＣＤ４、ＣＤ８、ＣＤ１６、ＣＤ１９、ＣＤ２５阳性细胞的百分率。结果：ＮＳＣＬＣ患者经紫杉醇联合顺铂化疗后ＣＤ４、ＣＤ４／ＣＤ８、ＣＤ１６、ＣＤ２５较化疗前显著升高（Ｐ〈０．０５）;ＣＤ８、ＣＤ１９、ＣＤ３化疗前后无显著变化（Ｐ〉０．０５）;化疗后ＣＤ４、ＣＤ４／ＣＤ８、ＣＤ１６、ＣＤ２５、ＣＤ８、ＣＤ１９、ＣＤ３与正常对照组无显著差异（Ｐ〉０．０５）;鳞癌、腺癌及大细胞癌３组间化疗前、化疗后各项指标之间无显著性差异（Ｐ〉０．０５）。结论：紫杉醇联合顺铂化疗可改善机体的免疫功能