宫颈鳞状细胞癌组织uPA、VEGF、Ki-67的表达在预测新辅助化疗远期疗效中的作用

目的探讨老年原发性宫颈鳞状细胞癌患者新辅助化疗前后主要肿瘤标志物尿激酶型纤溶酶原激活物(u PA)、血管内皮生长因子(VEGF)、肿瘤细胞增殖指数(Ki-67)的表达变化与远期疗效的关系。方法选取ⅠB2~ⅡB期原发性老年宫颈鳞状细胞癌患者32例,分别于新辅助化疗前和2个疗程结束当日采用免疫组织化学SP法检测主要肿瘤标志物的表达情况;跟踪随访10~18个月,记录患者预后情况。结果新辅助化疗两个疗程后,u PA、VEGF、Ki-67的阳性表达率明显低于化疗前(P0.05)。化疗前u PA、VEGF为阴性的患者治疗有效率明显高于u PA、VEGF阳性患者(P0.05);化疗前Ki-67为阳性的患者治疗有效率明显高于Ki-67阴性患者(P0.05)。结论 u PA、VEGF、Ki-67表达反映老年宫颈鳞状细胞癌新辅助化疗疗效的敏感性较佳,化疗前u PA、VEGF阴性、Ki-67阳性的患者可获得较好的远期预后效果。     

新辅助化疗对宫颈鳞状细胞癌CK5/6和p63蛋白表达的影响

目的探讨新辅助化疗对宫颈鳞状细胞癌(鳞癌)CK5/6和p63蛋白表达的影响。方法对48例临床ⅠB-ⅡB期宫颈鳞癌患者行以顺铂为基础的新辅助化疗3周期,其后3周行手术治疗,观察临床疗效及病理组织学疗效;用免疫组织化学方法检测癌组织化疗前后CK5/6和p63表达情况。结果新辅助化疗临床总有效率为56%(27/48),病理组织学总有效率为50%(24/48),48例患者化疗前癌组织均弥漫表达CK5/6和p63,阳性表达率均为100%,化疗后有癌残留的46例患者癌组织均表达CK5/6和p63,阳性率均为100%(P≥0.05),但阳性表达强度均弱于化疗前。结论新辅助化疗对宫颈鳞癌特异性标记物CK5/6和p63表达无显著影响,CK5/6和p63可用于形态学难确诊的化疗后宫颈鳞癌的诊断与鉴别诊断。     

40例子宫颈癌患者新辅助化疗前后癌组织NF-κB p50、NF-κB p65表达及意义

目的 寻找预测子宫颈癌新辅助化疗效果的分子生物学指标.方法 采用real time RT-PCR和免疫组织化学法检测40例子宫颈癌患者新辅助化疗前后癌组织中NF-κB p50、NF-κB p65表达水平.结果 新辅助化疗后子宫颈癌组织中p50、p65表达水平明显升高(P均<0.01);化疗总有效率为72.5%,化疗效果与临床分期、病理分级无关(P>0.05);NF-κB阴性化疗者有效率高于阳性者(P<0.05).结论 NF-κB表达状态有可能作为预测化疗效果的参考指标.     

术前新辅助化疗辅助治疗中晚期宫颈癌疗效观察

目的观察术前新辅助化疗辅助治疗中晚期宫颈癌的疗效。方法采用新辅助化疗辅助治疗46例Ⅱb~Ⅲb期巨块型宫颈癌患者。结果 17例患者化疗后符合宫颈癌根治术指征,均行广泛性的子宫切除＋盆腔淋巴结清扫术。术后随访6~36个月,未出现局部复发病例,仅有2例发生淋巴转移。结论中晚期宫颈癌术前行新辅助化疗能有效的降低宫颈癌分期,达到宫颈癌根治手术的标准,且术后疗效良好。     

新辅助化疗对直肠癌患者肿瘤标记物及免疫功能的影响

目的探讨II、III期直肠癌单纯新辅助化疗对肿瘤标记物及免疫功能的影响。 方法分析我院31例II、III期直肠癌单纯新辅助化疗患者数据,并在化疗前后给予监测肿瘤标记物及免疫功能。 结果本组31例患者前后对比肿瘤标志物CEA(P＝0.049)、CA242(P＝0.048)有显著性差异;而CA199未见显著性差异(P＝0.252)。免疫功能中仅B细胞有显著性差异(P＝0.044),其余总T细胞、辅助T细胞、细胞毒性T细胞、CD4/CD8、自然杀伤细胞、调节性T细胞均未见显著性差异。 结论新辅助化疗可以显著降低II、III期直肠癌患者肿瘤标志物CEA、CA242;而对细胞免疫功能无影响,仅降低B细胞功能。     

新辅助化疗对肺癌患者肿瘤标记物及免疫指标的影响

目的观察术前行新辅助化疗对A期非小细胞肺癌患者的影响。方法142例A期非小细胞肺癌患者随机分为两组。实验组:先给予两个疗程的新辅助化疗,3周后行手术治疗,化疗方案为MVP或NVB DDP方案;对照组:确诊后直接行手术治疗。结果实验组术后心律失常发生率高于对照组,其余术后并发症发生率无显著差异(P>0.05);术后实验组NK细胞水平低于对照组(P<0.05),其余各项免疫指标无显著性差异(P>0.05)。实验组术后血清肿瘤标记物水平低于对照组(P<0.05)。结论新辅助化疗作为治疗A期非小细胞肺癌的一种方法是安全的,对患者免疫功能和术后并发症发生率的影响较小,并能明显降低患者术后血清肿瘤标记物水平。     

新辅助化疗对宫颈癌患者 OPN和 MMP-9表达的影响

目的：探讨新辅助化疗对宫颈癌患者骨桥蛋白（OPN）和基质金属蛋白酶-9（MMP-9）表达的影响。方法对81例宫颈癌患者采用紫杉醇联合顺铂进行新辅助化疗,2个疗程后评价疗效和安全性,采用免疫组化法测定肿瘤组织中的OPN和MMP-9表达。结果化疗2个疗程的总有效率为79．0％,不良反应包括贫血、白细胞减少、血小板减少、神经毒性、肝肾功能损害、恶心呕吐等。化疗前肿瘤组织中OPN和MMP-9的表达阳性率分别为88．9％和84．0％,化疗后分别为13．6％和12．3％,化疗前后比较均有统计学差异（P均＜0．01）。化疗前OPN阳性者化疗总有效率为77．8％,阴性者为88．9％;化疗前MMP-9阳性者化疗总有效率为77．9％,阴性者为84．6％;化疗前OPN阴性、MMP-9阴性的患者化疗效果更理想（P均＜0．05）。结论对宫颈癌患者进行新辅助化疗可以明显降低OPN和MMP-9的表达,二者的表达程度与化疗效果有关。     

CAF短周期密集方案新辅助化疗在乳腺癌中的应用

目的探讨CAF方案在乳腺癌短周期密集新辅助化疗中的安全性、近期疗效以及对手术方式的影响。方法36例乳腺癌患者采用短周期密集CAF方案化疗2周期。结果完全缓解2例,部分缓解26例,总有效率77·8%,毒副作用主要为不同程度的脱发、胃肠道反应,如恶心、呕吐,骨髓抑制主要是白细胞下降,对症治疗后缓解,不影响手术治疗。结果CAF方案在乳腺癌短周期新辅助化疗中,可以使肿块明显缩小,提高手术切除率,增加化疗的敏感性,指导术后化疗,毒副作用可为患者所耐受,由于周期较短,可减少外科手术治疗前的时间。     

Ki-67在新辅助化疗乳腺癌中的表达及意义

目的探讨Ki-67在新辅助化疗乳腺癌中的表达及意义。方法采用新辅助化疗TE方案对42例Ⅱa～Ⅲb期乳腺癌患者治疗2周期,化疗前（粗针穿刺）、化疔后（手术切除标本）获取乳腺癌组织进行病理诊断,同时用免疫组化方法检测Ki-67表达。结果Ki-67表达阳性者化疗有效率为71．9％,阴性者化疗有效率为28．1％,二者比较有统计学差异（P〈0．05）;化疗前Ki-67阳性表达率61．9％（26／42）,化疗后为35．7％（15／42）（P〈0．05）。结论Ki-67表达水平是乳腺癌TE方案新辅助化疗疗效的重要预测因子,阴性者对TE方案疗效欠佳。     

Resection of hepatocellular carcinoma with tumor thrombus of the portal vein after neoadjuvant regional chemotherapy

We report a successfully managed case of far‐advanced hepatocellular carcinoma (HCC) by intraarterial infusion therapy. A 55‐year‐old man was admitted to our hospital with abdominal pain and subileus. Abdominal ultrasonography, computed tomography, and angiography revealed HCC with obstruction of the main portal vein due to tumor thrombus. Serum levels of α‐fetoprotein (AFP) and protein induced by vitamin K absence or antagonist‐II (PIVKA‐II) were elevated. Neoadjuvant chemotherapy was tried with a course of low‐dose cisplatin (CDDP) +5‐fluorouracil (5‐FU) intrahepatic arterial infusion through the indwelling catheter via the subcutaneous reservoir port. After 7 weeks of administration (total dose CDDP 370 mg/5‐FU 18.5 mg), the main tumor size was effectively reduced. Serum levels of AFP and PIVKA‐II decreased markedly. Adverse effects were tolerated. Following the chemoinfusion therapy, posterior segmentectomy and thrombectomy were performed. Reconstruction of the portal vein was not necessary because we removed the tumor thrombus without resecting the portal vein. The postoperative course was uneventful, and the patient has been doing well more than 2 years after surgery, with no evidence of recurrence or metastasis. Preoperative low–dose CDDP +5‐FU intrahepatic arterial infusion therapy in combination with hepatic resection may be an effective treatment for advanced HCC with portal vein tumor thrombus.     

食管癌新辅助放化疗患者血清肿瘤标记物水平动态变化及意义

目的：探讨血清肿瘤标记物水平动态变化判断食管癌新辅助放化疗患者疗效及预后的价值。方法对30例行新辅助放化疗食管癌切除术患者的血清细胞角化素蛋白片段19（ CYFRA21-1）、癌胚抗原（ CEA ）及糖链抗原19-9（CA19-9）水平行动态观察,分析其变化与临床疗效及预后的关系。结果治疗前CEA阳性者中位生存期明显短于CEA阴性者,P＜0．05;CA19-9阳性者中位生存期短于CA19-9阴性者（但因阳性例数过少,无法行统计学处理）;CYFRA21-1阳性与阴性者中位生存期无统计学差异。治疗过程中标志物呈下降趋势者中位生存期长于、有效率高于呈上升趋势者,P均＜0．05。结论对食管癌新辅助放化疗患者血清CYFRA21-1、CEA及CA19-9联合动态及变化趋势检测,可评价治疗效果及判断预后。     

Subtotal hepatectomy following neoadjuvant chemotherapy for a previously unresectable hepatocellular carcinoma

An awareness of variant hepatic vascular anatomy provides vital information in the preoperative evaluation of patients with hepatocellular carcinoma. The authors present a patient with unresectable hepatocellular carcinoma who responded to combination systemic and regional chemotherapy. Because of the presence of an enlarged inferior right hepatic vein, the patient subsequently underwent successful subtotal hepatectomy with resection of all three main hepatic veins. This case illustrates that the combination of innovative neoadjuvant chemotherapy and well-planned surgical approaches may benefit a small number of patients previously deemed unresectable.     

肝细胞癌肿瘤标志物的研究进展

肿瘤标志物检测是目前协助诊断、监测肝细胞癌(HCC)及评估预后的重要方法之一。总结了肿瘤标志物对HCC的诊断、预测肿瘤生物学特性及预后等方面的价值,以及多项肿瘤标志物联合诊断的价值。新的肿瘤标志物不断被发现,有助于提高HCC的早期诊断率和评估治疗效果。     

Neoadjuvant chemotherapy in locally advanced cervical cancer: two randomised studies

Between August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIBIV A were randomised (study 1) to receive either two cycles of bleomycin, ifosfamide-mesna and cisplatin (BIP) chemotherapy (CT) followed by radiotherapy (RT) ‘CT-RT Group’ a=94 or RT alone, RT Group n=90. In the ‘CT-RT Group’, of evaluable 89 patients, 64 responded: complete response (CR) four (4.5%) and partial response (PR) 60 (67.5%). Of the remaining 25 patients 23 had stable disease and two progressed. Eighty of 89 patients completed RT as planned. Following RT 56 (70%) achieved CR, 19 (23.7%) had residual disease and five (6.3%) had progressed. Patients aged>45 and those with Hb >10 gm/dL had significantly better response to CT. Further, CT responders had a better response to RT; 83% (49/59) vs 33.3% (seven/21), p<0.01. In the ‘RT Group’ 88 patients were evaluable; 61 (69.3%) patients achieved CR, 25 had residual disease and two progressed. The estimated overall survival at 48 months in the ‘CT-RT Group’ and the ‘RT Group’ is 38%+2.01 (SE) and 36%+1.85 (SE), p=0.59 respectively. In a subsequent randomised study (study 2) 36 patients with stage III B cervical cancer received three cycles of BIP (as above) followed by RT vs 36 patients who received RT alone. In the ‘CT RT Group’ 29 patients responded; CR-8 (22.2%>), PR-21 (58.3%). Six patients had no response to CT and one patient died of CT toxicity. Following RT - 24 of 35 (68.6%) patients achieved CR, eight had residual disease and three patients progressed while on RT. In the ‘RT Group’ - 21 of 36 (58.4%) achieved CR, 12 had residual disease and three progressed. Estimated survival was 71%> in the ‘CT-RT Group’ and 69% in the ‘RT Group’, p=ns. Nausea/vomiting, alopecia, grade I-II myelosuppression, diarrhoea and mucositis were the major side effects of CT. Three patients died of CT toxicity - two in study 1 and one in study 2. Cystitis, proctitis and local skin reaction after RT occurred equally in the two groups in both the studies. BIP CT prior to RT in patients with locally advanced cervical cancer results in a high response rate. Response to CT predicts response to RT. There is no increase in the toxicity to subsequent RT. Our studies have failed to demonstrate any significant difference in overall and disease-free survival when neoadjuvant CT is added prior to the standard RT regimen.     

宫颈上皮内瘤变、宫颈癌中乙酰肝素酶的表达及意义

目的 探讨乙酰肝素酶在宫颈黏膜上皮内瘤变与宫颈癌中的表达及其意义.方法 采用免疫组化SP法检测乙酰肝素酶在56例宫颈黏膜上皮内瘤变(轻度12例,中度26例,重度18例)、54例宫颈癌(伴有淋巴结转移的20例,不伴淋巴转移34例)中的表达.结果 乙酰肝素酶在宫颈黏膜上皮轻、中、重度上皮内瘤变组织中表达率分别为33.33%,38.48%,44.44%,宫颈癌中表达率为48.14%.乙酰肝毒酶在宫颈黏膜上皮内瘤变与宫颈癌中的表达无统计学意义(P＞0.05).20例宫颈癌伴淋巴结转移者,乙酰肝素酶表达(70.00%)明显高于无转移组(35.29%),P＜0.01.结论 乙酰肝素酶表达与宫颈癌发生、发展无关,与宫颈癌组织淋巴结转移有关.     

Assessment of changes in tumor heterogeneity following neoadjuvant chemotherapy in primary esophageal cancer

To assess the changes in computed tomography (CT) tumor heterogeneity following neoadjuvant chemotherapy in esophageal cancer. Thirty‐one consecutive patients who received neoadjuvant chemotherapy for esophageal cancer were identified. Analysis of primary tumor heterogeneity (texture) was performed on staging and post‐chemotherapy CT scans. Image texture parameters (mean grey‐level intensity, entropy, uniformity, kurtosis, skewness, standard deviation of histogram) were derived for different levels of image filtration (0–2.5). Proportional changes in each parameter following treatment were obtained. Comparison between pathological tumor response and texture parameters was analyzed using Mann–Whitney U‐test. The relationship between CT texture and overall survival) was estimated using the Kaplan–Meier method. Tumor texture became more homogeneous after treatment with a significant decrease in entropy and increase in uniformity (filter 1.0 and 2.5). Pretreatment (filter 1.5, P = 0.006) and posttreatment standard deviation of histogram (filter 1.0, P = 0.009) showed a borderline association with pathological tumor response. A proportional change in skewness <0.39 (filter 1.0) was associated with improved survival (median overall survival 36.1 vs. 11.1 months; P < 0.001). CT tumor heterogeneity decreased following neoadjuvant chemotherapy and has the potential to provide additional information in primary esophageal cancer.