新辅助化疗前后系统免疫炎症指数的变化对进展期胰腺癌患者预后的临床价值

目的 确定新辅助化疗前后系统免疫炎症指数(SII)变化对进展期胰腺癌远期预后的评估价值.方法 回顾性收集2013年1月至2016年12月期间在盘锦辽油宝石花医院接受胰腺切除术前进行辅助化疗且符合本研究纳入和排除标准的进展期胰腺癌患者.收集新辅助化疗前后的实验室数据以计算SII,根据新辅助化疗后SII的变化结果将患者分为...     

胰腺癌立体定向放射治疗的临床疗效

目的 探讨立体定向放射治疗胰腺癌的近期疗效.方法 :对我院采用立体定向放射治疗107例胰腺癌患者的临床资料及随访情况进行回顾分析.结果 :治疗后症状缓解86例(86/95),107例患者中95例有疼痛或黄疸症状,2~3个月CT复查93例,肿瘤消失8例(占8.6%),肿瘤缩小34例(占36.5%),肿瘤稳定38例(占40.8%),肿瘤较治疗前增大13例(占13.9%).血液肿瘤标记物CEA、CA19-9较治疗前降低.治疗过程中胃肠道反应发生率达29.5%.生存时间1年以上有31例(31/46,67.4%).结论 :胰腺癌的立体定向放射治疗近期疗效显著,是一种安全、可靠的治疗方法.     

放射治疗在胰腺癌治疗中的应用现状和展望

胰腺癌是恶性程度很高的实体瘤之一.最新的大型流行病学研究显示,胰腺癌在中国及西方发达国家的发病率和死亡人数均有所升高,总体5年生存率仅10％左右[1].近年来,随着对胰腺癌的认识和研究不断深入,临床医师对该疾病的认知也由"局部"向"系统"转变,治疗策略也由"单纯依靠外科手术"向多学科团队联合诊疗模式下的"综合治疗"转变...     

240例胰腺癌肝转移临床特征及预后分析

目的研究胰腺导管腺癌(PDAC)肝转移患者临床与病理特征,并分析影响患者预后危险因素。方法回顾性分析2007年1月至2014年10月中山大学孙逸仙纪念医院具有完整临床病理资料PDAC肝转移病例共240例,并随访本组患者。采用Kaplan-Meier统计学方法评估患者生存情况,并用Cox单因素分析、多因素回归模型筛选影响患者预后的独立危险因素。结果在纳入本研究患者中,截至随访终点,共有227名患者死亡(94.58%),中位生存时间为5.34月。6个月,1年,3年生存率分别为36.50%、16.36%和5.39%。单因素生存分析提示年龄、CA19-9、肿瘤分化程度、T分期、化疗为预后危险因素。多因素分析显示T4分期、肿瘤低分化、未接受化疗为胰腺癌肝转移患者预后独立危险因素。结论 T4分期、肿瘤低分化程度、未接受化疗为胰腺癌肝转移患者预后独立危险因素。     

联合应用肿瘤标记物在胰腺癌诊断中的意义

目的 探讨肿瘤标记物糖链抗原199(CA 199)、肿瘤抗原242(CA 242)与癌胚抗原(CEA)联合检测对胰腺癌诊断及预后判断的意义.方法 用化学发光技术分别检测胰腺癌50例、胰腺良性疾病42例和健康体检者60例的血清CA 199、CA 242与CEA表达.结果 胰腺癌组CA199、CA 242与CEA等3种标志物血清值分别为(226.26±42.06)、(68.82±7.63)与(9.63±5.84)μg/L,均明显高于其他组(P<0.05);胰腺癌组CA 199、CA 242与CEA阳性率分别为82.61%、76.09%与60.87%,与其他两组比较.差异均有统计学意义(P<0.05);CA 199、CA 242与CEA等3项联检准确性达97.83%.CA 199与胰腺癌分期呈正相关,与患者生存期呈负相关.结论 肿瘤标志物联合检测可明显提高胰腺癌早期确诊率,CA 199对判断预后有一定参考价值.     

EphA2/EphrinAl及E-cadherin在胰腺癌中的表达及临床意义

目的 探讨EphA2、EphrinAl及E-cadherin在胰腺癌及癌旁非肿瘤组织中的表达及临床意义.方法.采用免疫组织化学EnVision二步法,检测48例胰腺癌及癌旁非肿瘤胰腺组织中EphA 2、EphrinAl和E-cadherin的表达,并分析其与临床病理因素的关系.应用log-rank检验和Cox比例风险模型分析EphA 2、EphrinAl和E-cadherin的表达与患者预后的关系.结果 EphA 2、EphrinAl和E-cadherin在胰腺癌组织和癌旁非肿瘤组织阳性表达差异均有统计学意义.Ⅲ～Ⅳ期胰腺癌EphA 2、EphrinAl强阳性染色及E-cadherin阴性染色分别为47.9%、47.9%和64.6%,显著高于Ⅰ～Ⅱ期的6.25%、8.3%和14.6%(P<0.05).E-cadherin表达阳性与阴性患者术后生存率比较差异有统计学意义(P<0.05).Cox多因素分析表明,JPS分期、EphA 2阳性表达及E-cadherin阴性表达是反映胰腺癌预后的独立指标.结论 EphA2/EphrinAl与E-cadherin蛋白表达异常可能共同参与了胰腺癌的发生、发展与转移;联合检测三种蛋白对于评价胰腺癌的预后有一定参考价值.

Abstract：

Objective To investigate the relationship between EphA2, EphrinAl and E-cadherin expressions and tumor stage and prognosis in pancreatic cancer. Method EphA2, EphrinAl and Ecadherin expressions were detected by immunohistochemistry in the tumor tissue and normal tissue specimens from 48 patients with primary pancreatic cancer. Results The expressions of EphA2 and EphrinAl were higher in the pancreatic carcinoma tissues than in the normal pancreatic tissues (P<0. 05). The E-cadherin expression was lower in the pancreatic cancer tissues than in the normal pancreatic tissues (P<0. 05). With decreasing histological differentiation, the expressions of EphA2 and EphrinAl in carcinoma tissues increased significantly (P<0. 05), while the E-cadherin expression decreased significantly (P<0. 05). The positive expressions of EphA2 and EphrinAl in the primary tumor significantly increased in stageⅢ and Ⅳ than in stage Ⅰ and Ⅱ (47. 9%vs 6. 25% , P<0. 05;47. 9% vs 8. 3%, P<0. 05), while the negative expression of E-cadherin was reversely correlated with these tumor stages (14. 6% vs 64. 6%, P<0. 05). Cox multivariate analysis showed that the clinical stage, EphA2 positive expression and E-cadherin negative expression were significantly associated with survival. Conclusion Abnormal expressions of EphA2, EphrinAl and E-cadherin were involved in the progression of pancreatic cancer and they were useful in predicting prognosis.     

HIF-1α、P-gp在胰腺癌中的表达及其临床病理学的意义

目的 检测HIF-1α、P-gp蛋白在胰腺癌组织中的表达,探讨它们的临床病理学意义及其相互之间的相关性.方法 应用免疫组织化学法检测74例胰腺癌组织,10例正常胰腺组织中HIF-1α、P-gp蛋白的表达.结果 HIF-1α、P-gp蛋白在胰腺癌组织中的阳性表达率分别为75.7%和86.5%,而正常胰腺组织中均呈阴性表达(P＜0.05).胰腺癌组织中HIF-1α和P-gp蛋白的表达呈显著正相关(r=0.304,P=0.009).胰腺癌组织中的HIF-1α蛋白表达与淋巴结转移、TNM分期呈正相关(P＜0.05);胰腺癌组织中的P-gp蛋白表达与淋巴结转移呈正相关,P-gp高表达与年龄大于60岁有关(P＜0.05).HIF-1α和P-gp蛋白高表达者的中位生存期明显短于低表达者(P＜0.05).结论 胰腺癌组织中HIF-1α、P-gp蛋白的表达上调,HIF-1α和P-gp呈正相关.胰腺癌组织中HIF-1α和P-gp蛋白的表达与淋巴结转移呈正相关.胰腺癌组织中HIF-1α和P-gp蛋白的高表达与预后差有关.

Abstract：

Objective To investigate the expression of HIF-1α and P-gp protein in pancreatic carcinoma and determine their clinicopathological significance and the correlation between the expression of HIF-1α, P-gp and the clinical prognosis. Method In samples from 74 cases of pancreatic carcinoma and 10 healthy individuals, the expression of HIF-1α and P-gp were detected by immunohistochemical method. Results The positive expression rate of HIF-1α and P-gp was 75.7% and 86.5%,respectively, which were remarkably higher than that in normal pancreatic tissue (P＜0.05). There was a positive correlation between the expression of HIF-1α and that of P-gp. The aberrant expression of HIF-1α and P-gp was associated with lymph node metastasis but not the location, size, clinical stages and nerve invasion of the tumor. Patients with high intensity of HIF-1α and P-gp expression showed a significantly lower median survival time than those with low intensity expression.Conclusions The expression of HIF-1α and P-gp is up-regulated in pancreatic carcinoma and there is a positive correlation between them. The expression of HIF-1α and P-gp might be related to the lymph node metastasis and poor prognosis.     

黏蛋白芯片在诊断胰腺癌中的临床应用

目的　制备黏蛋白检测用蛋白芯片 ,探讨该芯片用于胰腺癌血清学诊断的可行性。方法　利用黏蛋白MUC1、MUC2及MUC5AC的单抗及多抗 ,制备黏蛋白芯片 ,用化学发光原理进行检测 ,并用CEA作为指示指标 ,对 3 0例胰腺癌患者及 3 0例健康人进行黏蛋白血清水平的检测。结果　胰腺癌组与对照组比较 ,3种黏蛋白和CEA血清水平均增高 ,两组间差异有统计学意义(P <0 .0 5 )。3种黏蛋白中至少两种为阳性的联合诊断敏感性及特异性分别为 80 %和 96.67%。结论　应用蛋白芯片联合检测 3种黏蛋白 ,可以提高胰腺癌诊断的敏感性及特异性 ,并且较CEA的检测结果和临床CA19 9的检测结果为高。     

基于在线数据库分析E2F转录因子家族成员信使RNA在胰腺癌组织中表达水平及其在胰腺癌患者中的预后意义

目的:基于在线数据库分析阐明E2F转录因子家族成员mRNA在胰腺癌组织中的表达水平及其在胰腺癌患者中的预后意义。方法:利用基因表达谱交互式分析(GEPIA)在线分析数据库,采用Mann-Whitney U检验及Kaplan-Meier生存分析的统计学方法分别分析E2F转录因子家族成员mRNA在179例胰腺...     

LAMA3在胰腺癌中的表达及其临床意义

目的 探讨层粘连蛋白3（laminin 3,LAMA3）在胰腺癌患者中的表达,并分析其临床意义。方法 采用回顾性分析法收集温州医科大学定理临床学院2011年5月至2018年12月胰腺癌病例40例,利用免疫组化、qRT-PCR、Western blotting等方法检测胰腺癌患者手术切除癌组织及癌旁正常组织的LAMA3表达情况,分析LAMA3表达与临床病理特征及肿瘤预后的相关性。利用GEO及Oncomine生物信息数据库验证LAMA3在胰腺癌组织中的表达情况。结果 免疫组化检测结果表明胰腺癌组织中的LAMA3蛋白高表达率比癌旁组织中显著升高（60.0% vs 25.0%,χ² =10.026,P＜0.05）。LAMA3蛋白表达与肿瘤大小、TNM分期显著相关（χ² =9.184,7.111,P＜0.05）,与性别、年龄、CA199、分化程度、淋巴结转移等因素无明显相关（P＞0.05）。生存分析表明LAMA3高表达提示预后不良（P＜0.05）。对GEO及Oncomine数据库分析显示,与正常癌旁组织相比LAMA3在胰腺癌组织中呈明显高表达（GSE16515,P＜0.0001;GSE15471,P＜0.0001;GSE3654,P＜0.0001）。结论 本研究表明LAMA3在胰腺癌组织中表达上调,其表达情况与患者的肿瘤大小、TNM分期显著相关,LAMA3可能是胰腺癌预后不良的预测因子。     

胰腺癌新辅助化疗进展

胰腺癌目前仍然是临床非常棘手的问题,但在一些胰腺外科中心通过手术切除改善了胰腺癌的预后.目前已有结果提示新辅助治疗对胰腺癌患者安全,且能够显著提高手术切除率.但新辅助治疗与手术治疗、术后辅助治疗及姑息治疗相比较其疗效如何,到目前为止,尚缺少高质量的循证医学证据,也没有关于胰腺癌新辅助化疗或放化疗与外科手术后系统化疗间比较的随机对照研究.需要设计完善的随机对照研究对比新辅助化疗和手术治疗,以此来评价新辅助化疗在胰腺癌多种治疗方案中的价值.     

局部进展期胰腺癌术前介入治疗新方法的应用

目的　通过术前联合化疗药物区域性动脉灌注介入治疗 ,探讨局部进展期胰腺癌介入治疗新方法应用的疗效。方法　 94例局部进展期胰腺癌患者术前进入介入治疗组和未介入治疗组 ,观察介入治疗前后肿瘤大小的改变、疼痛缓解率、血清肿瘤标志物的变化和副反应程度 ,通过免疫组化法检测介入治疗对肿瘤细胞凋亡和凋亡基因bcl 2、bax表达的影响 ,并比较两组患者手术切除率。结果　术前介入组和未介入组的手术切除率分别为 4 6 .8%和 2 3.3% (P <0 .0 5 ) ;术前介入治疗组肿瘤细胞调亡明显增加 ,肿瘤细胞bcl 2基因表达明显减少 ,而bax基因的表达显著增加 (P <0 .0 5 ) ;介入治疗能显著降低血清肿瘤标志物水平 ,并能明显缓解患者疼痛 (缓解率为 6 8.6 % ,P <0 .0 5 )。结论　术前介入治疗对胰腺癌肿瘤细胞有明显的杀伤和诱导凋亡作用 ,有助于提高手术切除率和改善患者疾病相关症状 ,是胰腺癌综合治疗的有效措施之一     

胰腺癌根治切除术308例分析

目的回顾分析复旦大学中山医院胰腺肿瘤外科308例胰腺癌根治切除术的临床诊治情况。方法自2001年1月至2005年12月，收治胰腺癌539例，手术491例，行根治性切除术308例（切除率62．7％），其中根治性胰十二指肠切除222例，胰体尾切除69例，全胰切除17例。结果术后发生并发症77例（25％），其中，胰瘘8例（2．6％）。胆瘘23例（7．5％），胃潴留17例（5．5％），上消化道出血6例（1.9％），肺部感染8例（2．6％），切口裂开4例（1．3％），腹腔内出血4例（1.3％）。死亡7例（2．3％）。结论成立胰腺肿瘤专业组后，年收治病人成倍数增加，根治性切除率明显提高。手术死亡率则明显降低。坚持“善待胰腺”的“微创”原则，即尽量减少胰腺组织不必要的创伤及胰管内引流是降低胰瘘发生率的关键。     

Prognostic factors for long-term survival in patients with locally invasive pancreatic cancer

Background/Purpose We aimed to investigate predictors of survival in patients with resectable locally invasive pancreatic cancer. Methods The patient cohort consisted of 55 patients with locally invasive pancreatic cancer (International Union Against Cancer [UICC] stage III in 36 patients and stage IV in 19) who had undergone resection. The patients were informed about the advantages and the adverse effects of postoperative chemotherapy, and prospectively selected either observation alone or postoperative chemotherapy. The postoperative chemotherapy regimen options were: (1) intraarterial chemotherapy alone, (2) systemic chemotherapy alone, or (3) intraarterial chemotherapy combined with systemic chemotherapy. Results Overall 1-year and 2-year survival rates after resection were 40.5% and 13.5%, respectively. Median survival time was 10.9 months. Twenty-nine patients (52.7%) received postoperative chemotherapy. On univariate analysis, only postoperative chemotherapy was associated with long-term survival (P < 0.01). In the patients with postoperative chemotherapy, the 1-year survival rate and MST were 61.7% and 16.3 months, compared with 20.1% and 7.9 months in the patients without postoperative chemotherapy. Multivariate analysis also showed that only postoperative chemotherapy was identified as an independent survival factor. Conclusions It was suggested that postoperative chemotherapy was essential for the improvement of survival in patients with locally invasive pancreatic cancer.     

Molecular alterations associated with improved survival in pancreatic cancer patients treated with radiation or chemotherapy

Multiple genetic alterations, several of which may be important prognostic markers, characterize the development of cancer in pancreas. We review our findings from previously published studies with regard to molecular alterations associated with survival differences in patients treated with conventional radiation and chemotherapies used as adjuvant or palliative therapy. K-ras-negative patients with pancreas cancer show improved survival with radiation therapy compared to K-ras-positive patients with pancreas cancer. p53 expression is associated with shorter survival when compared to no p53 expression in pancreas cancer patients treated with radiation therapy or chemotherapy. Pancreas cancer patients whose tumors express p21 show significant survival advantages when treated with chemotherapy or radiation therapy. An inverse relationship is observed with respect to p21 and p53 expression and clinical stage. Although stage and surgical resectability remain the most important variables with respect to pancreas cancer survival, these findings suggest promising opportunities for gene therapies designed to enhance p21 expression or restore wild-type K-ras or p53 function in pancreatic tumors. Received for publication on June 17, 1998; accepted on July 27, 1998     

不可逆电穿孔同步化疗治疗局部进展性胰腺癌

目的 探讨不可逆电穿孔(IRE)同步化疗治疗局部进展期胰腺癌(LAPC)的安全性及有效性。方法 对2016年10月至2018年1月收治于广州复大肿瘤医院的30例LAPC患者的临床资料进行回顾性研究,所有患者在IRE消融开始前均静脉滴注吉西他滨30 min,IRE术后2周进行常规静脉滴注吉西他滨联合替吉奥化疗方案。结果 术后90 d内未发生与IRE相关的死亡病例。中位随访时间为23.8个月(3.5～36.4个月),联合治疗后的中位总生存期为20.5个月(诊断)和17.1个月(IRE术后)。在1、3和6个月的客观反应率(ORR)分别为93.3%、83.3%、66.7%。发生了4例严重不良反应,其中2例胰腺炎、1例严重中性粒细胞减少和1例胃十二指肠动脉出血,经对症治疗后均得到缓解。结论 IRE同步化疗治疗LAPC有效且耐受性良好,为LAPC患者提供了一种潜在的治疗策略。     

The feasibility of dose escalation using concurrent radiation and 5-fluorouracil therapy following pancreaticoduodenectomy for pancreatic carcinoma

We evaluated the feasibility of dose escalation using external beam radiation therapy (RT) and 5-fluorouracil (5-FU) following pancreaticoduodenectomy for pancreatic carcinoma. Fourteen patients who underwent pancreaticoduodenectomy for stage I–III adenocarcinoma of the pancreas received postoperative high-dose chemoradiation. RT was given at 1.8-Gy daily fractions to total doses of 54 Gy for patients with negative surgical margins (n = 12), and 64.8 Gy for those with gross residual disease (n = 2). Concurrent 5-FU was given as a continuous infusion (CI) at 225 mg/m² per day (n = 9) beginning or day 1 and continuing until the completion of RT, or by bolus injection at 500 mg/m² per day (n = 5) during weeks 1 and 4 of RT. Follow-up ranged from 32 to 36 months (median, 35 months). All patients were able to complete the planned high-dose postoperative chemoradiation and none required a treatment break. No grade 4 acute toxicity was observed. Grade 3 acute toxicity was limited to 2 patients. Two patients developed grade 3 (n = 1) or 4 (n = 1) subacute toxicity, all gastrointestinal-related. There have been no fatal toxicities and no grade 3 or 4 late toxicity has been observed. The 3-year survival is 21%. Dose escalation of postoperative 5-FU chemoradiation following pancreaticoduodenectomy for pancreatic carcinoma is well tolerated. Further dose-intensification of postoperative adjuvant therapy in these patients appears feasible and is being evaluated in a recently activated national trial. Received for publication on Feb. 16, 1999; accepted on June 10, 1999     

Spontaneous rupture of varicocele testis associated with advanced pancreatic cancer

We report a rare case of strain-induced spontaneous rupture of varicocele associated with renal vein involvement by advanced pancreatic cancer. Computed tomography and color Doppler sonography yielded the correct diagnosis and the patient could maintain quality of life without surgery for acute scrotum.