原发韦氏环非霍奇金淋巴瘤治疗和预后分析

目的 分析原发韦氏环非霍奇金淋巴瘤（NHL）的临床疗效及预后.方法 回顾性分析陕西电子四〇九医院于2004年3月至2010年3月收治的40例Ⅰ～Ⅱ期韦氏环NHL患者,其中弥漫大B细胞型淋巴瘤36例,NK/T细胞型淋巴瘤3例,结外黏膜组织相关淋巴瘤1例.根据治疗方法不同分为综合治疗组和单纯放疗组.综合治疗组25例,治疗采用CHOP方案化疗联合受累野放疗.单纯放疗组15例采用受累野单纯放疗.近期疗效根据恶性淋巴瘤Cheson疗效判定标准.结果 40例患者均可评价疗效,近期总有效率为100%.综合治疗组3年生存率为84%,单纯放疗组3年生存率为66.7%.结论 CHOP方案化疗合并受累野照射治疗Ⅰ～Ⅱ期韦氏环NHL的疗效较好,放射不良反应轻.对于化疗抗拒或不能耐受化疗的早期患者,仍可以考虑单纯放疗.     

原发性心脏血管肉瘤的诊疗进展

原发性心脏肿瘤极为少见,由于缺乏特异性症状及体征,早期诊断困难,导致患者就诊时往往已进入疾病晚期,无法进行根治手术及治疗,因而预后极差。目前认为手术联合放疗、化疗的多学科综合治疗有助于控制肿瘤,改善患者预后。现通过复习相关文献,就原发性心脏血管肉瘤的发病率、诊断、治疗现状及预后进行综述,以期提高对该瘤的认识。     

结节性淋巴细胞为主型霍奇金淋巴瘤研究进展

结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)原发于单克隆性B细胞,免疫组织化学特征包括淋巴肿瘤细胞(BCL6、CD20)及微环境细胞(CD23、IgD、PD1)的标志。NLPHL转化为侵袭性淋巴瘤前后的肿瘤细胞可能源于共同的前体细胞,10年累计转化率为7%～12%,并随着时间的增加而增加。目前ⅠA或ⅡA期NLPHL治疗标准方案为受累野放疗,但ABVD方案治疗在临床研究中已初步显示出优势,认为利妥西单抗应用于初治和复发NLPHL的患者均可得到较好疗效。然而转化淋巴瘤对治疗反应性较未转化者差,尚无标准治疗方案。     

34例淋巴瘤骨髓浸润患者治疗与预后分析

目的 探讨淋巴瘤骨髓浸润患者的治疗与预后。方法 34例淋巴瘤骨髓浸润患者分为单纯化疗组、化疗+放疗组、大剂量化疗+自体干细胞移植组进行治疗,长期随访,分析其预后状况。结果 全组中位生存期为20个月;1年和3年生存率分别为76.47％和26.47％,最初疗效为完全缓解和部分缓解患者的1年和3年生存率均大于未缓解患者(P<0.05);大剂量化疗+自体干细胞移植组的3年生存率大于单纯化疗组和化疗+放疗组(P<0.05)。结论 淋巴瘤骨髓浸润患者的生存率与最初疗效有关;大剂量化疗+自体干细胞移植能提高其生存率,改善预后。     

非白血病性粒细胞肉瘤临床分析

目的 探讨非白血病性粒细胞肉瘤的临床特点和治疗方法。方法回顾性分析12例非白血病性粒细胞肉瘤患者的临床资料,其中手术或放疗联合化疗5例,单纯化疗4例,自体干细胞移植1例,放疗加手术1例,单纯手术1例。化疗的患者均采用类似治疗非霍奇金淋巴瘤的方案（CHOP或DICE方案）。5例曾误诊为非霍奇金淋巴瘤．免疫组化检查后明确诊断。结果随访期间5例患者在治疗后由非白血病性粒细胞肉瘤转化为急性髓系白血病（AML）,其中未接受化疗者2例,即只接受了局部手术或放疗者均转化为AML,由非白血病性粒细胞肉瘤转化为急性髓系白血病的中位间隔时间为6个月（3-10个月）。12例患者中位生存时间为11个月（4～35个月）。结论非白血病性粒细胞肉瘤误诊率高．免疫组化对于明确诊断十分重要：宜采用强有力的抗白血病样的化疗方案进行治疗以提高其生存率。     

57例原发鼻腔NK—T细胞淋巴瘤临床分析

目的探讨原发鼻腔NK—T细胞淋巴瘤临床特征、治疗及影响预后因素。方法收集蚌埠医学院附属医院1995年1月-2003年7月收治的原发鼻腔NK—T细胞淋巴瘤57例,按照AnnArbor分期标准,ⅠE期30例,ⅡE期21例,Ⅲ期4例,Ⅳ期2例。单纯放疗27例,放化疗30例。结果全组中位生存62个月,5年总生存率单纯放疗组、放化疗联合治疗组分别为64．0％、56．0％;中位生存期分别为64个月、61个月,差异无统计学意义（P〉0．05）。分析显示,硬腭和／或鼻中隔穿孔、PS评分、发热等B症状与预后关系密切,AnnArbor分期仍然是影响生存率的主要因素（P〈0．05）。结论原发鼻腔NK／T细胞淋巴瘤早期治疗是关键,放疗联合化疗未改善预后。     

原发皮肤间变大细胞淋巴瘤临床诊治分析

目的 探讨原发皮肤间变大细胞淋巴瘤(PCALCL)的临床表现、治疗及预后特点.方法 回顾性分析中国医学科学院肿瘤医院1999年1月至2009年1月收治的10例PCALCL患者的临床资料.结果 中位发病年龄48岁(22～69岁),男8例,女2例.皮损单发患者7例,多发3例.初期皮损呈红色皮下结节,质地较硬,多固定,部分皮损可呈自限性或反复出现,增大后可出现表面溃疡,呈菜花状.皮损可位于头颈部(5例)、躯干(3例)或全身各处(2例).有2例淋巴结受侵和1例骨受侵,骨受侵者有间变大细胞淋巴瘤激酶(ALK)阳性和细胞增殖指数偏高(ki-67＞80%).初始治疗:7例单发病灶患者采用手术切除后进行放疗、化疗或化放疗,除1例复发外,6例均无病生存;3例多发病灶患者采用化疗联合放疗或生物治疗,2例复发,1例无病生存.中位随访44个月(9～95个月)时,患者的无进展生存率为89%,总生存率为100%.结论 PCALCL多见于中年男性,不易侵犯内脏器官和淋巴结.病变局限性者,经治疗预后好;病变广泛者即使采用手术、放疗联合化疗,多数仍不能治愈.     

血管内大B细胞淋巴瘤17例临床分析

目的 分析血管内大B细胞淋巴瘤的临床特点、治疗及预后。方法 回顾性分析四川大学华西医院血液科2009年2月至2015年7月诊治的17例血管内大B细胞淋巴瘤患者的临床资料,并进行生存分析。结果 纳入患者17例,男10例,女7例,发病年龄24~83岁,平均53岁;反复发热是患者最常见的首发症状（76.5%）,骨髓是最易累及的部位（64.7%）,临床分期多为ⅣB期（70.6%）,常合并噬血细胞综合征（29.4%）。R-CHOP（利妥昔单抗、环磷酰胺、表阿霉素、长春地辛、强的松）或CHOP方案化疗（10例）可以显著改善患者的生存时间（与未治疗的7例患者相比,P=0.000 2）。骨髓受累的患者治疗后易复发。结论 血管内大B细胞淋巴瘤侵袭性强,预后差。R-CHOP方案化疗可以显著改善患者的预后,治疗后获得完全缓解的患者进行自体造血干细胞移植,可能在长期生存上获益。     

宫颈癌前期调强放疗与常规体外照射疗效比较

目的比较宫颈癌前期调强放疗与常规体外照射疗效。方法选择2009年9月—2010年9月在临沂市肿瘤医院初治宫颈癌患者80例的临床资料进行回顾性分析。结果前期调强组总生存率（66.8%）明显高于常规放疗组（30.4%）（P=0049）;常规放疗局部肿瘤消退时间（6.86±1.74）明显低于前期调强组（4.19±1.54）（P〈0.01）;前期调强组急性膀胱直肠反映发生率明显低于常规组（P〈0.05）;阴道狭窄骨髓抑制、晚期放疗反应均差异无统计学意义（P〉0.05）。结论前期调强放疗可提高初治宫颈癌患者近期生存率及局部肿瘤控制率,并能减轻患者的部分急性放射性损伤。     

原发于甲状腺的恶性淋巴瘤

目的探讨原发于甲状腺的恶性淋巴瘤的临床过程。方法分析、总结4例原发于甲状腺的恶性淋巴瘤病人的治疗过程，并复习相关文献。4例病人中男性1例．女性3例。年龄均〉60岁。Ⅰ期3例，Ⅱ期1例。均为B细胞来源。4例患者均接受了手术、化疗和放疗的综合治疗。2例行甲状腺全切除术，1例行甲状腺次全切除术，1例行肿瘤活检术。化疗方案采用CHOP方案，放疗量44-56GY，中位剂量50GY。结果1例患者放疗后2a死于肿瘤全身广泛侵犯。另3例患者至今仍无瘤生存，生存期分别为4、6及7a。均长期口服甲状腺片，2例出现甲状腺功能减低。结论原发于甲状腺的恶性淋巴瘤主要为B细胞来源的非霍奇金淋巴瘤，治疗宜采取综合治疗。年龄及期别影响其预后。     

ⅠB-ⅡA期宫颈小细胞癌的临床特点和治疗

目的分析探讨早期期宫颈小细胞癌（SCCC）的临床特点及其治疗和预后,为临床进一步了解SCCC提供帮助。方法对于肿瘤直径大于4cm的患者先行2～3个疗程的新辅助化疗,化疗方案为EP（铂类＋VP16）或VAC（长春新碱＋阿霉素＋环磷酰胺）,手术方式为子宫广泛性切除加盆腔淋巴结清扫,如有腹主动脉旁淋巴结肿大则行腹主动脉旁淋巴结切除,术后辅助化疗4～5个疗程,化疗方案仍为EP或VAC,部分患者辅助放疗。结果ⅠB1期10例、ⅠB2期2例、ⅡA期8例,深间质浸润、脉管及淋巴结转移率分别为55％、40％、25％;Syn、NSE、CgA阳性率分别为75％、90％、80％,CerB2、p53阳性率分别为30％、35％。单纯放疗及手术治疗各1例,术前接受新辅助化疗5例,术后辅助化疗3例,辅助放疗或同步放化疗15例。平均随访36个月,11例患者出现淋巴结和远处转移,2、3年生存率分别为75％和50％,平均生存期417个月。结论SCCC以手术治疗为主,但术后深间质浸润、脉管、淋巴转移率高,常早期发生远处转移,预后较差,术后根据具体情况进行相应的放化疗可以一定程度的改善预后。     

以手术为主的综合疗法治疗结直肠癌伴肝转移患者的疗效评价

目的：评价结直肠癌肝转移患者以手术为主综合治疗的临床疗效。方法：总结手术结合术前介入、术中腹腔低渗化疗、术后介入和静脉交替化疗加免疫疗法，治疗结直肠癌肝转移患者49例的临床资料。结果：该组49例结直肠癌患者原发癌均获切除，同时一期切除肝转移癌。全组患者1、3和5年累积无病生存率分别为94％、47％和32％，累积总生存率分别为100％、61％和44％。结论：结直肠癌肝转移患者以手术为主的综合治疗安全有效。     

EP方案同步放化疗治疗非小细胞肺癌的疗效观察

目的:观察EP方案同步放化疗治疗局部晚期非小细胞肺癌的疗效及毒性反应。方法:32例Ⅱ~Ⅲb期非小细胞肺癌患者接受放化疗同步治疗,6mV加速器常规分割剂量放射治疗,2GY/(次.d),每周5d,DT:60~66GY(6~7周),治疗范围包括原发灶,同侧肺门和纵隔淋巴结,放疗开始同步使用EP方案4个周期,其中2周期是在放疗中应用,其余2周期是在放疗后接周期应用。结果:同步放化疗近期有效率84.38%,1年生存期为68.75%。主要毒副反应为骨髓抑制(71.88%)、胃肠道反应(75.0%),其次是放射性食道炎(56.25%)和放射性肺炎(21.88%)。结论:EP方案同步放化疗是目前治疗NSCLC的标准治疗方案之一,其疗效确切,局控率高,经济,毒性可以接受,值得临床推广。     

Mediastinal diffuse large B-cell lymphoma invading the left atrium mimicking coronary artery disease with a mural thrombus

A left atrial mass associated with coronary artery disease is often diagnosed as a mural thrombus rather than other possible etiologies such as benign primary cardiac tumor (myxoma, lipoma), a malignant primary cardiac tumor (sarcoma, lymphoma), or secondary involvement for extracardiac tumors. Malignant lymphoma initially presenting as intracardiac masses is very rare. Chest computed tomography with contrast enhancement and cardiac magnetic resonance may be the best methods for distinguishing primary cardiac tumors from direct extension from adjacent mediastinal structures. We report the case of a 59-year-old man with incidentally found mediastinal diffuse large B-cell lymphoma invading the left atrium, which presented with coronary artery disease and a left atrial mass. Improvement in cardiac ventricular function heart after coronary artery bypass grafting may provide the patient with a better chance of receiving an adequate dose of chemotherapy.     

紫杉醇单药同步三维适形放疗治疗Ⅲ期食管癌90例临床分析

目的探讨紫杉醇单药同步放化疗治疗Ⅲ期食管癌的近期疗效、局部控制率、生存率及毒性反应。方法90例Ⅲ期食管癌患者根据入选标准随机分组,45例进入三维适形放疗＋紫杉醇组（放化组）,45例进入单纯三维适形放疗组（单放组）。单放组采用三维适形放疗,95%PTV：60-66GY/30-33次,每周五次;放化组：放疗从第1天即开始采用三维适形放射治疗,同时化疗（紫杉醇40 mg/m^2）;第1、8、15、22、29、36天静滴。结果局部近期疗效放化组好于单放组,两组比较差异有统计学意义（P〈0.05）。放化组与单放组1、2、3年生存率：放化组分别为87.6%、57%、46%,单放组分别为82.6%、37%、21%,两组1年生存率比较差异无统计学意义（P〉0.05）;但两组2、3年生存率对比,差异有显著统计学意义（P〈0.05）。毒副反应放化组稍高于单放组,但两者差异无统计学意义（P〉0.05）。结论以紫杉醇单药同步三维适形放疗治疗Ⅲ期食管癌近期疗效和局部控制率较好,能提高远期生存率可能,虽毒性反应增加但能耐受。     

II、III期乳腺癌的新辅助化疗

Background: Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages II and III breast cancer after neoadjuvant chemotherapy. Methods: This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages II and III breast cancer. Group 1 (n=54) were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. Group 2 (n=43) initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed. Results: Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage II (P=0.034) and 0% to 12.6% in stage III (P=0.016), and decreased the dermatoplasty rates from 17.1% to 2.8% in stage II (P=0.046) and 28.1% to 8.1% in stage III (P=0.026). After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage III disease were significantly higher in Group 1 than in Group 2 (68.4% vs. 31.2%, P=0.028, and 63.2% vs. 25.0%, P=0.024, respectively). There were no significant differences in the overall and disease-free survival rates of stage II disease for Group 1 compared with Group 2 (85.7% vs. 85.2%, P=0.953, and 80.6% vs. 74.1%, P=0.400, respectively). Conclusions: Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease-free survival rates in stage III disease. However, neoadjuvant chemotherapy did not confer greater survival on stage II disease.     

Neoadjuvant chemotherapy in patients with stages II and III breast cancer

Background Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages II and III breast cancer after neoadjuvant chemotherapy. Methods This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages II and III breast cancer. The patients in Group 1 （n=54） were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. The patients in Group 2 （n=-43） initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed. Results Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage II （P=0.034） and 0% to 12.6% in stage III （P=0.016）, and decreased the dermatoplasty rates from 17.1% to 2.8% in stage II （P=0.046） and 28.1% to 8.1% in stage Ill （P=0.026）. After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage III disease were significantly higher in Group 1 than in Group 2 （68.4% vs 31.2%, P=0.028, and 63.2% vs 25.0%, P=0.024, respectively）. There were no significant differences in the overall and disease-free survival rates of stage II disease for Group 1 compared with Group 2 （85.7% vs 85.2%, P=0.953, and 80.6% vs 74.1%, P=0.400, respectively）. Conclusions Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease-free survival rates in stage III disease. However, neoadjuvant chemotherapy did not confer greater survival on stage II disease.     

Management of primary small cell carcinoma of the esophagus

Background Primary small cell carcinoma of the esophagus is rare. Although surgery is successful in eradicating local tumor, the five-year survival rate of patients with primary small cell carcinoma of the esophagus after resection is lower than that of patients with primary squamous cell carcinoma of the esophagus. The purpose of this study was to analyze the clinical manifestations, pathological features and treatment of primary small cell carcinoma of the esophagus. Methods A total of 73 patients with primary small cell carcinoma of the esophagus who had been treated by surgery from 1984 to 2003 were analyzed retrospectively. Results In this series, the overall resection rate was 94.5% （69/73）, the radical resection rate 89.0% （65/73） and the operative mortality 1.4% （1/73）. The 1-, 3- and 5-year survival rates of patients were 50.7%, 13.7% and 8.2%, respectively. Conclusions Primary small cell carcinoma of the esophagus is rare with a poor prognosis. Surgical resection is the leading method for patients with stage Ⅰ or Ⅱ primary small cell carcinoma of the esophagus. Postoperative chemotherapy is beneficial to these patients. The patients of stage Ⅲ or IV should be given chemotherapy and radiation therapy.     

原发性肺淋巴瘤三例报道并文献复习

目的探讨原发性肺淋巴瘤的临床特点、诊断和治疗方法。方法回顾性总结原发性肺淋巴瘤3例,并结合文献对其临床表现、影像学特点、诊断及治疗方法进行分析。结果原发性肺淋巴瘤罕见,无特异性临床表现和影像学改变,易误诊。其主要症状为咳嗽、发热等。影像学可表现为单发或多发结节或片状影甚至实变,常见有充气支气管征。确诊依靠开胸手术、胸腔镜或经皮肺穿刺获取组织,结合病理学和免疫组化检查。主要治疗手段为化疗。结论及时进行有创检查有利于早期诊断原发性肺淋巴瘤。     

Evaluation of clinical outcomes and prognostic factors for synovial sarcoma arising from the extremities.

BACKGROUND: Synovial sarcoma is an uncommon tumor and remains a disease with poor prognosis. Although several prognostic factors have been previously reported, prognostic factors associated with synovial sarcoma are conflicting. This study was undertaken to evaluate our institutional clinical outcomes and to determine prognostic factors for synovial sarcoma. MATERIAL/METHODS: A series of 17 patients with synovial sarcoma arising from the extremities surgically treated between September 1979 and April 2005 was analyzed retrospectively. Data regarding patient age, sex, primary tumor site, primary tumor size, histologic subtype, management of primary tumor (surgery, chemotherapy, radiotherapy), microscopic surgical margins, previous treatment at other hospitals for synovial sarcoma and follow-up information were recorded. Furthermore, statistical analysis of survival rates and prognostic variables were examined. RESULTS: The mean and median follow-up time were 82.4 months and 79.0 months, respectively. Seven of 17 patients (41.2%) initially underwent inappropriate unplanned surgery at other hospitals. The surgical margins of the definitive surgery at our hospital were adequate in all patients. The local recurrence and metastasis rates after definite surgery with adequate surgical margins at our hospital were 5.9% and 35.3%, respectively. The 5-year and 10-year overall survival rates were 88.2% and 79.4%, respectively. A statistically significant adverse prognostic factor was undergoing initial surgical resection at other hospitals (p=0.02). CONCLUSIONS: Initial surgical treatment with adequate surgical margins by experienced surgeons for synovial sarcomas, preferably at specialized hospitals, should be considered to increase local control and improve outcome and survival.