新辅助放化疗在预防食管癌微转移中的作用

目的:通过术前应用5-FU和顺铂,同时行食管区的体外照射40Gy,术后行淋巴结微转移检测,了解新辅助放化疗在降低微转移中的作用。方法:120例食管癌患者随机分为单纯手术组、新辅助化疗+手术组,每组60例。新辅助化疗组术前给予5-FU和顺铂,3周为一周期,同时行食管区的体外照射40Gy,完成两周期后在全麻下行左开胸食管部分切除食管胃颈部吻合术,并清扫区域淋巴结。HE染色"阴性淋巴结"组,免疫组化染色。结果:新辅助放化疗组CK(AE1/AE3)单克隆抗体阳性反应淋巴结数明显少于单纯手术组,有显著性差异。结论:新辅助放化疗方案,可以有效控制微转移。     

Factors associated with degree of tumour response to neo-adjuvant radiotherapy in rectal cancer and subsequent corresponding outcomes

Background

Tumour response to neo-adjuvant radiotherapy for rectal cancer varies significantly between patients, as classified by Tumour Regression Grade (TRG 0–3), with 0 equating to pathological complete response (pCR) and 3 denoting minimal/no response. pCR is associated with significantly better local recurrence rates and survival, but is achieved in only 20–30% of patients. The literature contains limited data reporting factors predictive of tumour response and corresponding outcomes according to degree of regression.

同步放化疗与序贯放化疗对晚期食管癌的临床疗效分析

目的探讨同步放化疗和序贯放化疗对晚期食管癌患者生存期和并发症等临床疗效的差异。方法选取2013年4月至2015年4月间江苏省泰州巿第二人民医院收治的82例晚期食管癌患者,采用随机数表法分为同步放化疗组和序贯放化疗组,每组41例。观察并比较两组患者的生存期、生活质量、病灶缓解情况和不良反应情况。结果同步组1~2年生存率低于序贯组,>2年生存率大于序贯组,差异均有统计学意义(均P<0.05)。两组患者<1年生存率比较,差异无统计学意义(P>0.05)。序贯组患者中位生存期和进展期分别为17.3个月和12.5个月,同步组患者的中位生存期和进展期分别为22.3个月和14.2个月。同步组患者的吞咽哽咽感、呕血和胸骨后疼痛方面评分均高于序贯组患者,差异均有统计学意义(均P<0.05)。同步组客观缓解率(ORR)和疾病控制率(DCR)均大于序贯组,差异均有统计学意义(均P<0.05)。两组患者在治疗期间均无IV度不良反应发生;序贯组0度和I度放射性食管炎、0度血液毒性及0度和I度胃肠道毒副作用发生例数多于同步组,差异有统计学意义(P<0.05)。结论采用同步和序贯放化疗治疗晚期食管癌安全性良好,但同步放化疗在提高晚期食管癌患者生存期,改善生活质量和疾病疗效方面优于序贯放化疗。     

全身炎症反应与食管癌预后

全身炎症反应在肿瘤的发生和发展中具有十分重要的作用,而较高的全身炎症反应往往是预后不良的标志,目前评价全身炎症反应的指标主要包括中性粒细胞/淋巴细胞比值、C反应蛋白、格拉斯哥预后评分、血小板/淋巴细胞比值等,许多研究表明这些指标为食管癌预后的独立影响因子,对这些全身炎症反应标志物的研究可能对食管癌临床治疗和预后的判断具有重要价值.     

Expression of apoptosis-related proteins and response to chemoradiotherapy and prognosis in esophageal cancer

Purpose

Defects in the apoptotic pathway confer insensitiviry to the cytotoxic effects of chemotherapy and hence represent an important distal mechanism for the development of chemoresistance. In this study, we sought to obtain results on which to base clinical hypotheses about this mechanism. The aim of this study was to analyze the correlation of the expression of three of these apoptotic molecules, Bc1-2, Bax and Bc1-X, with chemoradiotherapy response and clinical outcome in patients with esophageal tumors.

Patients and methods

Tumor biopsy specimens from 42 patients were assessed by immunohistochemistry for expression of Bc1-2, Bax and Bc1-X proteins. The expression of these proteins was correlated with response to chemoradiotherapy in 24 patients.

Results

The overall expression of Bc1-2, Bax and Bc1-X was 29%, 68% and 88%, respectively. Bax expression was lower in lymph-node-positive tumors (p = 0.01). Probability of response to chemoradiotherapy was higher in Bax-negative tumors than in Bax-positive tumors (80% vs 35%, p = 0.1). In addition, 62% of patients with low Bc1-X expression (< 50% stained cells) showed response to chemoradiotherapy, as opposed to only 33% of patients with higher Bc1-X expression (p = 0.2). Patients with low Bc1-X expression showed a significantly better prognosis than those with high Bc1-X expression (p =0.02), and a tendency towards higher survival was detected in Bc1-2 positive patients.

Conclusion

The correlation detected between Bax and Bc1-X expression and response to chemoradiotherapy suggests that screening for these apoptosisrelated proteins could be useful in determining patients who would benefit from chemoradiotherapy. However, further investigation is warranted to elucidate the potential role of Bax in taxane-treated patients. Clearly, since high Bc1-X expression conferred poor survival in our study, it could be a useful prognostic marker in esophageal cancer.     

Overexpression of survivin mRNA is associated with a favorable prognosis following neoadjuvant radiochemotherapy in esophageal cancer

Survivin is a member of the inhibitor of apoptosis (IAP) gene family known to be involved in resistance to chemo- and radiation therapy. We examined the potential of quantitative survivin mRNA expression to predict histopathologic tumor response and prognosis following neoadjuvant radiochemotherapy (cis-platinum, 5-FU, 36 Gy) in patients with locally-advanced esophageal cancer (cT2-4, Nx, M0). Tumor (T) and normal tissue (N) samples from 51 patients were collected by endoscopic biopsy prior to treatment. Survivin mRNA expression was analyzed by quantitative real-time RT-PCR assays. Histomorphologic regression was defined as a major response when resected specimens contained <10% of residual vital tumor cells or if a pathologically complete response was achieved. Some 7/51 patients had progressive disease and 44/51 proceeded to surgical resection. Of 44 resected tumors, 17 (31.4%) showed a major and 27 (61.4%) showed a minor histopathologic response; the survival rates were significantly different (p<0.01). Median absolute survivin expression was 5.1 in the tumor and 2.4 in corresponding normal tissue samples (Wilcoxon, p<0.001). Median relative (T/N ratio) survivin mRNA expression was 1.7. Survivin mRNA expression levels did not show a significant association with histomorphologic regression. Relative survivin mRNA expression of a T/N ratio >1 indicated a favorable prognosis (log-rank, p<0.003). Expression levels of survivin mRNA in pretherapeutic biopsies did not predict the extent of histomorphologic tumor regression following preoperative radiochemotherapy for esophageal cancer. However, overexpression of survivin mRNA in pretreatment biopsies (T/N ratio >1) was associated with superior survival probabilities.     

食管癌患者手术前采用多西他赛联合顺铂同步放射治疗的疗效观察

目的探讨食管癌患者手术前采用多西他赛联合顺铂同步放射治疗的临床疗效。方法对126例食管癌患者临床资料进行回顾性分析,其中术前行多西他赛联合顺铂同步放射治疗者（新辅助放化疗组）62例,直接进行手术切除者（单纯手术组）64例。比较两组患者的生存率、手术根治切除率、围术期死亡率和并发症发生率。结果新辅助放化疗组客观缓解率为61．3％,新辅助放化疗组手术根治切除率为87．1％,显著高于单纯手术组（67．2％,P〈0．05）;新辅助放化疗组患者的1、3年生存率分别为85．5％和56．5％,显著高于单纯手术组患者的62．5％和31．3％（P〈0．05）;两组患者的围术期死亡率和并发症发生率差异无统计学意义（P〉0．05）。结论食管癌患者手术前采用多西他赛联合顺铂同步放射治疗可提高手术根治切除率和生存率,安全性好。     

Expression of survivin in esophageal cancer: correlation with the prognosis and response to chemotherapy

Survivin, a new member of the inhibitor-of-apoptosis (IAP) family, has been reported to be expressed in many cancers but not in differentiated normal tissue. Its expression in esophageal cancer, however, has not been reported. We investigated 51 esophageal cancers and their adjacent normal epithelial tissues for mRNA expression of survivin by RT-PCR. The survivin expression in esophageal cancer tissue was significantly higher than that in normal esophageal tissue (0.211 +/- 0.226 vs. 0.057 +/- 0.135, p < 0.0001). pN4 tumors had significantly higher survivin expression than the pN0-3 tumors (p = 0.0093). Fourteen patients with advanced esophageal cancer had received chemotherapy prior to surgery. The survivin expression in the cancer tissue in patients who achieved a partial response (PR) was significantly lower than that in patients with no change (NC) and in patients with progressive disease (PD; 0.099 +/- 0.134 vs. 0.320 +/- 0.222, p = 0.0434). The median survival for patients with high survivin expression (9.0 months) was less than that for patients with low survivin group expression (30.0 months, p = 0.0023). Survivin expression was one of the significant predictors of survival on univariate analysis (hazard ratio 2.471; 95% confidence interval 1.104-5.533). The results suggest that survivin expression may provide prognostic information in patients with esophageal cancer.     

Tumour-stroma ratio to predict pathological response to neo-adjuvant treatment in rectal cancer

IntroductionManagement of rectal cancer has advanced, with an increasing use of neoadjuvant chemoradiotherapy (nCRT). This opens options for organ preserving treatment for those with a major response to nCRT. However, the degree of clinical response, based on MRI and post-treatment biopsies, only poorly matches the degree of actual pathological response. In order to select patients with major pathological response without surgical resection, it is of importance to define tumour markers predicting the degree of pathological response to nCRT. The intra-tumoural tumour-stroma ratio (TSR) might be this marker.MethodsTSR in pre-treatment biopsies was estimated according to the method described by van Pelt et al. The degree of pathological response was assessed on the tumour resection according to tumour regression grading (TRG) by Mandard. The primary endpoint of this study was the difference in pathological response to nCRT between TSR-high and TSR-low groups.ResultsWe found that 26.2% of patients with major response was classified as TSR-high, while 73.8% of patients were classified as TSR-low. A high TSR in pre-treatment biopsies was associated with a lower chance of major-response to nCRT (OR = 0.37, 95%CI; 0.19–0.73), p = 0.004), independent of tumour stage and time between nCRT and surgery.ConclusionIn rectal cancer, TSR in pre-treatment biopsies predicts pathologic response to nCRT, with a high TSR bringing twice the risk of poor to no response compared to low TSR. In future, assessment of TSR may fulfil a role in a therapeutic algorithm identifying patients who will or will not respond to nCRT prior to treatment initiation.     

放化疗联合治疗食管癌患者的临床疗效及预后分析

目的探讨并分析同步放化疗联合治疗食管癌患者的疗效和预后。方法选取2009年3月至2011年3月收治的78例晚期食管癌患者,按照治疗方式分为观察组和对照组,每组39例。对照组患者给予序贯放化疗治疗,观察组患者给予同步放化疗治疗。比较两组患者的近期疗效,并对患者预后进行分析。结果观察组患者治疗总有效率为74.4%（29/39）,对照组患者为51.3%（20/39）,观察组总有效率高于对照组（P〈0.05）。观察组患者白细胞减少和放射性食管炎发生率分别为64.1%和74.4%,高于对照组（P〈0.05）。两组患者的1年生存率差异无统计学意义（P〉0.05）,而观察组的2年生存率显著高于对照组（P〈0.05）。观察组复发率和转移率均低于对照组（P〈0.05）。结论同步放化疗显著提高了患者的治疗效果和2年生存率,抑制了肿瘤的转移和复发,且无严重不良反应出现,有助于患者完成治疗。     

紫杉醇联合放疗同步治疗中晚期食管癌的临床观察

目的:探讨中晚期食管癌每周应用小剂量紫杉醇同步放化疗治疗的疗效及毒副反应。方法:63例中晚期食管癌患者,随机分成两组(放化组和单放组),放化组32例,单放组31例。两组均采用6MV-X射线三维适形放射治疗,总剂量60～66Gy/6～6.6周。放化组放疗第1天开始同时给予紫杉醇40mg/m2,每周给药1次,连用6周。结果:近期疗效放化组完全缓解(CR)56.25%、部分缓解(PR)34.38%、稳定(SD)6.25%和病情进展(PD)3.13%,单放组CR38.71%、PR 25.81%、SD 19.35%和PD 16.13%,差异有统计学意义,P<0.05。放化组与单放组的1、2、3年生存率分别为75.0%、56.3%、28.1%和64.5%、32.3%、16.1%,总生存率差异有统计学意义,P<0.05;1、2、3年无进展生存率分别为65.6%、43.8%、18.8%和41.9%、19.4%、12.9%,差异有统计学意义,P<0.05。放化疗组的放射性食管炎、黏膜炎、恶心和血液毒性高于单放疗组。结论:同步放化疗可提高局部晚期食管癌的有效率、总生存率,降低远处转移率,部分毒副反应增加,但患者能够耐受。     

Histological cell type and DNA value in the prognosis of squamous cell cancer of uterine cervix

Based on the evaluation of 362 cases of squamous cell carcinoma of the uterine cervix, the distribution of the tumours in relation to their modified Broders'' grade, histological cell type as proposed by Wentz and Reagan, and the clinical stage of disease was evaluated. The morphological characteristics of the 3 cell types—large cell non-keratinizing, keratinizing, and small cell cancers—were described. The 5 year survival in relation to Broders'' grade, cell type, extent and DNA values of the malignant cells were evaluated and compared. Broders'' grading system was not useful in predicting the biological behaviour of cervical squamous cancer. The histological cell type and extent of the tumour were important factors in prognosis. The 5 year survival for large cell cancer was 51·8%, keratinizing cancer 34·7% and small cell cancer 10·0%. The 5 year survival was 63·3% for stage I neoplasms, 52·9% for stage II neoplasms, 30·7% for stage III neoplasms and 15·0% for stage IV neoplasms. When the DNA values of neoplastic cells were considered in relation to cell type and extent of disease, the biological behaviour of cervical squamous cell cancers was determined more accurately. The 5 year survival of women with cervical cancer in which the DNA values of the neoplastic cells exceeded 155 was more favourable than those with DNA values of less than 155. This difference in 5 year survival was evident for comparable cell type and clinical stage of disease.     

Do breast implants after a mastectomy affect subsequent prognosis and survival?

In a large study, published in this issue of Breast Cancer Research, Le and colleagues report that women receiving implants after mastectomies for early-stage breast cancer experience lower breast cancer mortality than women not receiving implants. Assessment of survival patterns among women receiving reconstructive implants is complex given unique patient characteristics, disease attributes, and treatment patterns. The interpretation of reduced mortality from breast cancer must be assessed in light of significantly reduced risks of death from most other causes. In contrast, patients receiving post-mastectomy implants had elevated rates of suicide, consistent with findings among women with cosmetic implants. Additional well-designed investigations are needed to clarify survival patterns among women receiving reconstructive implants.     

多西他赛联合顺铂行食管癌新辅助化疗的疗效观察

背景与目的：单一采用手术治疗进展期食管癌的效果较差,通过新辅助治疗能否改善进展期食管癌患者的预后是近年来食管癌治疗研究的热点,但仍存在争议。本研究旨在探讨多西他赛联合顺铂在食管癌新辅助化疗中的价值。方法：以多西他赛联合顺铂行食管癌新辅助化疗患者49例为研究组,观察化疗的有效率;以同期行单纯手术患者50例为对照组,比较2组手术切除率及术后1年生存率。结果：研究组49例患者均完成2个疗程的化疗,有48例行手术治疗,客观缓解率ORR（CR＋PR）为59.2%（29例）,术前分期明显降低。对照组50例均顺利完成手术。研究组和对照组行根治性手术切除率差异存在统计学意义（P〈0.05）。新辅助化疗后获得客观缓解患者的术后1年生存率与对照组比较差异有统计学意义（P〈0.05）。结论：多西他赛联合顺铂行食管癌新辅助化疗有助于降低术前分期,提高根治性手术切除率和新辅助化疗后获得客观缓解患者的1年生存率。     

直肠癌新辅助放化疗敏感性预测进展

直肠癌是我国最常见的恶性肿瘤之一。近年来,直肠癌的新辅助放疗或放疗联合化疗及全直肠系膜切除的根治术已逐步成为治疗中下段进展期直肠癌的标准模式。目前已经有大量研究证实新辅助治疗的优点,但尚有一部分患者无法在其中受益。在新辅助放化疗前或其早期预测其敏感性,达到肿瘤的“个体化治疗”,目前在这方面已经进行了大量研究。本文将就预测新辅助治疗敏感性的进展进行综述。     

Proton MR spectroscopy for monitoring early treatment response of breast cancer to neo-adjuvant chemotherapy

With respect to treatment monitoring, conventional modalitiessuch as physical examination, ultrasonography, and mammographyare frequently used, but vary in reliability for measuring tumor'stherapeutic response [1, 2]. Magnetic resonance imaging (MRI)is increasingly being used to evaluate locally advanced breastcancer undergoing neo-adjuvant chemotherapy. However, changesin lesion size or dynamic contrast enhanced MRI are not detecteduntil several weeks following chemotherapy [3]. Recently, proton magnetic resonance spectroscopy (¹H-MRS) hasbeen proven helpful for the diagnosis of breast cancer basedon total choline-containing compounds (tCho). The presence oftCho may indicate active cell replication, thus can be usedfor diagnosis. The role of ¹H-MRS at 1.5 T for