局部晚期食管鳞状细胞癌术后放疗和化疗的前瞻性研究

Objective To investigate the role of postoperative chemoradiotherapy ( CRT) as a multimodality treatment option for locally advanced thoracic esophageal squamous cell carcinoma (ESCC) by a prospective comparison between surgery alone and postoperative CRT. Methods Using preoperative computed tomography (CT)-based staging criteria, 158 patients with ESCC (stage Ⅱ-Ⅲ) were enrolled in this prospective study. With informed consent, the patients were randomized into two groups: postoperative CRT (78 cases ) and surgery alone (S, 80 cases). After a few minor adjustments to the enrolled patients, the actual patients of postoperative CRT group and S group were 74 cases and 77 cases, respectively. Comparison of the complications, local recurrence rate, distant metastasis rate, survival rate and progression-free survival in the two groups was carried out. Results With a median follow-up of 37.5 months, the 1-,3-,5-, 10-year overall survival (OS) rates were 91.0% , 62.8%,42.3%,24.4% and 87.5% , 51.3% , 33.8% , 12. 5% for the postoperative CRT and S arm, respectively. A significant difference in OS was detected between the two arms (P =0.0276). There was a significant difference of progression-free survival (PFS) between the two arms (P=0.0136). The local recurrence rates in the postoperative CRT group and S group were 14.9% and 36.4% , respectively (P<0.05). No significant difference was detected between the complications of the two groups ( P > 0. 05). Toxicities of chemoradiotherapy in the postoperative CRT arm were moderate, which can be relieved rapidly by adequate therapy. Conclusion Rational application of postoperative chemoradiotherapy can provide a benefit in progression-free survival and overall survival in patients with locally advanced esophageal squamous cell carcinoma.     

Observation of the Curative Effect of Mabthera in Combination with the CHOP Regimen in Treating Invasive B-Cell Lymphoma： A Report of 45 Cases

OBJECTIVE To observe the clinical effcacy and toxic effects of Mabthera (rituximab) in combination with the CHOP (R-CHOP) regimen for treating invasive B-cell non-Hodgkin’s lymphoma. METHODS A total of 45 patients with CD20 positive B-cell non-Hodgkin’s lymphoma were randomly divided into the R-CHOP (22 cases) and CHOP groups (23 cases for controls).They received the regimens of Mabthera in combination with CHOP or single CHOP therapy respectively.An appraisement of the curative effect could only be performed following 4 cycles of chemotherapy for the 45 patients.Follow-up was conducted to observe the conditions of survival. RESULTS The rate of complete remission(CR)in the R-CHOP group was 68.2%,with a total effective rate of 81.8%,and in the CHOP group these rates were 34.8% and 78.3% respectively.There was a significant difference in comparing the CR rates between the two groups (P<0.05).The 1,2 and 3-year overall survival (OS) rates of the RCHOP group were 90.9%,81.8% and 77.3%,respectively.In the CHOP group,the OS rates were respectively 91.3%,69.5% and 47.8%.The difference in the 3-year OS between the two groups was significant (P<0.05).The toxic effects of the two groups were mainly a slight and moderate bone marrow depression and a gastrointesinal reaction,with similar tolerable toxic effects in the two groups (P>0.05). Adverse effects related to the Mabthera infusions occurred in 6 cases of the R-CHOP group (27.2%).These effects lessened after symptomatic treatment. CONCLUSION The therapeutic regimen of Mabthera,in combination with CHOP (R-CHOP) has an obvious curative effect for treating invasive B-cell non-Hodgkin's lymphoma,with a favorable tolerance.It is highly recommended as the treatment of choice.     

Prognostic Factors for Patients with FIGO Stage-IB Cervical Squamous Cell Carcinoma：Does the Tumor Size（≤4 cm or〉4 cm）Really Matter？

OBJECTIVE To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery. METHODS A retrospective analysis of clinical data from 174 cases of FIGO Stage-IB cervical squamous cell carcinoma treated in our institute was conducted. RESULTS The 5-year overal disease-free survival of the patients was 79.4%and the recurrence rate was 16.7%.Seventy-five percent of the 60 patients with a tumor>4 cm and 28.1%of the 114 patients with a tumor≤4 cm received preoperative radiotherapy,resuting in a significant difference be- tween the two groups(P<0.001).The 5-year disease-free survival rate for the groups with a tumor≤4 cm without and with preoperative radiotherapy, and with a tumor>4 cm without and with preoperative radiation therapy were 80.5%,85.2%,69.3%and 77.1%,respectively.There was no significant dif- ference between any of the groups(P>0.05).A univariate analysis showed that pelvic node metastasis,a positive parametrial surgical margin and post- operative adjuvant therapy were al significantly correlated with the 5-year disease-free survivals(P<0.05).Multivariate analysis revealed that pelvic node metastasis(P=0.004)and a positive parametrial surgical margin(P= 0.040)were independent factors that influenced the prognosis.The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 57.4%and 44.7%respectively in the high-risk group(patients with pelvic lymphatic metastasis and/or positive parametrial surgical margin)(P=0.575) and the recurrence ratio was 7/18 and 6/14 for the cases of the two tumor sizes in the same risk group.There was no significant difference between the two groups(P=0.821).The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 86.5%and 82.9%respectively in the low-risk group(patients without pelvic lymph-node metastasis and/or positive para- metrial surgical margin),respectively(P>0.05)and the recurrence ratio was 9/95 and 7/47 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups(P>0.05). CONCLUSIONS For FIGO Stage-IB cervical squamous cel carcinoma patients with radical surgery as the major means of treatment,the features of pelvic lymph-node metastasis and a positive parametrial surgical margin are independent factors that influence the prognosis.The tumor size can not be used as a criterion for predicting the prognosis.     

Clinical study on radiotherapy combined with surgical treatment of 162 patients with cervical cancer

Objective: To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer.Methods: 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy.The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy.External irradiation used 60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of "B" point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used 192lr,the dose of "A" point was 5-15 Gy.Results: The 5-year survival rate of preoperative combined radiotherapy group was 78.0%(71/91), preoperative intracavitary radiotherapy group 64.9% (24/37), and postoperative radiotherapy group 35.3% (12/34).Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference (P＜0.05).The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% (32/91), 32.4% (12/37), 38.2% (13/34), respectively, and the differences were not statistically significant (P＞0.05).Conclusion: The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.     

Chemotherapy of cerebral gliomas directed by the chemosensitivity test in vitro： a clinical study

Objective: To evaluate correlation between chemosensitivity of tumor cells in vitro and their clinical responsive- ness in vivo by comparing the difference of curative effect between chemotherapy of cerebral gliomas directed by chemo- sensitivity test in vitro and its routine chemotherapy. Methods: Sixty-two patients with cerebral gliomas were recruited as the experiment group, who had received total resection or subtotal resection of the tumor. The resected tumor cells were cultured in vitro, followed by chemosensitivity test using colorimetric MTT assay. Finally, chemotherapeutic protocol was made based on the results of the chemosensitivity test. Fifty patients with cerebral gliomas subjected to the routine chemotherapeutic protocol were simultaneously recruited as the control group, whose age, gender, survival functional status and operational fashion were matched with the experiment group. The two groups were equally followed up for the survival functional status, recurrence and death. All data were analyzed using SPSS 10.0 software. Results: At the time of evaluation, KPS values of 64.52 ± 35.84 were seen in the experiment group, and 33.60 ± 36.24 in the control group, showing statistical difference between the two groups (t = 4.5163, P = 0.000). During 2–4 years of follow up, a recurrence rate of 32.26% was seen in the experimental group, and 60.00% in the control group, showing a statistical difference between the two groups (χ2 = 8.620, P = 0.003). The fatality was 22.58% in the experiment group, and 48.00% in the control group, showing a statistical difference between the two groups (χ2 = 7.978, P = 0.005). The survival rate of the experimental group was higher than that of the control group, showing a statistical differences between the two groups (χ2 = 7.29, P = 0.0069). Conclusion: Chemotherapy of glio- mas under the guidance of chemosensitivity test in vitro contributes to obvious improvement on the current survival functional status, a clear decline of the recurrence rates and fatality rate, and raised survival rates of the patients. A close correlation between the chemosensitivity in vitro and clinical responsiveness in vivo is observed.     

Correlation of prothrombin time with clinicopathological features and prognosis of patients with osteosarcoma北大核心CSCD

Objective: To investigate the correlation of prothrombin time (PT) with clinicopathological features and prognosis of the patients with osteosarcoma. Methods: The activated partial thromboplastin time (APTT), PT, fibrinogen (FIB) and D-dimer in peripheral blood of 111 patients with osteosarcoma and 35 concurrent healthy volunteers (as the control) from May 2011 to May 2018 were tested. The correlation of PT with clinicopathological features and prognosis of the patients with osteosarcoma was analyzed. Results: The median survival time of 111 patients with osteosarcoma was 25 months, and the one-and two-year survival rates were 76.6% and 51.4%, respectively. The levels of D-dimer and FIB in the patients with osteosarcoma were higher than those in the control group (both P < 0.01), and the PT was shorter than that in the control group (P < 0.01), while the APTT was not statistical different between these two groups (P > 0.05). The PT was longer in the patients with osteosarcoma younger than 20 years old (P = 0.002), while PT had no correlation with gender, tumor size, clinical stage, tumor location and metastatic status (all P> 0.05). The overall survival time of the patients with osteosarcoma in PT ≥ 10.4 s group was shorter than that in PT < 10.4 s group (P = 0.024), the progression-free survival time of the patients with osteosarcoma had no significant difference between these two groups (P= 0.594). The overall survival time and progression-free survival time of the patients with osteosarcoma in metastasis group were shorter than those in non-metastasis group (both P< 0.001). The overall survival time (P= 0.004) and progression-free survival time (P= 0.013) of the patients with osteosarcoma in stage I / II group were longer than those in stage EI/IV group. The clinical stage, PT and metastasis status were related with the prognosis of patients with osteosarcoma (all P< 0.05). The PT and metastasis status were independent predictive factors for the prognosis of patients with osteosarcoma (both P < 0.05). Conclusion: The changes of PT may provide a reference for monitoring the condition and prognosis of patients with osteosarcoma. © 2019 by TUMOR. All rights reserved.     

A multi-institutional retrospective study of hyperthermic plus intravesical chemotherapy versus intravesical chemotherapy treatment alone in intermediate and high risk nonmuscle-invasive bladder cancer

Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after transurethral resection.Methods:We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers.We matched 364 intermediate or high risk cases and divided them into 2 groups:the HIVEC+IVEC group[chemohyperthermia(CHT)composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia]and the IVEC group(intravesical instillation without hyperthermia).The data were recorded in the database.The primary endpoint was 2-year recurrence-free survival(RFS)in all NMIBC patients(n=364),whereas the secondary endpoints were the assessment of radical cystectomy(RC)and 5-year overall survival(OS).Results:There was a significant difference in the 2-year RFS between the two groups in all patients(n=364;HIVEC+IVEC:82.42%vs.IVEC:74.18%,P=0.038).Compared with the IVEC group,the HIVEC+IVEC group had a lower incidence of RC(P=0.0274).However,the 5-year OS was the same between the 2 groups(P=0.1434).Adverse events(AEs)occurred in 32.7%of all patients,but none of the events was serious(grades 3–4).No difference in the incidence or severity of AEs between each treatment modality was observed.Conclusions:This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients.Both treatments were well-tolerated in a similar manner.     

Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy

Objective:Though D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC),the modified D2 (D1 + 7,8a and 9) lymphadenectomy may be more suitable than D2 dissection for T2 stage GC.The purpose of this study is to elucidate whether the surgical outcome of modified D2 lymphadenectomy was comparable to that of standard D2 dissection in T2 stage GC patients.Methods:A retrospective cohort study with 77 cases and 77 controls matched for baseline characteristics was conducted.Patients were categorized into two groups according to the extent of lymphadenectomy:the modified D2 group (mD2) and the standard D2 group (D2).Surgical outcome and recurrence date were compared between the two groups.Results:The 5-year overall survival (OS) rate was 71.4％ for patents accepted mD2 lymphadenectomy and 70.1％ for those accepted standard D2,respectively,and the difference was not statistically significant.Multivariate survival analysis revealed that curability,rumor size,TNM stage and postoperative complications were independently prognostic factors for T2 stage GC patients.Patients in the mD2 group tended to have less intraoperative blood loss (P=0.001) and shorter operation time (P＜0.001) than those in the D2 group.While there were no significant differences in recurrence rate and types,especially lymph node recurrence,between the two groups.Conclusions:The surgical outcome ofmD2 lymphadenectomy was equal to that of standard D2,and the use of mD2 instead of standard D2 can be a better option for T2 stage GC.     

经尿道膀胱肿瘤整块切除术治疗初发非肌层浸润性膀胱癌的安全性及疗效分析

Objective　To evaluate the safety and efficacy of transurethral en bloc resection of bladder tumor (ERBT) in the treatment of primary non-muscular invasive bladder cancer (NMIBC). Methods　The clinical data of 67 patients with primary NMIBC were analyzed retrospectively, including 31 cases of ERBT and 36 cases of TURBT. The operation time, hospital stay, indwelling catheter time, bladder muscle layer, bladder perforation, obturator nerve reflex and recurrence-free survival rate were compared between the two groups. Results　The operation time of ERBT group and TURBT group was (39.8±9.76) min vs. (30.4±8.25) min (P=0.001), the hospital stay was (3.6 ±1.0) days vs. (4.3 ±0.9) days (P=0.003), and the indwelling catheter time was (2.4 ±0.7) days vs. (2.8 ±0.6) days (P=0.010), respectively. The existence rate of bladder muscle layer in ERBT group was 96.8%, which was significantly higher than that in TURBT group (77.8%)(P=0.031). The incidence of intraoperative obturator nerve reflex in the ERBT group was 0%, which was significantly lower than that in the TURBT group (16.7%)(P=0.027). There was 1 case of bladder perforation in ERBT group and 4 cases in TURBT group, and there was no significant difference between the two groups (P=0.363). The 1-year recurrence-free survival rate (RFS) of the ERBT group was 88.7%, while that of the TURBT group was 82.5%, but the difference was not statistically significant (P=0.397). Conclusion　ERBT has shorter hospitalization time and catheter indwelling time, lower incidence of obturator nerve reflex, better safety and remarkable curative effect in patients with newly diagnosed NMIBC, which is worthy of clinical promotion.