胃癌预后指标的多因素回归分析

目的探讨影响胃癌患者长期生存的独立预后因素。方法采用Cox比例风险模型对可能影响胃癌患者预后的15个临床病理、治疗措施及分子生物学指标,进行多因素回归分析。结果单因素分析显示TNM分类、病期、肿瘤生长方式、淋巴管静脉侵犯、术前动脉插管介入化疗、术后腹腔化疗、CD44拼接变异体V6(CD44V6)和E-钙黏附素(E-CD)表达及增殖细胞核抗原标记指数(PCNALI)与胃癌患者术后生存率显著相关(P均<0.05)。Cox多因素回归分析显示,按作用强度、TNM分类、术前动脉插管介入化疗、术后腹腔化疗、肿瘤生长方式依次为影响胃癌患者长期存活的预后因素。结论TNM分类、术前动脉插管介入化疗、术后腹腔化疗、肿瘤生长方式为胃癌患者的独立预后因素。术前动脉插管介入化疗和术后腹腔化疗对改善胃癌患者的预后具有重要价值。     

术前区域性动脉灌注联合化疗治疗进展期胃癌的初步报告

目的 探讨含紫杉醇脂质体(力朴素)的联合化疗方案行术前区域性动脉灌注治疗进展期胃癌的可行性.方法 84例临床诊断Ⅱ期以上进展期胃癌患者在手术前接受区域性动脉灌注化疗,方案为:5-氟尿嘧啶(5-FU)1.1 g/m2,顺铂60 mg/m2,力朴素135 mg/m2;10～14 d后接受手术(研究组).同期收治的78例Ⅱ期以上胃癌患者行常规手术治疗(对照组).观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应,以及两组问的疗效差异.结果 对照手术组48例(61.5%)获得根治性切除,1年总生存率为74.3%.新辅助化疗组全部完成术前区域性动脉化疗,毒性作用主要为胃肠道反应和骨髓抑制,均属可控范围内(1～2级);其中66例(78.5%)获得根治性切除,较对照手术组提高17.0%(P=0.018);1年总生存率为80.9%,较对照手术组无显著提高(P=0.283).结论 针对进展期胃癌患者,术前以力朴素联合5-FU、顺铂的方案行动脉介入化疗是安全有效的,它能提高根治手术切除率,但两组近期疗效无显著差异,可能与病例数较少和随访时间有关,尚须继续深入研究.     

进展期胃癌术前区域动脉灌注化疗的研究进展

目的总结进展期胃癌术前区域动脉灌注化疗的研究进展。方法对有关进展期胃癌术前区域动脉灌注化疗研究进展的文献进行综述。结果进展期胃癌术前区域动脉灌注化疗可显著降低肿瘤分期,提高R0切除率,提高远期生存率;可有效提高肿瘤及门静脉的药物浓度,既可直接杀伤、破坏癌细胞,还可有效防治肝及淋巴结转移,并可减少毒副作用;动脉灌注化疗短时间内就可导致癌细胞核发生固缩和碎裂;进展期胃癌术前区域动脉灌注化疗时间一般为4~9周,然后根据疗效评价结果进一步决定是否行手术治疗。结论进展期胃癌术前区域动脉灌注化疗理论上较静脉全身化疗更有优势,进一步多中心、大型的临床试验的深入研究可能会为其开辟更为广阔的应用前景。     

进展期胃癌肝十二指肠韧带淋巴结转移的危险因素及其对预后的影响

目的探讨进展期胃癌患者肝十二肠韧带淋巴结(HDLN)转移的危险因素及其对预后的影响。方法回顾性分析2011年1月至2013年12月期间安康市中心医院普外科行D2胃癌根治术及HDLN清扫术的进展期胃癌患者的临床资料,采用多因素logsitic回归分析HDLN转移的危险因素,Kaplan-Miere法比较HDLN转移患者与非HDLN转移患者和其他淋巴结转移患者术后2年生存率,COX比例风险模型分析患者死亡的危险因素。结果进展期胃癌HDLN转移的发生率为10.7%,多因素logsitic回归分析结果显示,胃体中下部肿瘤(OR=6.014,P=0.002)以及T3和T4期肿瘤(OR=5.133,P=0.021)为HDLN转移的独立危险因素。HDLN转移患者术后2年生存率为36.7%,HDLN转移患者术后2年生存率明显低于无HDLN转移患者(P=0.002),对于所有淋巴结转移的患者,HDLN转移术后2年生存率亦明显低于其他淋巴结转移患者(P=0.027)。Cox回归分析显示,低分化或未分化癌、T3和T4期肿瘤以及HDLN转移是影响进展期胃癌预后的独立危险因素(P0.05)。结论胃体中下部肿瘤以及T3和T4期肿瘤是发生HDLN转移的独立危险因素,HDLN转移提示预后不良。     

术前区域性动脉灌注化疗治疗进展期胃癌的临床研究

目的:探讨新辅助化疗中应用术前区域性动脉灌注化疗治疗进展期胃癌的临床疗效.方法:35例临床诊断Ⅱ期以上胃癌病人在手术前接受新辅助化疗,方案为:丝裂霉素C 15 mg/m2,顺铂60 mg/m25-氟尿嘧啶1 000 mg/m2,经股动脉插管区域冲击化疗一次,6～9 d后接受手术.同期收治的41例Ⅱ期以上进展期胃癌病人行常规手术治疗.比较观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应及两组间的远期生存率变化.结果:新辅助化疗组35例全部完成术前区域性动脉化疗,毒性反应主要为胃肠道反应和骨髓抑制,均属可控范嗣内1～2级,其中29例(82.9%)病人获得根治性切除(R0切除),中位生存期26.6个月,1、3和5年生存率分别为68.6%、37.1%和14.3%.常规手术组41例中有28例(68.3%)获得R0切除,中位生存期为15.3个月,1、3和5年生存率分别为63.4%、19.5%和7.3%.结论:术前区域性动脉化疗耐受性良好;新辅助化疗有望提高进展期胃癌病人的远期疗效.     

奥沙利铂联合5-FU术前动脉化疗对进展期胃癌的临床疗效

目的：探讨进展期胃癌患者术前用奥沙利铂（OXA）联合5-氟尿嘧啶（5-FU）行区域性动脉灌注化疗的临床效果。
方法：48例Ⅱ期以上胃癌患者,术前行区域性动脉灌注化疗（A组）,方案为OXA 130 mg/m+ 5-FU 750 mg/m,经股动脉插管行区域冲击化疗1次,8～12 d后接受手术。同期另48例相同临床分期的胃癌患者直接行手术治疗（B组）。两组术后均接受OXA /甲酰四氢叶酸钙/5- FU方案化疗6个周期,观察两组的毒副反应、手术并发症和临床疗效。
结果：A组有38例（79.2%）获得根治性切除;镜检32例（66.7%）出现组织病理学改变,如肿瘤组织坏死、淋巴细胞炎性浸润、癌细胞凋亡、以及间质水肿纤维组织增生等。B组有30例（62.5%）行根治性切除,根治切除率显著低于A组,两组间差异有统计学意义（P<0.05）,且B组病理检查未出现上述变化。A组术前化疗的毒性反应均限于Ⅰ～Ⅱ级;两组的术后并发症无统计学差异。A组患者的中位生存期为36.0个月;1,2,3年总生存率分别为79.2%,62.5%和52.1%。B组中位生存期为21.5个月;1,2,3年总生存率分别为66.7%,45.8%和35.4%。A,B组比较,2年和3年总生存率差异有统计学意义（P<0.05）。
结论：术前应用OXA/5-FU方案行区域性动脉灌注化疗可使肿瘤组织产生显著的组织病理学改变,有利于提高进展期胃癌根治性手术切除率及2,3年生存率。     

手术前后经动脉药盒导管植入系统区域灌注化疗在80例进展期胃癌中的应用

目的探讨手术前、后经动脉药盒导管植入系统（PCS）区域灌注化疗对进展期胃癌的临床疗效。方法将80例Ⅲ～Ⅳ期胃癌按随机数字表法随机分为治疗组40例,术前1～2个疗程PCS区域灌注化疗加手术加术后4个疗程PCS区域灌注化疗）和对照组（40例,手术加术后化疗）,比较两组的治疗效果。结果治疗组术中见肿瘤病灶周围出现不同程度的纤维化,浸润粘连少,局部组织疏松水肿,肿瘤缩小且易于剥离：术后2年生存率为72．5％,明显高于对照组（47．5％．P〈0．05）。结论进展期胃癌经介入方法留置PCS行手术前、后序贯性区域灌注化疗能使肿瘤缩小,提高手术切除率,改善远期生存率。     

63例大肠癌肝转移患者的回顾性临床分析

目的 回顾性分析影响大肠癌肝转移患者预后的因素,并探讨手术切除加化疗、肝动脉栓塞灌注化疗、姑息化疗治疗大肠癌肝转移的疗效.方法 回顾性分析2001年至2007年间63例大肠癌肝转移患者的临床资料,采用多因素分析方法(Cox模型)分析大肠癌肝转移患者的临床特征、治疗方法及与预后的关系,并比较不同治疗方法的疗效.结果 63例大肠癌肝转移患者中位无疾病进展时间为6个月(0～50个月),中位生存期8个月(1～33个月).单因素生存分析显示术后至发生肝转移时间少于24 个月、术前CEA水平>15ng/ml、淋巴转移数、单纯肝动脉栓塞灌注化疗和姑息化疗的患者预后不良,P<0.05;多因素生存分析发现,治疗方法和术前CEA水平是影响预后的危险因素.结论 采用手术切除加化疗治疗大肠癌肝转移患者疗效较好.     

进展期胃癌术中动脉化疗对p53和ki-67表达及细胞凋亡作用的影响

目的:观察进展期胃癌术中动脉化疗对原发灶和癌旁转移淋巴结p53、ki-67表达和细胞凋亡的影响.方法:35例进展期胃癌随机分为2组,20例术中经胃周动脉灌注化疗药物即术中灌注(intraoperative artery infusion chemotherapy,IAIC)组,1 5例术前介入化疗即术前介入组.采用免疫组织化学SP法检测原发灶和癌旁转移淋巴结p53、ki-67蛋白基因表达和TUNEL法检测细胞凋亡情况.结果:2组动脉化疗前、动脉化疗后p53、ki-67蛋白表达及细胞凋亡指数(apoptosis index,AI)组内比较差异有统计学意义(P<0.05);2组立即有效性差异无统计学意义(P>0.05);IAIC组治疗后原发灶、癌旁转移淋巴结的p53、ki-67表达与术前介入组治疗后比较差异无统计学意义(P>0.05);治疗后IAIC组原发灶、癌旁淋巴结的Al不如术前介入组(P<0.05).结论:进展期胃癌IAIC可增强药代动力学优势和精确的靶向化疗,对减少和防止术中癌细胞的医源性扩散、种植及术后复发有重要的临床意义,IAIC可望成为进展期胃癌多模式治疗重要的组成部分.     

区域动脉灌注化疗在进展期胃癌短程新辅助化疗中的应用

目的 探讨短程新辅助化疗应用于进展期胃癌的可行性,并比较不同化疗方式短程新辅助化疗的临床疗效.方法 回顾性分析2008年1月至201 1年12月间在南京中医药大学附属医院接受短程（1个周期）EOF方案（表柔比星、奥沙利铂、氟尿嘧啶加亚叶酸钙）新辅助化疗的310例进展期胃癌患者的临床资料.比较全身静脉化疗方案与区域动脉灌注化疗方案的临床疗效.结果 310例患者均完成了1个周期的短程EOF方案新辅助化疗,无一例因化疗毒副反应而终止.术后病理缓解率为33.9％（105/310）,其中5例（1.6％）获病理完全缓解.接受区域动脉灌注化疗者的病理缓解率为42.4％（72/170）,明显高于全身静脉化疗者的23.6％ （33/140） （P=0.001）.Logistic多因素回归分析证实,化疗方式是影响进展期胃癌短程新辅助化疗后病理缓解率的独立危险因素（HR=1.827; 95％ CI：1.006～3.316; P=0.048）.结论 进展期胃癌短程新辅助化疗病理缓解率总体较低;区域动脉灌注化疗能提高进展期胃癌短程新辅助化疗的术后病理缓解率。     

进展期胃癌术前区域动脉灌注化疗进展

进展期胃癌的单纯手术治疗效果不理想,术后仍有较高的局部复发率和远处转移率.近年来,通过新辅助化疗减少肿瘤负荷,降低肿瘤分期,增加手术切除率,提高远期疗效,已逐步受到人们的重视.其中术前区域动脉灌注化疗直接作用于肿瘤的血管内皮细胞,局部药物浓度高,全身毒副作用小,为进展期胃癌提供了一种有效的治疗方法.本文就进展期胃癌术前区域动脉灌注化疗的适应证、并发症、疗效评价、手术时机、化疗方案及病理改变等方面进行一综述.     

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     

新辅助区域动脉化疗在进展期胃癌中的临床疗效

目的 观察新辅助区域动脉化疗对进展期胃癌的临床疗效及毒性反应.方法 回顾性分析2000年2月至2005年5月上海交通大学医学院附属仁济医院收治的158例相同临床分期的进展期胃癌患者的临床资料.其中76例(研究组)给予术前区域动脉化疗,方案为表阿霉素50 mg/m2+顺铂60 mg/m2+5-氟尿嘧啶1000 mg/m2,2003年起方案改为奥沙利铂130 mg/m2+5-氟尿嘧啶1000mg/m2,一次性动脉灌注,6～11 d后手术治疗.另82例(对照组)术前未行化疗,直接手术治疗.两组患者术后均接受静脉辅助化疗.对两种治疗方式的临床效果、根治性(R0)切除率、手术并发症和远期预后进行评估.采用x2检验,Kaplan-Meier法行生存分析.结果 研究组和对照组的R0切除率分别为86%(65/76)和71%(58/82),两组比较,差异有统计学意义(x2=5.01,P<0.05).研究组的化疗毒副反应轻微.研究组和对照组的术后并发症发生率分别为20%(15/76)和16%(13/82),两组比较,差异无统计学意义(x2=0.41,P＞0.05).研究组和对照组的中位生存时间分别为41个月和23个月,5年总体生存率分别为44.6%和29.1%,两组比较,差异有统计学意义(x2=3.95,P<0.05).结论 进展期胃癌患者采用新辅助区域动脉化疗耐受性良好,有助于提高R0切除率,并延长其生存时间.     

Clinicopathologic features of gastric cancers producing alpha-fetoprotein

BACKGROUND: Patients with gastric cancers producing alpha-fetoprotein (AFP) were reported to have a poor prognosis with high rates of liver metastasis. The purpose of the present study was to clarify the clinicopathological features of AFP-producing gastric cancers, in particular characteristics of liver metastasis, and to evaluate treatment of these cancers. METHODS: In 27 of the 29 cases with elevated preoperative serum AFP levels among a total of 974 primary gastric cancers, AFP production was confirmed in gastric cancer cells by immunohistochemistry. These cases were included in the AFP-positive gastric cancer group (AFP(+), 2.7%). The remaining 945 cases with normal serum AFP levels were designated the AFP-negative gastric cancer group (AFP(-)). RESULTS: There was a higher incidence of lymph node metastasis, a deeper invasion of the gastric wall, a higher frequency of advanced stage, a more marked lymphatic invasion and a higher rate of liver metastasis in the AFP(+) group than in the AFP(-) group. The patients received curative resection in AFP(+) group had a significantly worse survival rates in comparison to that in AFP(-) group. With respect to liver metastasis (n = 17) in AFP(+) group, of 3 cases who received curative hepatic resection, 1 patient survived more than 3 years, while the remaining 2 died in less than 3 years due to multiple liver recurrence. The patients (n = 5) who received palliative resection for liver metastasis followed by transarterial continuous infusion chemotherapy all died in less than 1 year. CONCLUSION: AFP-producing gastric cancers had aggressive behavior and their clinical or biological features were quite different from the common AFP-negative gastric cancers. Surgical resection of liver metastasis from AFP-producing gastric cancers was unsatisfactory. The development of a novel multimodal therapy against AFP-producing gastric cancers is needed.     

Combination cancer chemotherapy by regional intra-arterial or intra-aortic infusion of 5-fluorouracil and mitomycin-C with or without irradiation

Conclusion In conclusion the combination cancer chemotherapy with intra-arterial or intra-aortic infusion of 5-FU and MMC with or without irradiation has proved of great value in the treatment of unresectable or recurrent cancer and offered selected patients significant palliation (Table 1). In our studies of the patients with advanced head and neck cancer unsuitable for conventional surgery, 68% of the patients showed regression with intra-arterial infusion of 5-FU and MMC with or without irradiation. In 38 evaluable patients with primary and metastatic liver tumors and pancreatic cancer, 71% of the patients showed objective evidence of response following hepatic artery infusion of 5-FU and MMC. Survival with this treatment for approximately 6 months was achieved in 53% of the patients so treated and 20% survival rate was achieved at the 12 month point. Objective tumor response was noted in 53% of the patients with pulmonary and gastrointestinal tract cancer by regional intra-aortic subselective infusion of 5-FU and MMC with or without irradiation. Analysis showed that 40% of the evaluable patients with lung cancer, 57% of the patients with stomach cancer, and 47% of the patients with colorectal cancer respectively demonstrated positive response to this therapy. The patients with unresectable colorectal cancer showed 50% survival rate at 12 month point after start of treatment with an average survival of 12.9 months. In 67 of over all 109 evaluable patients (61%) so treated the results has been good in terms of objective tumor regression and they sustained transient clinical benefits. Forty two of the 109 evaluable patients were classified as unimproved. Forty-three patients were un-evaluable since either the patient failed to complete the therapeutic regimen according to the protocol or the primary tumor was resected before starting the infusion chemotherapy or the patient was recent case before evaluation. Our results suggest that far advanced, non-resectable local malignancies without demonstrable distant metastasis should be treated vigorously with combined intra-arterial or intra-aortic infusion chemotherapy of 5-FU and MMC and irradiation.     

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??Plasma infusion during perioperative period on the prognosis of the gastric cancer patients with gastrectomy??An analysis of 255 cases CHEN Ren-xiong??ZHANG Jun??ZHANG Zhong-tao. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing100142, China
Corresponding author: ZHANG Jun?? E-mail??zhangjundoctor@sina.com
Abstract Objective To investigated the plasma infusion on the prognosis of the patients with gastric cancer. Methods The clinical data of the patients performed gastric resection from January 2005 to December 2009 in Beijing Friendship Hospital were analyzed retrospectively with COX regression. Then the perioperative plasma infusion was stratified to analyze its impact on gastric cancer survival. Results Multivariate survival analysis showed that pyloric obstruction??TNM stage??perioperative plasma infusion and tumor size≥6cm were independent prognostic factors. When stratified according to TNM stage??tumor size??preoperative hypoalbuminemia and anemia??plasma infusion group had significantly worse prognosis than no plasma infusion group in those stage ?? and stage ?? patients??whose tumor size less than 6cm??those with preoperative hypoalbuminemia and those without anemia. The differences were significant??P<0.05??. Conclusion In patients with gastric cancer, perioperative plasma infusion is an independent prognostic factor??which had greater influence on stage ??and stage ?? gastric cancer??tumor size less than 6cm??no preoperative hypoalbuminemia and no anemia patients.     

Preoperative adjuvant therapy for urinary bladder cancer--preoperative intra-arterial anticancer drugs infusion using artificial liver, and preoperative radiotherapy

One hundred patients with carcinoma of the urinary bladder were treated with preoperative intra-arterial anticancer drug infusion in combination with an active carbon-based artificial liver or preoperative radiotherapy (400 rad X 5 days, total 2000 rad) in order to alleviate systemic side effects after preoperative adjuvant therapy and to perform radical cystectomy as soon as possible. Five-year survival was 69.8% in the artificial liver combined preoperative intra-arterial anticancer drug infusion group, and that of the no-pretreatment group and the preoperative irradiated group was 48.6% and 45.8%, respectively. In particular, the CDDP treated group had a higher 5-year survival of 77.4% than did the without CDDP treated group. This was attributable mostly to improved prognosis of T2, whereas either of these preoperative adjuvant therapies failed to ameliorate the prognosis of T3 or T4 stage patients. Therefore, systemic preoperative anticancer chemotherapies such as M-VAC are necessary to destroy "micrometastases" and to improve the prognosis of highly advanced bladder cancer.     

围手术期化疗与术后化疗对行手术切除晚期胃癌病人预后影响对比研究

目的 研究围手术期化疗与术后化疗对行手术切除晚期胃癌病人的预后影响。 方法 回顾性分析2004年1月至2016年12月南方医科大学南方医院普通外科行胃切除手术治疗的Ⅳ期胃癌病人资料。其中,行手术切除联合术后辅助化疗228例（术后化疗组,A 组）,行术前化疗+手术切除+术后化疗49例（围手术期化疗组,B组）。采用倾向得分匹配法（PSM）均衡组间混杂因素的影响,选取8个协变量进行1∶1匹配 (性别、年龄、肿瘤生物学分类、化疗完成度、术后病理的肿瘤浸润深度分期、淋巴结转移分期、淋巴结清扫范围、胃切除范围),最终49例A组病人和49例B组病人成功进行匹配。采用Kaplan-Merier法进行生存分析,应用Cox比例风险回归模型对行手术切除的晚期胃癌病人进行独立生存危险因素的分析。 结果 匹配前,两组病人的肿瘤生物学分类（P<0.001）、化疗周期（P<0.001）、肿瘤浸润深度分期（P<0.001）、淋巴结转移分期（P=0.049）、淋巴结清扫范围（P=0.001）、胃切除范围（P=0.001）等差异有统计学意义,而匹配之后,仅有化疗完成度（P<0.001）在两组间差异有统计学意义,B组的化疗完成度优于A组。匹配之后,A组中位生存时间（MST）为16个月（95%CI 10.36～21.64）,与B组MST 29个月（95%CI 17.24～40.76）之间差异无统计学意义（P=0.191）。生存单因素分析显示,生物学分类、化疗周期、淋巴结转移情况和淋巴结清扫情况等四个因素可影响行手术切除晚期胃癌病人的生存预后,进一步多因素分析提示,化疗周期≤2次,淋巴结转移、淋巴结清扫范围不足D2等3个因素为独立预后不良因素。化疗与手术的先后次序（围手术期化疗相比术后化疗）并不影响病人生存预后（HR 0.986,95%CI 0.539～1.806,P=0.964）。 结论 相比术后化疗,围手术期化疗并不是改善行手术切除晚期胃癌病人生存预后的独立因素,但能够使病人有更好的化疗耐受性和依从性,从而使其生存显著优于术后开始化疗的病人。这可为后续晚期胃癌治疗的前瞻性研究设计提供参考和指导。