57例胃间质瘤预后分析

目的：探讨胃间质瘤手术治疗后肿瘤复发及患者生存的影响因素。方法：对2006年1月至2012年6月新疆肿瘤医院收治的57例胃GIST患者临床病理和随访资料进行回顾性分析。结果：57例胃GIST患者中复发、转移10例（17．5％）,主要发生部位为肝脏及腹腔。1年和3年无复发生存率分别是93％和84％。单因素分析显示,术后复发转移与核分裂象（＞5/50 HPF）、肿瘤直径（＞10cm）、Fletcher分级高有关;核分裂象（＞5/50 HPF）、复发转移与患者生存有关。结论：手术治疗是局部可切除原发GIST的标准治疗。Fletcher分级标准是评估 GIST 复发转移比较公认的指标。对于高危或复发转移胃GIST患者,建议服用伊马替尼治疗。     

肠源性胃肠道间质瘤71例临床分析

目的 探讨分析肠道来源胃肠道间质瘤(gastrointestinal stromal tumor,GIST)患者的临床和病理特征及影响预后的因素.方法 回顾性分析经手术治疗的71例肠源性GIST患者的临床、病理及部分随访资料,对其预后进行单因素分析.结果 71例GIST患者中,病灶原发部位小肠51例,结直肠15例,肠系膜5例.临床表现以消化道出血为主(45.1％,32例),其次为腹部不适及腹部包块(22.5％,16例;16.9％,12例),复发风险极低危l例,低危16例,高危54例.单因素分析显示,肿瘤最大径、核分裂相和复发危险度是影响预后的因素(均P＜0.05).复发风险高危组中,术后服用靶向药物患者的预后好于未服用药物的患者(P＜0.05).结论 肿瘤完整切除联合靶向治疗是肠源性GIST的最佳治疗模式,肿瘤最大直径、核分裂相及复发危险度是影响患者预后的危险因素.     

小肠间质瘤临床、影像及病理学特征与预后的相关性分析

目的:分析小肠间质瘤临床、影像及病理学特征与术后转移复发和死亡的相关性。方法:回顾性分析2013年01月至2016年12月北京友谊医院及北京市房山区良乡医院普外科收治的经手术治疗且病理检查确诊的61例小肠间质瘤患者,术后对其进行为期3年的随访。观察指标包括患者的临床特征、影像学特征、临床病理特征以及预后情况。结果:单因素分析结果提示,小肠间质瘤患者术后复发或转移与肿瘤直径、CT肿瘤密度不均匀改变、核分裂象计数、是否浸润、改良NIH危险度分级、切除分级、是否服用伊马替尼相关;小肠间质瘤患者术后死亡与年龄、肿瘤直径、核分裂象计数、是否浸润、改良NIH危险度分级和切除分级相关。多因素分析提示肿瘤直径>5 cm和核分裂象＞5/50高倍镜视野是小肠间质瘤患者复发或转移的独立危险因素;肿瘤直径>5 cm和改良NIH危险度中高危组是小肠间质瘤患者死亡的独立危险因素。结论:肿瘤大小、核分裂象计数以及改良NIH危险度分级是影响小肠间质瘤患者预后的独立相关因素。     

影响胃肠间质瘤患者预后的相关临床病理因素分析

目的分析影响胃肠间质瘤(GIST)患者预后的相关临床病理因素,为GIST的临床治疗提供参考。方法选取2013年1月至2015年10月柳州市中医医院普通外科收治的300例GIST患者,所有患者均行手术治疗,且于术后行病理和免疫组化检测,对其临床病理资料进行回顾性分析及随访,采用Cox风险模型分析影响GIST患者术后3年生存情况的临床病理因素。结果 GIST患者3年生存率有差异的指标包括肿瘤切除情况、切缘阳性情况、有无破裂、有无转移、核分裂数、Ki-67指数、NIH分级和术后甲磺酸伊马替尼服用与否及服用疗程(P0.05);Cox风险模型结果显示,肿瘤切除不完整、切缘阳性、肿瘤破裂、肿瘤转移、核分裂数增多、Ki-67指数5%、NIH分级高危险性、术后未进行靶向治疗皆为影响GIST患者预后的独立危险因素(P0.05)。结论影响GIST患者预后的独立危险因素有切缘阳性、肿瘤破裂、肿瘤转移、核分裂数增多、Ki-67指数5%、NIH分级高危险性、术后未进行靶向治疗,临床治疗应结合各临床病理因素综合考虑,以准确判断患者的预后。     

胃癌根治术后早期复发转移的影响因素分析

摘 要：［目的］ 探讨胃癌根治术后早期复发转移的影响因素。［方法］ 回顾性分析232例胃癌根治术后复发转移患者的临床病理特征,分析患者术后早期复发转移的影响因素。［结果］ 232例患者中位复发时间为术后17.3个月（95%CI：15.0~19.6）,早期复发转移（复发转移时间≤ 24个月）153例（65.9%）,晚期复发转移（复发转移时间＞24个月）79例（34.1%）。多因素分析显示神经侵犯(P=0.009)、术后并发症（P=0.013）是根治术后早期复发转移的独立危险因素。［结论］神经侵犯、术后并发症与胃癌根治术后早期复发转移相关。     

食管胃结合部腺癌术后早期复发与死亡的相关危险因素

摘 要：［目的］ 探讨食管胃结合部腺癌患者术后1年内复发与死亡的相关危险因素。［方法］ 回顾性分析了2006年3月至2007年2月在河北医科大学第四医院胸外科诊治的387例食管胃结合部腺癌患者的临床病例资料。［结果］ 全组患者1年生存率为79.0%,5年生存率为28.7%,术后1年内复发死亡的患者71例,术后5年以上未复发的患者为109例。单因素分析显示：性别、肿瘤最大直径、肿瘤浸润深度、淋巴结转移及残端是否阳性是影响预后的因素。多因素分析显示：性别（P=0.037）、肿瘤最大直径（P=0.030）、淋巴结转移（P=0.000）是影响预后的独立危险因素。［结论］ 食管胃结合部腺癌的预后仍较差,复发转移依然是主要的致死原因。而性别、肿瘤最大直径和淋巴结转移是预测术后早期复发转移的独立危险因素。     

原发性胃肠间质肿瘤121例临床分析

目的:探讨胃肠间质肿瘤(gastrointestinal stromal tumor,GIST)的临床特征、治疗以及相关的预后因素.方法:对1999年7月-2007年6月121例原发性GIST患者的临床和病理特征、治疗以及预后情况进行了回顾性分析.结果:原发性GIST患者的男女之比为1.57:1,年龄26～83岁,中位年龄61岁.常见肿瘤部位以胃和小肠多见.CD117阳性114例,CD34阳性94例.121例患者均接受了外科治疗,其中完全切除84例,31例行淋巴结清扫或活检术,获检274枚淋巴结中只有2枚被检出有转移.68例患者于术后接受了3～38个月伊马替尼的治疗.121例患者中有106例接受了7～85个月的随访,1、3、5年累计无进展生存率分别为88.8%、55.6%和35.9%,总生存率分别为97.8%、71.8%和57.0%.单因素生存分析显示,生存率与肿瘤部位、肿瘤大小、核分裂相数目、危险度分级、手术方式以及是否接受伊马替尼治疗有关.分层分析结果显示,完全切除术后危险度分级和伊马替尼治疗是影响术后无复发生存时间的因素.多因素回归分析结果显示,肿瘤大小、核分裂相数、危险度分级、完全切除以及伊马替尼治疗是影响生存预后的独立危险因素.结论:肿瘤大小和核分裂相数是GIST的2个重要的预后因素.完全切除与GIST预后独立相关,但并不提倡常规进行系统淋巴结清扫;伊马替尼可提高GIST的3年生存率,完全切除术后给予伊马替尼治疗可延缓复发或转移.     

胃肠间质瘤复发危险度的临床分析

目的:探讨不同临床病理因素对胃肠间质瘤(gastrointestinal stromal tumor,GIST)预后的影响,以期为GIST诊断和治疗以及预后判断提供依据。方法:回顾性分析2001年1月—2006年12月接受手术治疗的128例GIST患者的临床病理资料并进行随访,分析肿瘤原发部位、肿瘤大小、组织学类型、核分裂相、远处转移、甲磺酸伊马替尼等因素和GIST危险度与生存率之间的关系。结果:本组患者CD117表达阳性率为94.5%(121/128),CD34表达阳性率为72.7%(93/128)。按照Miettinen危险度分级标准,相同危险度的胃间质瘤与非胃间质瘤的生存率差异无统计学意义;而组织学类型与危险度分级相关(P=0.0282)。远处转移与GIST患者的生存率密切相关(P<0.0001)。甲磺酸伊马替尼治疗GIST可以明显提高中-高危险度GIST患者的生存率。结论:Miettinen危险度分级标准作为GIST的预后判定标准更为合理。组织学类型和远处转移可以作为评估GIST的重要因素,应在分级标准中予以体现。对中-高度危险的GIST患者,应建议口服甲磺酸伊马替尼治疗。     

直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素分析

摘 要：［目的］ 探讨直肠神经内分泌肿瘤的淋巴结转移情况及其预后影响因素。［方法］ 60例直肠NET患者进行手术治疗,其中行肠镜下电灼术3例,行经肛根治术15例,行经肛局部切除术41例,另1例肝转移患者行姑息性直肠病灶切除术。分析患者淋巴结转移情况及其预后的影响因素。［结果］ 直肠NET的淋巴结转移受肿瘤G分级、T分期以及肿瘤大小影响（P＜0.01）。多因素分析显示T分期为影响淋巴结转移的独立因素（OR=45.997,95%CI：4.032~526.128,P=0.001）。肿瘤G分级、T分期、N分期、M分期以及肿瘤大小均与直肠NET患者的预后相关（P＜0.05）,M分期是直肠NET患者预后的独立影响因素（OR=2.895,95%CI：1.482~3.528,P＜0.001）。［结论］ NET的淋巴结转移情况与T分期密切相关,预后受肿瘤的M分期影响。     

19例结直肠胃肠道间质瘤的外科治疗

目的:探讨结直肠的胃肠道间质瘤(gastrointestinal stromal tumors,GIST)外科治疗效果及其影响因素.方法:对我院1990年1月至2004年3月首次治疗的19例结直肠GIST临床资料和病理切片(含免疫组织化学检查)重新复核并加以随访,分析手术切除的效果以及影响手术疗效的因素.结果:手术者中位生存时间为60.0个月,术后1、3、5年生存率分别为100%、79.3%和69.4%.非扩大切除术者(即肿瘤局部切除和肿瘤及所在器官切除)与扩大切除术者比较,差异有显著性(P=0.001).完全切除术患者的生存率与肿瘤大小、病理类型、核分裂和复发转移有关;但多因素COX回归分析显示,术后生存率仅与肿瘤大小、核分裂和复发转移相关(P＜0.05).结论:结直肠GIST仍以外科治疗为主,原则上行局部完全切除即可.     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Antitumor activities and mechanisms of action of harringtonine and homoharringtonine

The antitumor activities and the mechanisms of action of harringtonine and homoharringtonine, alkaloids isolated from cephalotaxus hainanensis Li, were compared to those of vincristine. The results obtained were as follows: Harringtonine and homoharringtonine Significantly inhibited the growth of L1210 cells in culture. The IC50 values were similar to that of vincristine. Harringtonine and homoharringtonine had little effects on changes in the DNA histograms of FL cells at any concentrations, which suggesting that these drugs prolong the duration of each phase of the cell cycle evenly. Harringtonine and homoharringtonine had only a minor effect in arresting P388 cells in mitosis. Harringtonine significantly inhibited the DNA synthesis of P388 leukemia cells in culture, while vincristine weakly inhibited RNA and DNA synthesis. The successive treatment with harringtonine and homoharringtonine were as effective as the successive treatment with vincristine against P388 and L1210 leukemia, while both drugs were ineffective against Lewis lung carcinoma.