影响鼻咽癌放疗后期长期生存因素（病例对照研究）

采用过程ＣＲＯＳＳＴＡＢＳ的统计方法对放疗后生存１０年以上与５年以下死亡的鼻咽癌病例进行病例对照研究，探索各入选因素与生存的相关性。结果显示：原发病灶类型、经济状况，精神状况、临床分期、颅神经症状，年龄及疗后ＶＣＡ－ＩｇＡ滴度与鼻咽癌的生存有相关性。有争议的性别及病理类型与生存无明显相关。     

鼻咽粘膜异常与鼻咽癌相关的前瞻性观察

在鼻咽癌高发区对３０～６４岁４３５４１健康人群进行了六年ＥＢ病毒血清学和鼻咽检查的前瞻性观察，对其中ＶＣＡ－ＩｇＡ阳性者及高滴度≥１：４０所对应的阴性对照者或有鼻咽粘膜异常者作为观察对象，共３７３７人。结果提示：①鼻咽粘膜异常多见于青壮年；部位以顶后壁最多；常呈滤泡增生和膨隆。②鼻咽粘膜异常组与无鼻咽粘膜异常组，ＶＣＡ－ＩｇＡ（壳抗原抗体ＩｇＡ）阳性率与几何平均滴度均无差异；粘膜异常患者百分率并不随ＶＣＡ－ＩｇＡ滴度升高而增大，且ＶＣＡ－ＩｇＡ滴度的变化与粘膜异常的变化无相关。③经六年前瞻性观察，两组的鼻咽癌出癌率在去除性别及年龄因素影响后显示有差异。目前，这种粘膜异常在病理组织学上尚未能证实为癌前病变。     

细胞连接蛋白基因在鼻咽癌中的表达

目的：为了解细胞连接蛋白（Ｃｏｎｎｅｘｉｎ,Ｃｘ）基因在鼻咽癌组织中的表达,探讨Ｃｘ基因表达与鼻咽癌组织的相关性。方法：采用定量逆转录－聚合酶链反应（ｑＲＴ－ＰＣＲ）及Ｎｏｒｔｈｅｒｎ印迹检测方法。系统研究了２８例鼻咽癌活检组织、６例慢性鼻咽炎组织中Ｃｘ２６、Ｃｘ３２、Ｃｘ３７、Ｃｘ４０、Ｃｘ４３、Ｃｘ４６６种Ｃｘ基因的表达情况,并进行了相对定量研究。结果：人类慢性鼻咽炎组织和鼻咽癌组织中均有Ｃｘ３７和Ｃｘ４３表达,且表达水平未见有明显差异,Ｃｘ２６、Ｃｘ３２、Ｃｘ４０和Ｃｘ４６未见可检出的表达。结论：鼻咽癌的发生和发展与Ｃｘ基因的表达水平可能无明显关系。说明细胞间隙连接通讯功能的缺陷并不一定是鼻咽癌形成及恶性转变的共同事件。     

增殖细胞核抗原在鼻咽癌中表达的定量研究

为了增加鼻咽癌的诊断和预后判定指标，应用抗增殖细胞核抗原（ＰＣＮＡ）单克隆抗体，采用免疫组化染色ＬＡＳ－ＳＰ法及图象分析技术，对８２例鼻咽鳞状细胞癌和２５例鼻咽粘膜炎症组织标本进行了定量研究，并对鼻咽癌患者５年生存率与ＰＣＮＡ表达情况进行了相关性分析。结果：①根据ＰＣＮＡ阳性细胞计算的鼻咽癌细胞增殖指数与鼻咽癌的病理分级呈明显的正相关，与患者５年生存率呈明显负相关。②图像处理检测的ＰＣＮＡ表达量与     

增殖细胞核抗原在鼻咽癌中表达的定量研究

为了增加鼻咽癌的诊断和预后判定指标，应用抗增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｅｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）单克隆抗体，采用免疫组化染色ＬＡＳ－ＳＰ法及图象分析技术，对８２例鼻咽鳞状细胞癌和２５例鼻咽粘膜炎症组织标本进行了定量研究，并对鼻咽癌患者５年生存率与ＰＣＮＡ表达情况进行了相关性分析。结果：①根据ＰＣＮＡ阳性细胞计算的鼻咽癌细胞增殖指数与鼻咽癌的病理分级呈明显的正相关，与患者５年生存率呈明显负相关。②图像处理检测的ＰＣＮＡ表达量与鼻咽癌的病理分级也呈明显的正相关，与５年生存率呈负相关，但泡状核细胞癌虽属低分化鳞癌却不符合上述规律。结论：ＰＣＮＡ能很好地反映鼻咽癌的增殖活性，在临床病理上具有应用前景，可作为对鼻咽癌预后判定及指导临床治疗的指标     

免疫球蛋白kappa轻链基因在鼻咽癌中表达的初步研究

目的：为了探讨Ｉｇｋ是否参与了鼻咽癌的癌变过程及可能机制，对Ｉｇｋ在鼻咽癌中的表达进行了研究，并初步探讨Ｉｇｋ与ＥＢ病毒潜伏膜蛋白基因ＬＭＰ－１在鼻咽癌中的相关性。方法：分别运用原位杂交技术和免疫组化技术检测鼻咽癌活检组织中Ｉｇｋ的ＲＮＡ和蛋白质水平的表达。Ｗｅｓｔｅｒｎ印迹分析两株鼻咽癌细胞系（ＣＮＥ１和ＣＮＥ＿ＣＭＰ）ｋａｐｐａ蛋白的表达及强度差异。结果：原位杂交技术显示１００％（４２例／４２     

鼻咽癌活检组织中HLA、EBNA及间质中T淋巴细胞亚群的分布

本实验对人类白细胞抗原（ＨＬＡ）、爱波斯坦－巴尔病毒核抗原（ＥＢＮＡ）、Ｔ细胞亚群的表达及分布进行综合分析，探讨其在癌变过程中的作用。用单克隆抗体Ｗ＿６／３２（抗ＨＬＡ－Ａ，Ｂ，Ｃ）、ＣＲ＿３／４３（抗ＨＬＡ－ＤＲ，ＤＰ，ＤＱ）、和Ｔ＿４、Ｔ＿８、Ｔ＿（１１），以碱性磷酸酶抗碱性磷酸酶法（ＡＰＡＡＰ）和用鼻咽癌患者血清以抗补体Ｃ＿３免疫荧光法，检测鼻咽癌（２５例）及慢性鼻咽炎（１０例）活检组织中ＨＬＡ、Ｔ细胞亚群分型和ＥＢＮＡ的表达。结果显示，鼻咽癌癌细胞多有ＨＬＡ－Ⅰ和Ⅱ型抗原表达，而以ＨＬＡ－Ⅱ型抗原表达为明显；慢性鼻咽炎上皮细胞表达ＨＬＡ－Ⅰ和Ⅱ型抗原较弱，与癌细胞比较，差异有显著性（Ｐ＜０．０５）。提示在癌变过程中，存在着ＨＬＡ表达的异常，体内ＥＢ病毒特异性Ｔ细胞可能不能识别带ＨＬＡ－Ⅱ型抗原的癌细胞，因而使其逃脱了机体的免疫监视。鼻咽癌组织中，癌细胞ＥＢＮＡ呈阳性和强阳性；癌间质中Ｔ细胞总数、Ｔ辅助、Ｔ杀伤细胞数量均减少，证明鼻咽癌局部细胞免疫功能降低。     

鼻咽癌患者机体免疫状态的测定

目的 探讨鼻咽癌病人机体的免疫状态及不同发展阶段的免疫状况,以求对病人的预后判断有一定帮助。方法 采用放射免疫扩散法和碱性磷酸酶－抗碱性磷酸酶法,对３５例鼻咽患者的免疫功能进行检测,取同期健康体检者４０例为对照组。结果 鼻咽癌组ＣＤ３＾＋、ＣＤ４＾＋细胞和ＣＤ４＾＋／ＣＤ８＾＋明显低于对照组（Ｐ〈０．０１）,ＩｇＭ、ＩｇＧ、ＩｇＡ较对照组偏低,但无显著性差异（Ｐ〉０．０５）;随病变发展ＣＤ３＾＋、     

鼻咽癌活检组织中HLA,EBNA及间质中T淋巴细胞亚群的…

本实验对人类白细胞抗原（ＨＬＡ）、爱波斯坦－巴尔病毒核抗原（ＥＢＮＡ）、Ｔ细胞亚群的表达及分布进行综合分析，探讨其在癌变过程中的作用。用单克隆抗体Ｗ６／３２（抗ＨＬＡ－Ａ，Ｂ，Ｃ）、ＣＲ３／４３（抗ＨＬＡ－ＤＲ，ＤＰ，ＤＱ）、和Ｔ４、Ｔ８、Ｔ１１，以碱性磷酸酶抗碱性磷酸酶法（ＡＰＡＡＰ）和用鼻咽癌患者血清以抗补体Ｃ３免疫荧光法，检测鼻咽癌（２５例）及慢性鼻咽炎（１０例）活检组织中ＨＬＡ、Ｔ细胞亚群     

鼻咽癌放疗后吞咽困难的外科治疗初探

目的探讨鼻咽癌放疗后吞咽障碍的外科治疗方式的有效性及可行性。方法选择2004～2009年我科治疗的鼻咽癌放疗后吞咽障碍的14例患者,根据其症状、体征及临床资料,对7例患者行环咽肌切断术,7例患者进行食管颈部造瘘术。结果 7例行环咽肌切断术的病例,5例有效,患者进食时间缩短,体重增加;2例无效,最后被迫接受胃造瘘手术。7例接受食管颈部造瘘术的病例,术后造瘘口稳定,术后患者生存质量明显提高。结论环咽肌切断术和食管颈部造瘘术是治疗鼻咽癌放疗后吞咽困难的有效手段,对复合脑神经损伤康复训练无效果者及时治疗可以明显改善患者的生存质量。     

气管食管壁组织瓣法发音重建术32例报告

目的探讨气管食管壁组织瓣法在全喉切除后发音重建的临床疗效。方法对１９８９年８月～１９９７年８月间手术的３２例病例进行临床随访,并评价发音效果。结果术后３周、１年、３年及５年发音总有效率分别为８７．５％、８６．７％、８４．２％及７２．７％,３年及５年的生存率分别为８２．６％及６８．８％。重建失败４例,术后发音变差４例。结论气管食管壁组织瓣法是全喉切除后有效的发音重建方法。     

Long-term results of tonsillectomy as a treatment for IgA nephropathy

IgA nephropathy (IgAN) is the most common form of chronic glomerulonephritis with IgA deposits present mainly in the mesangial areas. We performed a 10-year retrospective case-control study of 71 patients with IgAN to evaluate the long-term effects and prognostic factors associated with tonsillectomy. Forty-one patients (19 males and 22 females) underwent tonsillectomy (Group A) and 30 patients (13 males and 17 females) did not (Group B). These patients were followed for more than 10 years after renal biopsy. The average age at initial renal biopsy was 29.78 years in Group A and 33.0 years in Group B. The average follow-up period was 13 years and 3 months in Group A, and 12 years and 7 months in Group B. Glomerular damage demonstrated on renal biopsy was more extensive in Group A than in Group B. Prognosis after 10 years of follow-up was compared between the two groups. The clinical remission rate was 24.4% in Group A and 13.3% in Group B, the stable renal function rate was 82.9% in Group A and 70.0% in Group B, and the renal survival rate was 95.1% in Group A and 73.3% in Group B. The renal survival rate in Group A was significantly higher than that in Group B (p <0.05). Although evaluation of renal pathology based on renal biopsy was useful in predicting the long-term effects of tonsillectomy in IgAN patients, the results of tonsillar provocation tests were not.     

Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx--results of a pilot study.

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.     

颞骨鳞癌33例远期疗效分析

目的 评价乳突根治术加手术前或手术后放射治疗颞骨鳞癌的疗效。方法 回顾性分析３３例颞骨鳞吕治疗的远期疗效。根据病变范围分为３个亚组：鳞癌局限于外耳道３例（Ⅰ组））；病变侵及中耳乳突腔１７例（Ⅱ组）；更晚期病变１３例（Ⅲ组）。治疗方式分为：手术２例，放射治疗１１例，综合治疗（手术加术前或术后放射治疗）２０例。手术采用乳突根治术１９例，外耳道局部切除２例，颞骨次全切除１例；放射治疗剂量３５００￣１００     

Squamous cell carcinomas of the aryepiglottic fold: Therapeutic results and long-term follow-up

Three hundred fifteen patients with squamous cell carcinomas involving the aryepiglottic (A-E) folds were treated between January 1964 and December 1991. The age ranged from 39 to 87 years (mean, 62.4 years; median, 61.3 years) and the male-to-female ratio was 5:1 (54 women and 261 men). Symptom duration prior to diagnosis was 4.8 months. Eighty percent of patients had T3 and T4 lesions and 56.3% had neck metastases at presentation. Six patients (1.8%) had distant metastases and were excluded from this study. Clinically the tumors presented as either exophytic infiltrating lesions which were confined to the A-E fold (n = 57) or mucosally spreading tumors which extended to the lateral supraglottis or pyriform sinus (n = 258). Prior to 1978 preoperative radiation (3000 to 5000 cGy) was used. Higher doses of postoperative radiation (5000 to 6000+ cGy) were used thereafter. After 1982 the use of myocutaneous flaps for closure of partial laryngopharyngectomy defects was routine. Almost all NO neck disease was treated by radiation or surgery. Combined therapy was used in N1-N3 disease. One quarter of the patients had single-modality therapy (25.7%; 81 patients) with a cumulative 5-year disease-free survival of 53%. The remainder of the patients (n = 234) had combined therapy with a cumulative 5-year survival of 67.2%. The latter group had 163 conservation surgeries and 121 total laryngectomy resections. The 5-year disease-free survival for preoperative radiation with surgery (68%) and postoperative radiation with surgery (64%) was similar. Those treated by radiation alone had a 34% 5-year disease-free survival and those treated with surgery alone had a 61% 5-year disease-free survival. The cumulative locoregional control rate was 77%. The cumulative disease-free survival at 5,10,15, and 20 years is 66%, 57%, 55%, and 55%, respectively. Infiltrating tumors had a better disease-free survival (by more than 10%) than spreading tumors. The 5-year survival rates were separated well by clinical stages of tumors. In patients with T1 tumors the 5-year survival was 87%; in those with T2 tumors, 80%; in those with T3 tumors, 78%; and in those with T4 tumors, 41%. The survival rate was greater in those with NO tumors than in those with N+ tumors by 25% and greater in those with N1 tumors than in those with N2 + N3 tumors by an additional 18%. The overall complication rate was 26% and in 7.7% these were fatal. The salvage rate after single-modality therapy was equal for radiation and surgery (66.7%) and after combined therapy was better for surgery 53% (19/36) than radiation 24% (10/41). An incidence of distant metastases (16%), second primary tumors (8%), and death from intercurrent disease (11%) was documented. On a selected basis small T1N0 or T2N0 lesions can be treated equally well with single-modality therapy (>80%), but larger lesions or neck metastases require combined therapy with higher doses of postoperative radiation. Postoperative radiation reduced the complication rate and treatment-related fatalities, and increased the locoregional control and overall cure rates.     

High case volume of radiation oncologists is associated with better survival of nasopharyngeal carcinoma patients treated with radiotherapy: a multifactorial cohort analysis

Clin. Otolaryngol. 2011, 36 , 558–565 Objectives: The relationship between physician case volume and patient outcome in patients with head and neck cancers such as nasopharyngeal carcinoma treated by radiotherapy is unknown. This study was designed to investigate the association between the case volume of radiation oncologists and the survival of patients with nasopharyngeal carcinoma. Design: Retrospective cohort study. Setting: Based on nationwide claims data (National Health Research Insurance Database) in the years 2002–2008. Participants: Newly diagnosed patients with nasopharyngeal carcinoma receiving curative radiotherapy in the year 2003. Main outcome measures: Overall survival until 2008. We used the running log‐rank test to decide the optimal threshold for categorising the case volume of radiation oncologists. The characteristics of patients, their treatments and contact with health service providers were considered as co‐explanatory variables. The log‐rank test and Cox regression were performed. Sensitivity analyses were carried out regarding major study assumptions. Results: Five hundred and sixty‐two patients with nasopharyngeal carcinoma newly diagnosed in 2003 were identified as the study cohort. The 5‐year overall survival was better among patients treated by high‐volume (≥6 patients in year 2002) radiation oncologists than by low‐volume (<6 patients in year 2002) radiation oncologists (77%versus 64%, P = 0.0007). The adjusted hazard ratio of death was 0.65 (95% confidence interval, 0.48–0.91) upon multivariate analysis. Patients aged at least 65 years also had a lower survival rate than those younger than 65 years old (adjusted hazard ratio of death: 2.81, 95% confidence interval: 1.94–4.08).The physician case volume and patient outcome effect remained the same after sensitivity analyses. Conclusions: Patients with nasopharyngeal carcinoma treated by high‐volume radiation oncologists have better survival compared with those treated by low‐volume radiation oncologists. Further studies are needed to verify our findings with similar cancer cohorts treated by modern radiotherapy techniques or other types of radiotherapy.     

Methodological aspects of radiotherapy in the treatment of ear neoplasms

During 1978 to 1988, 35 patients with ear carcinoma (22 men and 13 women, aged 30 to 74 years) were treated. In 62% cases the tumor originated from the external acoustic meatus, in 30% cases--from the postoperative cavity (in patients operated on for chronic inflammation), and in 8% cases it was a primary tumor of the concha auriculae. 77% of the patients developed the III or IV stage of disease and 71% of patients had squamous cell carcinoma. Six patients underwent radiation therapy (Group 1), nine-radiation therapy and subsequent surgery within 14 to 30 days after exposure (Group 2), and twenty patients were exposed first to surgery and then to postoperative radiation therapy (Group 3). All the patients were followed up for at least one year and eight of them--for not less than 5 years. At the present time survivors make 37% of all the patients. In the study only routine dose fractionation was used. Regional metastatic areas were also exposed to irradiation. It is stressed that efforts are needed to increase the local effect of ear tumor therapy. Indications and contraindications for radiation therapy are presented and protocols of radiation therapy are described.     

Management of Malignant Salivary Gland Tumors

A total of 54 patients with major salivary gland tumor were treated with radiation therapy at the University of Michigan from 1955 to 1975, inclusive. Fifteen had total resection and radiation, 16 had subtotal resection and radiation, and 23 were inoperable and received radiation only. Local control rate was different between these groups, 86.7%, 75%, 21.7% respectively, as was survival rate at 5 years, 78.4%, 59.8%, 29.9% In patients with facial nerve palsy, with combined surgery and radiation, 65.3% local control and 49.7% 5year survival was obtained. Regional neck node metastasis was noted in 25.5% and distant metastasis in 24.1%. Local tumor control was found to be a very important factor in survival: 70.2% survival in patients with local control and 28.7% without. The authors conclude that a combined radical surgery and postoperative radiation would improve the prognosis of these patients with major salivary gland tumors.     

喉癌术前放射治疗及单纯手术疗效比较

目的 探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法 应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果 共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例，ＳＡ组３年     

喉癌术前放射治疗及单纯手术疗效比较

目的探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例。ＳＡ组３年生存率８３．３％，５年生存率８２．６％，１０年生存率８０．３％。ＲＳ组３年生存率７８．９％，５年生存率７６．４％，１０年生存率６８．６％。两组生存率差异无显著性（χ２＝２．６，Ｐ＝０．１）。声门上型喉癌ＩＩ、ＩＶ期两组病例在５年生存率上无区别，１０年生存率ＳＡ组优于ＲＳ组，１０年生存率前者为７３．６％，后者为６３．５％，（χ２＝８．３，Ｐ＝０．００３）。声门上型喉癌Ｔ３、Ｔ４病变行全喉切除的两组５年生存率无区别，１０年生存率则差异有显著性，ＳＡ组为６８％，ＲＳ组为５０％（χ２＝１０．６，Ｐ＝０．０００１）。结论术前放射治疗量４０Ｇｙ不能提高治愈率，而且声门上型喉癌ＩＩ、ＩＶ期病变综合治疗组的１０年生存率低于单纯手术组。