艾滋病合并恶性肿瘤患者临床特点及预后影响因素

目的 分析艾滋病病毒（HIV）感染者/艾滋病（AIDS）合并恶性肿瘤患者的临床特点及生存预后情况。方法 回顾性分析354例艾滋病合并恶性肿瘤患者资料,采用Log-rank检验进行单因素分析,采用Cox比例风险回归模型进行多因素分析。结果 患者平均年龄54.10±12.96岁,男女比例2.1:1,艾滋病合并淋巴瘤的患者最多（28.25%）;1、3、5年生存率分别为78.48%、62.13%、55.31%。单因素分析显示不同恶性肿瘤类型、年龄、性别、医保类型、确诊合并艾滋病后住院次数、平均住院天数、是否放疗、有无遵医嘱离院等患者的预后差异均有统计学意义;多因素分析显示性别、入院次数、平均住院天数、自费比例以及有无遵医嘱离院是影响患者生存预后的独立危险因素。结论 艾滋病容易合并淋巴瘤、肺癌、宫颈癌。患者在医院接受抗肿瘤疗程不足。     

青少年鼻咽恶性肿瘤51例远期生存质量分析

探讨根治放射治疗对青少年鼻咽恶性肿瘤远期生存质量的影响。方法　 5 1例年龄 <18岁的青少年鼻咽恶性肿瘤在本院接受根治放射治疗 ,随访超过 10年。结果　 10年生存率为 5 1.0 %。成年后平均身高、体重男性为 1.6 6m ,5 7kg ,女性为 1.5 5m ,5 3kg。 11人已结婚生育 ,后代均正常。无癌生存 2 6例中后遗症为面部放射性皮炎 2例 (7.7% )、龋牙 6例 (2 3 .1% )、传导性耳聋2例 (7.7% )、颈部放射性皮炎 5例 (19.2 % )、垂体功能减退 2例 (7.7% )。结论　根治性放射治疗对青少年鼻咽恶性肿瘤远期生长发育影响不大 ,较合适的剂量为鼻咽部 6 7～ 6 8Gy ,上颈部 5 5～ 6 5Gy ,下颈部 45～ 5 0Gy。要注重康复期的心理治疗。     

人乳头状瘤病毒感染与头颈部恶性肿瘤的关系

人乳头状瘤病毒是一种致瘤性ＤＮＡ病毒，在其９０个亚型中以高危型ＨＰＶ－１６，ＨＰＶ－１８，ＨＰＶ－３３等与人类头颈部恶性肿瘤关系密切。其致部机理是通过引起Ｐ５３，ｐＲＢ基因的突变，从而导致细胞转化及过度增殖，在不同部位的头颈部恶性肿瘤中ＨＰＶ的检出率存在差异，口腔、吕咽及喉部鳞状细胞癌中ＨＰＶ检出率高而鼻咽癌中检出率低，在头颈部腺癌和淋巴瘤中ＨＰ的感染鲜见报道，颈总转移淋巴结中ＨＰＶ的检测可以帮助临床提高原发病灶的检出率。     

病毒感染对恶性肿瘤患者抗肿瘤治疗的影响及抗病毒策略

临床上,合并病毒感染的恶性肿瘤患者越来越多,在给予抗肿瘤治疗时也会导致患者机体免疫功能下降而引起病毒再激活。病毒再作用于机体,可表现出不同的临床表现,常常需要抗病毒治疗的介入,这可能会导致抗肿瘤治疗中断或停止,进而影响患者预后。近年来,国内外学者针对在抗肿瘤内科治疗过程中预防病毒再激活开展了众多临床试验,为恶性肿瘤患者预防病毒再激活提供了新的理论依据。本文就恶性肿瘤合并乙型肝炎病毒、丙型肝炎病毒和人类免疫缺陷病毒对患者抗肿瘤内科治疗的影响及抗肿瘤治疗期间的抗病毒治疗策略进行综述。     

生存质量在中医药治疗恶性肿瘤领域中的应用研究

生存质量(quality of life,QOL)是近年医学领域颇受重视的课题.世界卫生组织(WHO)对生存质量的定义为:不同文化和价值体系中的个体对他们的目标、期望、标准以及所关心事情有关的生活状况的体验.     

恶性肿瘤中晚期病例长期生存七例

1975年到2000年,我院亲历治疗的100例中晚期恶性肿瘤病例中,有7例手术切除原发病灶后未做任何辅助治疗,生存期超过20年.这些患者的预后好于恶性肿瘤一般规律性结局,现报告如下.     

鼻咽癌组织学类型与EB病毒感染的关系

[目的]研究不同组织学类型鼻咽癌与EB病毒感染的关系.[方法]收集4种主要组织学类型的鼻咽癌288例,用原位杂交方法检测癌巢及肿瘤浸润淋巴细胞的EB病毒编码小RNAs(EBERs)的表达,其中EBERs阳性的31例非角化性癌和19例角化性鳞状细胞癌,进一步用原位杂交法检测EB病毒溶解期产物EA-D(early antigen-diffuse,EA-D)mRNA的表达.[结果]接近100%的鼻咽非角化性癌(99.32%,145/146)显示出EBERs阳性信号,鼻咽腺癌EBERs阳性率明显小于角化性鳞状细胞癌,分别是35.90%(14/39)、84.38%(81/96).双向分化的腺鳞癌的EBERs阳性率(71.43%,5/7)处于非角化性癌/角化性鳞状细胞癌(93.39%,226/242)与腺癌(35.90%,14/39)之间.非角化性鳞状细胞癌、腺癌、角化性鳞状细胞癌分别有23例(23/146,15.75%)、16例(41.03%,16/39)、31例(31/96,32.29%)可见表达EBERs的肿瘤浸润淋巴细胞.角化性鳞状细胞癌的EA-D mRNA表达率高于非角化性癌,分别是78.95%(15/19)、16.13%(5/31).[结论]4种不同组织学类型鼻咽癌的EB病毒感染率与感染状态不完全一致.鼻咽非角化性癌总是与EB病毒的潜伏感染密切相关,角化性鳞状细胞癌组织中的分化不良成分也与EB病毒潜伏感染关系密切,其中分化良好的癌细胞经常可以检测到EB病毒的溶解性感染产物表达.鼻咽腺癌与EB病毒感染的关系并不密切.     

EBV相关恶性肿瘤的新病毒靶向性治疗研究进展

EB病毒(Epstein-Barr virus,EBV)被证明与多种人类恶性肿瘤相关,如鼻咽癌(nasopharyngeal carcinoma,NPC)、Burkitt淋巴瘤(Burkitt’s lymphoma,BL)、移植后淋巴组织增生症(post-transplant lymphoproliferative disease,PTLD)、霍奇金淋巴瘤(Hodgkin’s lymphoma,HL)、非霍奇金淋巴瘤(non-Hodgkin’s lymphomas,NHL)以及胃癌(gastric cancer,GC)等。在大部分EBV相关性恶性肿瘤中,几乎所有的癌细胞内都包含病毒基因组,这为人们提供了种以EBV基因组作为靶点,治疗EBV相关恶性肿瘤的潜在可能。本综述主要描述EBV相关恶性肿瘤的病毒新靶向治疗的新研究进展,并深入探讨了药物诱导病毒活化作为肿瘤治疗手段的可能性及其相关信号通路。     

佛山市南海区HIV感染者/AIDS患者中恶性肿瘤常见类型及生存分析

目的：了解佛山市南海区艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者中常见的恶性肿瘤类型及患者生存状况。方法：在艾滋病综合防治信息管理系统中选择2010年1月1日至2017年3月31日在广东省人民医院南海医院登记并有随访记录的41例HIV/AIDS合并恶性肿瘤患者作为研究组,选择同期广东省人民医院南海医院收治的全部非HIV感染的恶性肿瘤患者作为对照,分析HIV/AIDS合并恶性肿瘤的常见类型,运用Cox回归模型分析HIV/AIDS合并恶性肿瘤患者的预后生存情况。结果：HIV恶性肿瘤患者平均年龄(41.7±7.9)岁,明显低于非HIV恶性肿瘤(58.7±14.8)岁,差异有统计学意义(t=7.346, P<0.001)。HIV恶性肿瘤患者的常见类型为,恶性淋巴瘤、子宫颈癌和卡波济肉瘤,合计占65.85%。恶性淋巴瘤、子宫颈癌及其他各类恶性肿瘤患者的CD4+T淋巴细胞计数水平均表现为HIV人群明显低于非HIV人群,差异具有统计学意义(P<0.05)。临床分期为IV期是HIV恶性肿瘤患者预后死亡的独立危险因素(RR=3.838, P<0.05);而采用HARRT治疗和抗肿瘤治疗联合疗法(RR=0.062)、诊断恶性肿瘤时CD4+T淋巴细胞计数越高(RR=0.177)是HIV恶性肿瘤患者预后死亡的保护因素(P<0.05)。结论: 本地区HIV/AIDS人群发生恶性肿瘤的主要类型为恶性淋巴瘤、子宫颈癌和卡波济肉瘤。HIV合并恶性肿瘤时的CD4+T淋巴细胞数显著低于非HIV恶性肿瘤患者。临床分期、治疗情况、CD4+T淋巴细胞水平是影响患者生存的主要因素。     

细胞间隙连接蛋白在乳腺癌中的作用

早期研究一致认为细胞间隙连接蛋白（connexin）基因是抑癌基因,在乳腺癌中起抑制肿瘤发生发展的作用,但近年研究发现在很多转移性乳腺癌中connexin表达反而升高,connexin基因可能促进乳腺癌的远处转移.故推测在乳腺癌发生发展、侵袭转移中,connexin通过多种作用机制扮演了不同的角色.在乳腺癌治疗中合理应用connexin将改善患者的疗效.     

A long-term survival case of small cell lung cancer in an HIV-infected patient

We report a case of small cell lung cancer in a patient with human immunodeficiency virus (HIV) infection. The patient was a 51-year-old man diagnosed 8 years previously as seropositive for HIV, who was admitted to our hospital for re-evaluation of antiretroviral medications due to multidrug resistance. Chest radiograph revealed an abnormal hilar shadow subsequently confirmed to be small cell lung cancer. He received chemotherapy concurrently with highly active antiretroviral therapy (HAART), and lived for 14 months after the diagnosis. The prognosis of lung cancer in HIV-seropositive patients is very poor, and adverse effects of chemotherapy occur more frequently than in other patients. However, the simultaneous antiretroviral agents and combination chemotherapy was successful. Such treatment may be effective despite an otherwise poor prognosis, including HIV infection.     

扶正健脾法配合化疗对实体瘤患儿生存情况的影响

 目的　探讨中医扶正健脾方法配合化疗治疗实体瘤小儿的远期疗效。方法　将2005年1月至2006年3月入组的76例实体瘤患儿随机分为治疗组（35例）,对照组（41例）。治疗组采用化疗+自拟扶正健脾中药,对照组采用单纯化疗。结果　治疗组患儿的生存率高于对照组,差异有统计学意义（P＝0.0024）。化疗后平均生存时间治疗组（31±2）个月（95 % CI 27～34个月）,对照组（21±2）个月（95 % CI 16～25个月）,治疗组高于对照组。结论　中医辨证论治、扶正健脾、气血双补,可使患儿体内阴阳气血得以平衡、机体状态比较稳定,能够顺利完成化疗,从而使生存期得以延长。     

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

PurposeTo examine the annual hospital volume of surgery in relation to survival in colorectal cancer. Previous studies on hospital volume and survival following colorectal cancer surgery are conflicting.MethodsAll 49 032 patients who underwent resection for colorectal cancer in 1987–2016 in Finland were included, with complete follow-up until December 31, 2019. Primary outcome was 5-year mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) for quartiles of annual hospital volume for colorectal surgery, adjusted for calendar period, age, sex, comorbidity, stage, tumor location and oncological therapy. Additionally, colon and rectal cancer surgery were assessed separately. Sensitivity analysis of patients with confirmed curative intent was conducted.ResultsCompared to highest quartile (≥108 resections annually), lowest hospital volume (≤37 resections annually) was associated with slightly increased 5-year all-cause mortality (adjusted HR 1.07, 95% CI 1.02–1.12). A pre-planned subgroup-analysis suggested a slightly improved 5-year survival in high-volume institutions for rectal cancer, but not colon cancer surgery. Sensitivity analysis including only those operated with confirmed curative intent suggested no differences between hospital volume groups in colorectal, colon or rectal cancer for 5-year all-cause mortality.ConclusionHigher hospital volume is associated with slightly improved all-cause 5-year mortality in colorectal cancer surgery, but this effect may be limited to rectal cancer surgery only. Volume-outcome relationship in rectal cancer surgery should be investigated further using large datasets. These results do not support centralization of colon cancer surgery based on hospital volume only.     

NC与GC方案治疗耐药晚期乳腺癌近期疗效对照研究

 目的 研究吉西他滨与长春瑞滨（商品名：诺维本）分别联合顺铂治疗对蒽环类和紫杉类药物耐药的晚期乳腺癌患者的近期疗效及毒副反应。方法 经病理组织学或细胞学证实的46例晚期乳腺癌患者，随机分为两组，吉西他滨联合顺铂组（A组）23例，以吉西他滨1000 mg／m2静脉滴注，第1天、第8天；顺铂25 mg／m2静脉滴注，第1天至第3天。长春瑞滨联合顺铂组（B组）23例，以长春瑞滨25 mg／m2，第1天、第8天溶于生理盐水100 ml中快速静脉滴注。顺铂用法同A组。两方案均每3周重复，2个周期以上评价疗效。结果 两组的有效率分别为60.8 %（14／23）和56.5 %（13／23），两组比较差异无统计学意义（P＞0.05）。A组Ⅲ～Ⅳ度血小板减少高于B组，但B组Ⅲ～Ⅳ度白细胞减少及静脉炎相对较明显。结论 NC与GC方案治疗耐药晚期乳腺癌有较高的缓解率，不良反应较轻。     

人类免疫缺陷病毒阳性和阴性弥漫大Ｂ细胞淋巴瘤的临床特点及近期疗效分析

目的 分析比较人类免疫缺陷病毒（HIV）阳性与阴性弥漫大B细胞淋巴瘤患者的临床特点及疗效。方法 收集博茨瓦纳弗朗西斯敦市仰加奎医院肿瘤内科2012年3月至2015年3月诊治的弥漫大Ｂ细胞淋巴瘤患者共71例,其中HIV阳性37例,HIV阴性34例,给予CHOP方案一线化疗,对两组的临床特点及疗效进行分析。结果 与HIV阴性组相比,HIV阳性组B症状发生率高（56.8% vs. 29.4%; P=0.020）,更容易出现胃肠道（37.8% vs. 14.7%; P=0.028）、肝（29.7% vs. 9.7%; P=0.027）、肺（27.0% vs. 9.7%; P=0.048）浸润。HIV阳性组与HIV阴性组治疗完全缓解率分别为18.9%（7/37）与41.2%（14/34）（P=0.040）;客观有效率分别为48.6%（18/37）与70.6%（24/34）（P=0.060）。HIV阳性组化疗后出现贫血、白细胞下降及继发感染比例高于HIV阴性组（均P<0.05）。HIV阳性组中有24例在确诊淋巴瘤前已给予高效价抗逆转录病毒治疗（highly active antiretroviral therapy,HAART）治疗,13例确诊后给予HARRT治疗,其客观有效率分别为41.7%和61.5%（P=0.248）。CD4⁺细胞数>200/mm³和≤200/mm³患者,其客观有效率分别为71.4%和34.8%（P=0.031）。结论 HIV阳性患者就诊时表现出更强的侵袭性。结合HARRT治疗,CHOP方案可使HIV阳性患者达到类似于HIV阴性患者的客观有效率,但完全缓解率低。HIV阳性组患者HARRT起始治疗时间不影响近期疗效。CD4⁺细胞数低是近期疗效不良的预测因素。     

Treatment and survival of locally recurrent rectal cancer: A cross-sectional population study 15 years after the Dutch TME trial

IntroductionOptimized treatment of primary rectal cancer might have influenced treatment characteristics and outcome of locally recurrent rectal cancer (LRRC). Subgroup analysis of the Dutch TME trial showed that preoperative radiotherapy (PRT) for the primary tumour was an independent poor prognostic factor after diagnosis of LRRC. This cross-sectional population study aimed to evaluate treatment and overall survival (OS) of LRRC patients, stratified for prior preoperative radiotherapy (PRT) and intention of treatment of LRRC.MethodsAll patients developing LRRC were selected from a collaborative Snapshot study on 2095 surgically treated rectal cancer patients from 71 Dutch hospitals in the year 2011. Cox proportional hazard analysis was performed to determine predictors for OS.ResultsA total of 107 LRRC patients (5.1%) were included, of whom 88 (82%) underwent PRT for their primary tumour. LRRC was treated with initial curative intent in 31 patients (29%), with eventual resection in 20 patients (19%). Median OS was 22 and 8 months after curative and palliative intent treatment, respectively (p < 0.001). Initial CRM positivity and palliative intent treatment were associated with worse OS after LRRC, while prior PRT was not.ConclusionsThis cross-sectional study revealed that rectal cancer patients, who underwent curative resection in the Netherlands in 2011 and subsequently developed local recurrence, were amenable for again curative intent treatment in 29%, with a corresponding median survival of 22 months. Prior PRT was not significantly associated with survival after diagnosis of LRRC.     

Examining the characteristics of unstaged colon and rectal cancer cases

Background: There are only three published studies that have examined unstaged cancers, including breast, prostate and colorectal cancer, but none have specifically examined which aspects of tumor staging were missing. The objective of the study was to identify which stage components were missing, to characterize and to identify predictors of unstaged cancer, and to evaluate prognosis of unstaged in colon and rectal cancer patients. Methods: Data on all colon and rectal cancer cases diagnosed during 1991 to 2002 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Information included in the analysis encompassed socio-demographics; tumor size (T); number of lymph nodes (N); metastases (M); SEER summary stage; SEER sites; cancer treatment; month and year of diagnosis; and last date known alive. Results: The study included 128,418 colon and 44,616 rectal cancer patients. Overall, 5.1% of colon and 7.8% of rectal cancer patients were unstaged. Compared to staged cases, both unstaged colon and rectal cancer cases were more likely to be older, African American, female, diagnosed in the Northeast and South, and have unknown treatment (all p < 0.001). The stage component of M was found to be the factor missing most frequently which attributed most to being unstaged. Survival was significantly higher in unstaged and the overall cohort compared to distant staged colon and rectal cancer patients (both p < 0.001) except for patients ≥ 65 years old (p > 0.99). Conclusions: Given that unstaged cases differ from staged, the findings have methodological implications in accounting for unstaged cases in epidemiological and health services research.     

转移性鼻咽癌的诊断和治疗

早期诊断、早期治疗以及选择正确的治疗模式是转移性鼻咽癌治疗的关键.目前,在鼻咽癌远处转移的诊断中,正电子发射计算机断层显像(PET)-CT是最优的检查方法.在治疗方面,以铂类为基础的化疗是首选的标准治疗方式,分子靶向治疗则有可能进一步提高疗效.如果患者转移灶局限,在使用化疗使病情得到控制后,针对转移灶进行局部姑息性治疗,有可能改善预后.     

低温等离子体在肿瘤治疗中的应用

研究表明,低温等离子体对肝癌、黑色素瘤、脑肿瘤、大肠癌、肺癌等具有一定的治疗作用.主要机制为：等离子体作用后使癌细胞内一氧化氮和活性氧水平增高,导致DNA损伤和线粒体功能障碍,细胞内线粒体凋亡通路被激活,改变了Bax/Bcl-2比例,活化凋亡蛋白caspase3、9,伴有细胞周期阻滞（G2-M期或S期）,最终导致细胞生长阻滞和细胞凋亡;增加β-catenin磷酸化,导致β-catenin降解,抑制整合蛋白2、4以及细胞表面局部黏着斑激酶的表达,破坏细细胞黏附,降低细胞的迁移和侵袭活性.