ERCC2、RAD51和BAG-1基因多态性与晚期非小细胞肺癌铂类化疗敏感性的研究

目的:研究着色性干皮病基因(ERCC2/XPD)、DNA修复基因RAD51 codon 135以及Bcl-2结合抗凋亡基因1(Bcl-2 associated athanogene 1,BAG-1)codon 324多态性与晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)以铂类药物为基础的化疗敏感性的关联。方法:选取100例晚期NSCLC患者,使用PCR-RFLP方法检测ERCC2/XPD Lys 751 Gln、RAD51 codon 135以及BAG-1 codon 324基因多态性,应用非条件Logistic回归计算OR值及95%CI,分析不同基因型与化疗敏感性的关系。结果:100例晚期NSCLC患者中,ERCC2/XPD 751基因Lys/Lys、Lys/Gln、Gln/Gln基因型的分布频率分别为69例(69%)、26例(26%)和5例(5%);RAD51 codon 135的基因型频率分布为G/G型占67%(67/100)、G/C型33%(33/100)、未发现C/C型;BAG-1 codon 324基因型频率分布C/C型占81%(81/100)、C/T型占19%(19/100),未发现T/T型。100例NSCLC患者化疗后,其中完全缓解(CR)、部分缓解(PR)、稳定(SD)和进展(PD)患者分别为0、31、41和28例。ERCC2/XPD C/A基因型多态性与化疗敏感性具有相关性(OR=3.53,95%CI=1.58-11.46,P<0.01);BAG-1 codon 324 C/C型患者与C/T型患者的化疗有效率差异有统计学意义(P=0.036),携带C/C基因型患者比C/T基因型患者化疗敏感(OR=2.67,95%CI=1.16-8.23,P<0.05);RAD51 codon 135G/C基因型患者是G/G基因型患者化疗敏感性的2.12倍(OR=2.12,95%CI=1.08-7.41,P<0.05)。结论:ERCC2/XPD、BAG-1 codon 324以及RAD 51 codon 135基因多态性可能与晚期NSCLC铂类药物化疗敏感性有关。     

食管癌中ERCC2/XPD和XRCC1基因多态性的表达

目的:探讨DNA损伤修复基因ERCC2/XPD和XRCC1基因多态性与食管癌遗传易感性的关系。方法:采用病例对照研究设计,选取100例食管癌病例和80例正常对照。选取ERCC2/XPD Lys751Gln和XRCC1 Arg399Gln基因多态性为研究位点,以聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法进行多态性检测,应用Logistic回归计算OR值及95%CI,比较不同基因型与食管癌发病风险的关系。结果:病例组和对照组中变异型等位基因ERCC2/XPD Lys751Gln的频率分别是15.7%和13.0%。与野生基因型Lys/Lys相比,携带XPD Lys/Gln和Gln/Gln基因型者患食管癌的危险度比值比(odds ratio,OR)分别是1.94(95%CI:1.22～3.36)和0.56（95%CI:0.15～2.64)。变异型等位基因XRCC1 399Gln的频率在病例组和对照组中分别是29.8%和30.2%,与野生基因型XRCC1 Arg/Arg相比,带Arg/Gln和Gln/Gln基因型者患食管癌的OR分别是0.94(95%CI:0.69～1.31)和1.83(95%CI:0.84～3.89)。分析结果提示饮酒、酸泡菜与XPD Lys751Gln基因多态存在交互作用,交互效应OR值分别为2.24(95%CI:1.18～2.87)和2.53(95%CI:1.71～3.46),携带XPD Lys751Gln和XRCC Arg1399Gln突变基因者若同时暴露于酸泡菜或酒精,则患食管癌的危险显著增加,相较未暴露于上述因素者,OR值均增大。结论:DNA损伤修复基因ERCC2/XPD和XRCC1单核苷酸多态性可能与当地居民食管癌遗传易感性有关,与饮酒、酸泡菜存在交互作用。     

BAG-1和ERCC1基因多态性与晚期非小细胞肺癌患者铂类药物敏感性的关系

目的:探讨Bcl-2结合抗凋亡基因1(Bcl-2associated athanogene1,BAG-1)codon324(C→T,rs11551682)和切除修复交叉互补基因1(excision repair cross-complementing group1,ERCC1)codon118(C→T,rsl1615)基因多态性与晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者对铂类药物敏感性的关系。方法:以聚合酶链-限制性片段长度多态性(PCR-restriction fragment length polymorphism,PCR-RFLP)方法检测142例接受铂类药物化疗的晚期NSCLC患者的BAG-1codon324基因型和ERCC1codon118基因型,比较不同基因型与化疗敏感性的关系。结果:BAG-1codon324基因型频率分别为C/C占77.46%(110/142),C/T占22.54%(32/142),未发现T/T。142例患者中,完全缓解4例,部分缓解42例,疾病稳定55例,疾病进展41例;总有效率为32.39%。BAG-1codon324C/C基因型患者对顺铂类药物的敏感性是C/T基因型患者的2.852倍(95%可信区间:1.133～7.182,P=0.026),且BAG-1codon324C/C基因型与C/T基因型患者的中位无进展生存期差异有统计学意义(分别为5.7和5.3个月,P=0.002)。携带BAG-1codon324C/C和ERCC1codon118C/C基因型,对铂类药物的敏感性存在一定的联合作用(P=0.005)。结论:BAG-1codon324和ERCC1codon118基因型可能是晚期NSCLC患者铂类药物敏感性的预测因子。     

ERCC1和XPD单核苷酸多态性与非小细胞肺癌铂类化疗敏感性的关系

目的：探讨DNA修复基因ERCC1 C118T和XPD Lys751Gln单核苷酸多态性与非小细胞肺癌（non-small-cell lung carcinoma,NSCLC）患者对含铂方案化疗敏感性的关系。方法：选择经病理确诊为NSCLC的患者73例,在实施化疗前采取静脉血,提取DNA,行DNA测序、用PCR-RFLP方法检测ERCC1 C118T和XPD Lys751Gln基因型。所有患者均经含铂方案化疗,观察疗效,统计临床获益率,分析NSCLC患者ERCC1和XPD单核苷酸多态性与含铂方案化疗敏感性的关系。结果：ERCC1 C118TC/C、C/T和T/T基因型临床获益率分别为94.9%、71.4%和83.8%。基因型C/C临床获益率明显高于C/T、T/T（P〈0.05）。XPD Lys751Gln基因型Lys/Lys、Lys/Gln临床获益率分别为80.3%和75.0%。基因型Lys/Lys与Lys/Gln临床获益率间的差异无统计学意义（P=0.702）。未检测到XPD Gln/Gln基因型。ERCC1 C118T、XPD Lys751Gln多态之间在对含铂方案的化疗敏感性方面无协同作用（P=0.134和P=0.236）。结论：DNA修复基因ERCC1 C118T单核苷酸多态性与NSCLC含铂方案化疗的敏感性有关,可作为预测NSCLC患者铂类药物化疗敏感性的参考指标之一。     

ERCC1和XPD基因SNPs与NSCLC含铂类药物化疗敏感相关性分析

目的:探讨切除修复交叉互补基因1(ERCC1)第118位密码子(C118T)和着色性干皮病基因D(XPD)第751位密码子(Lys751Gln)的单核苷酸多态性(SNPs),与晚期非小细胞肺癌(NSCLC)患者对含铂类药物化疗疗效的关系。方法:聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术检测78例NSCLC患者的ERCC1(C118T)和XPD(Lys751Gln)基因型。结果:ERCC1(C118T)SNPs与铂类化疗疗效有关,P<0.05。C/C型化疗有效者7例(8.9%),C/T型为11例(14.1%),T/T型2例(2.6%);C/C化疗无效41例(52.6%),C/T型17例(21.8%),T/T型0;两组差异有统计学意义,P=0.003。T等位基因(T/T+C/T)型与C等位基因(C/C)型的化疗疗效差异亦有统计学意义,P=0.005,比值比(OR)=0.223,95%的可信区间(CI)为0.076～0.657;XPD(Lys751gln)SNPs与含铂类药物化疗疗效无关。ERCC1(C118T)、XPD(Lys751Gln)SNPs分布与年龄、性别、吸烟史、临床分期、体力状况评分(ECOG)和病理类型无关,P>0.05。结论:ERCC1(C118T)含有T等位基因,可作为预测晚期NSCLC患者铂类药物化疗敏感性的预测指标。     

ERCC1与XPD和XPA的遗传多态性对非小细胞肺癌铂类化疗敏感性预测的研究

目的:分析非小细胞肺癌(NSCLC)患者ERCC1Asn118Asn,XPD Lys751Gln和XPA A23G各基因型与以铂类为基础的化疗敏感性的关系,以及不同基因型之间疗效及生存期之间的差异。方法:采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)方法分析94例NSCLC患者的基因型,并与疗效及生存期结合分析。结果:XPD Lys751GlnLys/Lys、Lys/Gln和Gln/Gln基因型之间的中位生存期差异有统计学意义,χ2=7.353,P=0.007。Lys/Lys中位生存期为11个月,而Lys/Gln和Gln/Gln中位生存期为12个月,95%CI分别为9.94~12.06和11.21~12.79。Lys/Lys、Lys/Gln和Gln/Gln各基因型对含铂类方案化疗临床获益(CR PR SD)差异无统计学意义,χ2=2.604,P=0.272。XPA A23G AA和GG基因型及ER-CC1Asn118Asn AA和TT基因型疗效之间差异无统计学意义(χ2=1.383,P=0.550;χ2=0.451,P=1.000)。未检测到XPA及ERCC1杂合子基因型。结论:XPD751可作为预测肺癌患者生存期的一个重要指标,为肿瘤的个体化治疗提供理论依据。     

DNA修复基因XPD 312 Asn和751Lys多态性与非吸烟女性肺癌的关系

目的 着色性干皮病互补基因D(xeroderma pigmentosum group D,XPD)是一种重要的DNA损伤修复基因,其常见的多态是位于751密码子的A→C颠换和312密码子G→A转换。本研究旨在探讨XPD基因751位点和312位点单核苷酸多态性与非吸烟女性肺癌易感性的关系。方法 采用病例-对照研究方法,纳入非吸烟女性肺癌患者222人和对照222人。以聚合酶链反应-限制性片段长度多态性方法分析XPD基因Lys751Gln和Asp312Asn多态基因型。结果 携带至少1个751Gln等位基因者和携带至少1个312Asn等位基因者患肺癌的风险均显著增高,调整OR分别为3.36(95%CI为2.29-4.90)和1.83(95%CI为1.16-2.91)。结论 XPD基因Lys751Gln和Asp312Asn多态是非吸烟女性肺癌的遗传易感因素。     

XPD751基因多态性与胃癌易感性的Meta分析

目的探讨XPD 751基因多态性与胃癌患病风险的关系。方法检索VIP、CBM、CNKI、Pubmed、EMBASE等数据库,收集有关XPD Lys751Gln基因多态性与GC易感性的病例对照研究,提取纳入文献的相关数据进行Meta分析。以病例组及对照组XPD Lys751Gln基因型分布的比值比(odds ratio,OR)为效应指标,对文献进行异质性检验,应用Rev Man 5.14软件对数据进行合并分析,计算合并OR值及95%可信区间(CI)。结果共14个病例对照研究符合纳入标准,累计病例2852例,对照6424例。Meta分析结果显示:Gln-allele与GC易感性无关联性(P>0.05);亚组分析:中国人群[Gln/Gln vs.Lys/Lys,OR=3.23(95%CI=2.28-4.56,I2=0%,P<0.001);Gln/Gln vs.Lys/Gln+Lys/Lys,OR=2.42(95%CI=1.74-3.38,I2=0%,P<0.001);Gln-allele vs.Lys-allele,OR=1.28(95%CI=0.81-2.02,I2=88%,P=0.28)];混合人群组各基因型之间比较,均无统计学差异(P均>0.05)。结论 XPD 751Gln/Gln基因型可能是中国人群GC的易感基因型,尚需要开展更大、更严谨的研究证实。     

CYP2D6基因G4268C和ERCC1基因C8092A位点的单核苷酸多态性与肺癌遗传易感性

目的:探讨辽宁地区CYP2D6基因G4268C和ERCC1基因C8092A位点的单核苷酸多态性对肺癌发生的影响。方法:采用病例-对照研究方法,选取肺癌患者和健康对照者各200例。应用KI法快速抽提人外周血基因组DNA,PCR-RFLP的方法检测CYP2D6基因G4268C和ERCC1基因C8092A位点的单核苷酸多态性。结果:G4268/G、G4268/C和C4268/C这3种基因型在病例和对照组的分布频率分别为1.50%、58.00%、40.50%和2.50%、44.00%、53.50%,非C4268/C基因型的个体发生肺癌的风险是C4268/C基因型个体的1.73倍(95%CI=1.02-2.95),在腺癌中OR=2.75(95%CI=1.27-5.94);按吸烟情况进行分层分析后发现不吸烟者及轻度吸烟者中携带非C4268/C基因型的个体患肺癌的风险显著增高,OR值为2.09(95%CI=1.09-4.25)和3.41(95%CI=1.24-9.93);非A8092/A基因型的个体发生肺癌的风险是A8092/A基因型个体的0.98倍(95%CI=0.52-2.17)。结论:C4268/C基因型在不吸烟者和轻度吸烟者中可能作为保护因素而降低肺癌的易感性,ERCC1 C8092A多态性与肺癌易感性无相关性。     

XPD Lys751Gln多态性与成年人急性白血病发病风险的关系研究

目的 探讨核苷酸切除修复基因XPD Lys751Gln多态性与成年人急性白血病(AL)发病风险的关系.方法 按照1∶1配对病例对照研究方法,选择100例成年人AL患者为病例组,100名健康体检人群为对照组,采用聚合酶链反应-限制性片段长度多态性方法检测观察对象外周血XPDLys751Gln基因多态性.结果 成年人AL病例组和对照组Lys/Lys、Lys/Gln、Gln/Gln基因型分布频率分别为83%、16%、1%和90%、10%、0,两组比较差异无统计学意义(x2=1.44,P=0.49);携带XPDLys751Gln突变基因(Lys/Gln+Gln/Gln)的个体不增加AL的发病风险(x2=2.10,P=0.15,OR=1.84;95%CI0.80～4.25).按FAB形态学分型,携带XPD Lys751 Gln突变基因型(Lyg/Gln+Gln/Gln)个体患AL的危险度增加(OR=2.77,95%CI0.99～7.73).结论 XPD Lys751Gln可能与成年人急性淋巴细胞白血病的发病风险有关.     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。     

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.     

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60–3.53) and 1.64 (95% CI 1.02–2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63–1.13) for CM and 1.03 (95% CI 0.95–1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.