局部晚期低位直肠癌术前同步放化疗的疗效观察

目的 探讨术前同步放化疗治疗局部晚期低位直肠癌的安全性和有效性.方法 对临床分期属T3/T4低位直肠癌患者分为A组和B组.A组28例患者,给予术前放疗,同步口服卡培他滨.B组26例患者直接给予手术.结果 A组和B组根治术率分别为82.1％和50.0％ (P ＜0.01),保肛率分别为64.3％和26.9％ (P＜0.0...     

术前同步放化疗治疗局部晚期直肠癌的疗效分析

目的:观察20例术前同步放化疗治疗局部晚期直肠癌疗效,以同期15例术前单纯放疗作为对照组,分析疗效及毒副反应。方法:20例局部晚期直肠癌给予术前放化疗(DT40～46GY/20～23次)加同步化疗(静滴5-FU和优福定口服剂),对照组为同期15例局部晚期直肠癌给予术前放疗(DT40～50GY/20～25次)。结果:两组根治性切除率分别为75%(15/20)和46.7%(χ2=4.98,P=0.036),3年无瘤生存率分别为66.8%和55.4%(χ2=0.49,P=0.483)。结论:术前同步放化疗可提高根治性切除率和生存时间,毒副反应可以耐受。     

miR-135b-5p在宫颈癌中的表达及其作用机制的研究

目的:检测非编码微小RNA135b在宫颈癌中的表达,并初步探讨其可能的作用机制。方法:Real-time PCR检测19例宫颈癌组织和癌旁组织中miR-135b-5p的表达量,并和患者年龄、细胞分化程度、临床分期、淋巴结转移的相关性进行分析;同时通过软件预测miR-135b-5p的目的基因KLF4,Western Blot检测靶基因蛋白的表达变化。结果:Real-time PCR结果显示,和癌旁组织相比,宫颈癌中miR-135b-5p的表达量明显增高,差异有统计学意义（P<0.05）;而且和宫颈癌患者的细胞分化程度、临床分期、淋巴结转移呈正相关（P<0.05）;Western Blot检测结果显示KLF4在宫颈癌组织中表达量较癌旁组织减低（P<0.05）。结论:miR-135b-5p能够促进宫颈癌的发生和发展,可能和抑制KLF4的表达有关。     

miR-23b-3p在结直肠癌中的表达及其靶向KLF3抑制结直肠癌细胞侵袭和迁移能力的机制研究

目的:研究miR-23b-3p在结直肠癌中的表达情况及对结直肠癌SW620细胞侵袭和迁移的影响机制。方法:收集2018年01月至2020年12月我院胃肠外科手术切除的58例结直肠癌组织及癌旁组织标本,以及结直肠癌细胞株SW480、SW620、HCT116、HT-29、Lovo和人正常结直肠黏膜细胞FHC,采用qPCR法检测miR-23b-3p和KLF3相对表达水平。采用脂质体转染技术将miR-23b-3p mimics、mimics-NC转染至SW620细胞,采用Transwell实验和划痕实验检测其侵袭和迁移能力的改变。利用生物信息学软件预测并通过双荧光素酶报告基因实验验证miR-23b-3p和KLF3的结合位点。将KLF3过表达质粒（pcDNA3.1-KLF3）或空载质粒（Vector）单独或联合miR-23b-3p mimics转染至SW620细胞,采用Transwell实验和划痕实验检测其侵袭和迁移能力的改变,采用qPCR和Western Blot实验检测SW620细胞中KLF3 mRNA及蛋白的表达。结果:miR-23b-3p在结直肠癌组织中的表达水平显著低于癌旁组织（P＜0.05）,并与患者TNM分期和远处转移有关（均P＜0.05）;miR-23b-3p在结肠癌细胞系中的表达水平均显著低于FHC细胞,上调miR-23b-3p表达能显著抑制SW620细胞的侵袭和迁移能力。KLF3在结直肠癌组织和细胞中高表达,与miR-23b-3p在结直肠癌组织中的表达呈负相关（r=-0.326,P=0.013）,双荧光素酶报告基因实验证实miR-23b-3p直接靶向调节KLF3的表达, KLF3过表达能促进SW620细胞的侵袭和迁移,同时转染miR-23b-3p mimics可下调KLF3蛋白和mRNA表达,逆转KLF3过表达对SW620细胞侵袭和迁移能力的促进作用。结论:miR-23b-3p在结直肠癌中低表达并与肿瘤患者TNM分期及远处转移相关,miR-23b-3p靶向调控KLF3表达抑制结直肠癌SW620细胞的侵袭和迁移能力。     

同期放化疗治疗局部晚期不可手术的直肠癌近期疗效观察

目的：观察同期放化疗治疗局部晚期不可手术的直肠癌患者的近期疗效及耐受性。方法：３８例经病理证实的局部晚期或局部 区域复发的直肠癌患者接受全盆腔三维适形放疗ＤＴ４６～５０Ｇｙ／２３～２５ｆ,后缩野至肿瘤区继续推量至ＤＴ６４～６６Ｇｙ／３２～３３ｆ,同期接受奥沙利铂１３０ｍｇ／ｍ^２ｄ_１,氟尿嘧啶３５０ｍｇ／ｍ^２ｄ_１～ｄ_５,甲酰四氢叶酸２００ｍｇ／ｍ^２ｄ_１～ｄ_５,４周为１周期,共２个周期。结果：获ＣＲ７例（１９.４％）,ＰＲ１６例（４４.４％）,ＳＤ６例（１６.７％）,ＰＤ７例（１９.４％）,总有效率（ＣＲ＋ＰＲ）为６３.９％;疼痛症状缓解率为１００％;全身状况好转率７２.２％;中位生存时间为２２个月,１年和２年总生存率分别为６７.７％和２１.３％。治疗相关的毒副反应以中性粒细胞减少、腹泻、恶心呕吐以及周围神经毒性反应为主,其３级毒副反应的发生率分别为１９.４％、１６.７％、１３.９％和１１.１％,均无３级以上毒副反应发生。结论：以奥沙利铂为基础的化疗同期联合放疗对局部晚期不可手术直肠癌患者具有较好的姑息治疗作用,其治疗依从性高,治疗相关毒性可以接受,值得临床进一步推广。     

miR-26b-3p对乳腺癌细胞生物学行为的影响及作用机制研究

背景与目的：miRNA是一类长度为21~23个核苷酸的单链非编码RNA分子,其作用机制主要为靶向于mRNA的3’非翻译区（3’ untranslated region,3’UTR）从而抑制其靶基因的表达。miRNA在肿瘤的发生、发展过程中发挥着关键作用,探讨miR-26b-3p对乳腺癌生物学行为的影响及作用机制。方法：通过实时荧光定量聚合酶链反应（real-time fluorescence quantitative polymerase chain reaction,RTFQ-PCR）检测miR-26b-3p在三种乳腺癌细胞系MCF-7、MDA-MB-231和MDA-MB-453中的表达,选取miR-26b-3p表达水平最低的乳腺癌细胞转染miR-26b-3p mimics后,采用细胞计数试剂盒（cell counting kit-8,CCK-8）法检测细胞的增殖,采用transwell迁移和侵袭实验检测细胞迁移和侵袭能力,通过小动物活体成像及裸鼠移植瘤模型检测miR-26b-3p对乳腺癌细胞裸鼠移植瘤生长和转移的影响,采用双荧光素酶报告基因分析检测miR-26b-3p与锌指E盒结合同源盒基因1（zinc finger E-box binding homeobox 1,ZEB1）的相互作用,采用RTFQ-PCR和蛋白质印迹法（Western blot）检测ZEB1的表达。结果：乳腺癌细胞系MDA-MB-453中miR-26b-3p表达最低,在MDA-MB-453细胞中转染miR-26b-3p mimics后,miR-26b-3p的表达水平显著升高（P<0.05）,细胞的增殖能力显著降低（P<0.05）,细胞的迁移（P<0.001）和侵袭能力（P<0.01）显著降低。过表达miR-26b-3p可抑制裸鼠体内乳腺癌移植瘤的生长和转移。miR-26b-3p可与ZEB1的3’UTR结合,抑制ZEB1的表达。结论：miR-26b-3p可靶向于ZEB1,抑制乳腺癌细胞的增殖、迁移和侵袭,抑制乳腺癌的生长和转移。     

局部进展期胃癌术前化疗与术前放化疗的对比研究

背景与目的：术前化疗和术前放化疗都是胃癌治疗指南推荐的针对局部进展期胃癌患者的治疗方法。然而,由于缺乏对比性的研究证据,两者的优劣性不详。本研究将对比术前放化疗与术前化疗在临床疗效及毒性反应之间的差异。方法：2007年6月—2012年10月期间,30例局部进展期胃癌患者入组一项术前化疗的Ⅱ期临床试验,采用EOF（表柔比星+奥沙利铂+氟尿嘧啶）方案进行3~4个周期的术前化疗,对于能手术的患者予以手术,术后给于2~3个周期的EOF方案化疗。2012年4月—2014年8月,40例局部晚期胃癌患者入组一项术前放化疗的Ⅱ期临床试验,患者接受1个周期的SOX［替吉奥（S-1）+奥沙利铂］方案化疗,继续行同步放化疗,再进行1个周期的SOX方案化疗,对于能手术的患者予以手术,术后给于4个周期的SOX方案化疗。比较两项临床试验患者的临床病理特点、术前治疗的效果、R0手术切除率、预后及不良反应。结果：术前化疗临床试验定义为化疗组,有30例胃癌患者入组,且完成了所有的术前化疗,都可评估。术前放化疗临床试验定义为放化疗组,有40例胃癌患者入组,其中36例（90%）患者可评估。两组间的基线参数,如性别、年龄、美国东部肿瘤协作组（Eastern Cooperative Oncology Group,ECOG）评分、临床T分期、临床N分期及肿瘤部位,差异无统计学意义。化疗组的临床有效率（CR+PR）为30%（9/30）,放化疗组的临床有效率（CR+PR）为41.7%,两者间的差异无统计学意义（P>0.05）。化疗组与放化疗组间的R0手术切除率差异无统计学意义（46.7% vs 66.7%）。放化疗组的病理有效率高于化疗组,且差异有统计学意义（50.0% vs 23.3%）。术前放化疗组的毒性反应较化疗组明显。放化疗组的3年总生存率为41%,高于化疗组的20% （P=0.009）。结论：放化疗组的病理有效率及3年总生存率高于化疗组。急性毒性反应也较化疗组明显,但无严重的毒性反应。     

miR-182、miR-136-5p表达与局部晚期口腔鳞癌患者TPF诱导化疗疗效的相关性分析

目的 分析miR-182、miR-136-5p表达与局部晚期口腔鳞癌患者TPF诱导化疗疗效的相关性分析.方法 选择局部晚期口腔鳞癌患者76例,将其纳入病例组.另于同期选择体检健康的受试者76例,将其纳入对照组.问卷调查患者的年龄、性别、分期、肿瘤部位、临床分级、病理分化程度、吸烟史和饮酒史.检查miR-182、miR-...     

局部晚期宫颈癌术前同步放化疗疗效及安全性评价

目的：探讨术前同步放化疗在局部晚期宫颈癌治疗中的疗效及安全性。方法2007年1月至2010年12月对70例Ⅰb2期及Ⅱa2期宫颈癌患者行PVB或TP或TC方案化疗结合腔内后装放疗后再行根治性子宫切除术,观察宫颈局部肿瘤变化及同步放化疗毒副反应,分析术前同步放化疗对局部晚期宫颈癌患者的疗效及安全性。结果70例患者中完全缓解和部分缓解分别为14例和45例,总有效率为84．3％。3年局部复发率为31．3％,3年远处转移率为25．4％,3年总生存率为79．1％。毒副反应发生情况,骨髓抑制30．0％（21/70）,周围神经毒性10．0％（7/70）,胃肠道反应80．0％（56/70）,肌肉关节痛12．9％（9/70）,脱发87．1％（61/70）。手术平均出血量410 mL,手术平均时间160min。术后输尿管尿瘘2例,尿潴留12例,盆腔淋巴囊肿合并感染1例,均对症治疗后痊愈。结论局部晚期宫颈癌术前同步放化疗能够获得较为理想的治疗效果,毒副反应可耐受,不影响后续的手术治疗,术后并发症轻微,具有良好的临床应用前景。     

热放化疗治疗局部晚期宫颈癌的疗效及安全性分析

目的 探讨热放化疗治疗局部晚期宫颈癌的疗效及安全性.方法 将90例局部晚期宫颈癌患者按治疗方式的不同分为热放化疗组(50例)和单纯放化疗组(40例),比较两组患者临床疗效、血清肿瘤标志物[鳞状细胞癌相关抗原(SCC-Ag)、癌胚抗原(CEA)]水平、生存情况及不良反应发生情况.结果 热放化疗组患者的有效率为84.00％...     

奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进展

目前基于氟尿嘧啶及卡培他滨的术前同步放化疗是局部进展期直肠癌的标准治疗模式,但仍有较高的远处转移率,为进一步提高疗效,探索新的化疗药物越来越受到学界的重视.其中奥沙利铂因其在辅助化疗及姑息治疗中的效果卓越,受到越来越多学者的关注,并因此开展了一系列Ⅰ～Ⅲ期临床研究.绝大多数Ⅰ/Ⅱ期临床研究表明奥沙利铂具有很好的应用前景,不仅达到良好病理完全缓解(pCR)率及肿瘤降期率,且不良反应可耐受.但是,在Ⅲ期临床研究中,STAR-01、ACCORD-12、NSABP-R04、PETACC-6均为阴性结果,仅CAO/ARO/AIO-04是阳性结果,显示奥沙利铂组能够获得显著的总生存期(DFS)获益,故奥沙利铂能否应用于局部进展期直肠癌术前放化疗存在明显的争议.因此根据目前研究结果,在直肠癌术前新辅助放化疗中,仍然不推荐在5-Fu/卡培他滨基础上常规使用奥沙利铂.全文对奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进行了总结,希望为进一步的临床研究提供依据.     

局部晚期直肠癌术前与术后同步放化疗的疗效比较

[目的]比较术前同步放化疗与术后同步放化疗对局部晚期中低位直肠癌的临床疗效和不良反应。[方法]收集100例局部晚期中低位直肠癌患者,50例行术前同步放化疗,同期50例先行根治术再行术后同步放化疗,比较两组的保肛率、局部复发率和生存率以及不良反应。[结果]术前同步放化疗的保肛率明显高于术后同步放化疗组,而局部复发率明显低于术后同步放化疗组（P〈0.05）,3、5年生存率两组间没有差别（P〉0.05）。[结论]局部晚期中低位直肠癌术前同步放化疗可以提高保肛率,降低局部复发率,值得临床推广。     

Outcomes of Preoperative Chemoradiotherapy and Combined Chemotherapy with Radiotherapy Without Surgery for Locally Advanced Rectal Cancer

Purpose: To evaluate the treatment outcomes of patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT) or combined chemotherapy together with radiotherapy (CMTRT) without surgery. Materials and Methods: A total of 84 patients with locally advanced rectal adenocarcinoma (stage II or III) between January 1st, 2003 and December 31st, 2013 were enrolled, 48 treated with preoperative CCRT (Gr.I) and 36 with combined chemotherapy and radiotherapy (CMTRT) without surgery (Gr.II). The chemotherapeutic agents used concurrent with radiotherapy were either 5fluorouracil short infusion plus leucovorin and/or capecitabine or 5fluorouracil infusion alone. All patients received pelvic irradiation. Results: There were 5 patients (10.4%) with a complete pathological response. The 3 yearoverall survival rates were 83.2% in Gr.I and 24.8 % in Gr.II (p<0.01). The respective 5 yearoverall survival rates were 70.3% and 0% (p<0.01). The 5 yearoverall survival rates in Gr.I for patients who received surgery within 56 days after complete CCRT as compared to more than 56 days were 69.5% and 65.1% (p0.91). Preoperative CCRT used for 12 of 30 patients in Gr.I (40%) with lower rectal cancer demonstrated that in preoperative CCRT a sphincter sparing procedure can be performed. Conclusions: The results of treatment with preoperative CCRT for locally advanced rectal cancer showed comparable rates of overall survival and sphincter sparing procedures as compared to previous studies.     

Correlative Significance of Tumor Regression Grade and ypT Category in Patients Undergoing Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Background: In patients with locally advanced rectal cancer, the treatment response to preoperative chemoradiotherapy (PRCRT) varies, and the ypT stage may change as a result of tumor shrinkage. The purpose of this study was to evaluate the correlative significance and determine the prognostic value of tumor regression grade and ypT category staging systems.Materials and Methods: This retrospective observational study was conducted in a tertiary center. A total of 1240 patients with rectal cancer who underwent curative resection after PRCRT between January 2007 and December 2016 were consecutively included.Results: A significant association was found between the American Joint Committee on Cancer/College of American Pathology tumor regression grading system and ypT category, indicating a potential correlation between worse tumor regression grade and more advanced T stage (Cramer's V = 0.255, P < .001). The ypT stage and tumor regression grade were independent predictors of each other (P < .001). The good response group (tumor regression grades 0-1) had significantly higher 5-year disease-free survival (85.5% vs. 68.2%, P < .001) and overall survival (92.1% vs. 81.0%, P < .001) rates than the poor response group (tumor regression grades 2-3). However, the ypT and ypN categories were the most important independent prognostic factors for disease-free and overall survival.Conclusions: Tumor regression grade and ypT category were significantly correlated. Although tumor regression grade alone is not definitive, it is closely related to the ypT stage and impacts oncologic outcomes. These findings should be taken into consideration when stratifying the prognosis of patients undergoing PRCRT.     

Phase I/II Study of Preoperative Chemoradiotherapy With TEGAFIRI for Locally Advanced Rectal Cancer

Introduction

Chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancer; however, the optimal chemotherapy sequence to administer simultaneously with radiotherapy remains unclear. We conducted a phase I/II study to test a new regimen, TEGAFIRI (combination tegafur, uracil [UFT], leucovorin [LV], irinotecan), for patients with locally advanced rectal cancer.

PDCD4 as a Predictor of Sensitivity to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients

Objective: The purpose of this study was to examine the role of programmed cell death 4 (PDCD4) expressionin predicting tumor response to neoadjuvant chemoradiotherapy and outcomes for patients with locally advancedrectal cancer. Methods: Clinicopathological factors and expression of PDCD4 were evaluated in 92 patientswith LARC treated with nCRT. After the completion of therapy, 4 cases achieved clinical complete response(cCR), and thus the remaining 88 patients underwent a standardized total mesorectal excision procedure.There were 38 patients (41.3%) with a good response (TRG 3-4) and 54 (58.7%) with a poor one (TRG 0-2).Results: Immunohistochemical staining analyses showed that patients with high expression of PDCD4 were moresensitive to nCRT than those with low PDCD4 expression (P=0.02). High PDCD4 expression before nCRT andgood response (TRG3-4) were significantly associated with improved 5-year disease-free survival and 5-yearoverall survival (P<0.05). Multivariate analysis demonstrated that the pretreatment PDCD4 expression was anindependent prognostic factor. Conclusion: Our study demonstrated that high expression of PDCD4 protein isa useful predictive factor for good tumor response to nCRT and good outcomes in patients with LARC.     

VMAT应用于局部晚期直肠癌术前同步放化疗的剂量学研究

[目的]比较局部晚期直肠癌术前静态调强放疗(IMRT)与动态容积调强放疗(VMAT)计划的剂量学差异.[方法]应用Pinnacle 9.0治疗计划系统分别对10例术前同步放化疗的直肠癌患者行IMRT和VMAT放疗计划设计,比较两种放疗技术的靶区剂量分布特点以及小肠、膀胱、双侧股骨头等危及器官的受照射剂量及体积.[结果]10例患者的靶区中位体积为2321.25cm3(2021.19cm3～2741.65cm3).IMRT和VMAT计划均能满足计划设计要求.VMAT与IMRT计划靶区的Dmax、Dmin、Dmean、V95％、V100％和V105％均无统计学差异,适形指数(CI)和均匀指数(HI)亦均无统计学差异(P=0.522,P=0.452).VMAT计划对小肠的保护较好,VMAT计划中小肠受量的Dmax、Dmean、V40及V50较IMRT计划均有明显下降(P=0.014,0.044,0.018和0.043).两组计划中膀胱及双侧股骨头受量的指标Dmax、Dmean、V50均未见统计学差异.VMAT计划的平均加速器跳数(MU)为507.220,IMRT计划为528.060(P=0.003).IMRT计划平均治疗时间390s,VMAT计划为157s (P＜0.001).[结论]VMAT计划具有降低总MU,缩短治疗时间及减少小肠受照射剂量的优势,但仍需要多中心、大样本的临床研究进一步证实.     

DWI在直肠癌术前同步放化疗疗效预测中的作用

 目的 探讨DWI在局部进展期直肠癌（LARC）术前同步放化疗疗效预测中的作用。方法 将经内镜活检病理证实的LARC患者44例纳入分析。将患者术后病理分期与治疗前临床分期作比较,分为T-降期组和T-未降期组,比较放化疗前后以及组间ADC值、组间ADC变化量（ΔADC）以及变化率（ADC%）之间的差异,并根据ROC曲线得出疗效预测的最佳临界ADC值。结果 44例患者中7例（15.9%）获得pCR。患者同步放化疗前后ADC值差异有统计学意义（P=0.000）。同步放化疗前T-降期组ADC值明显低于T-未降期组,差异有统计学意义（P=0.007）。同步放化疗后T-降期组ADC值明显高于T-未降期组,差异有统计学意义（P=0.005）。T-降期组同步放化疗后ΔADC及ADC%均高于T-未降期组,差异有统计学意义（Z=-5.53, P=0.000; P=-5.09, P=0.000）。取治疗前ADC值0.87×10^-3 mm²/s作为预测T分期是否降期的临界值,ROC曲线下面积为0.697（95%CI: 0.539~0.855）,预测疗效的敏感度为87.5%,特异性为55.0%。结论 通过对ADC的定量分析可早期预测直肠癌患者对术前同步放化疗的敏感度,对术前同步放化疗疗效的判断也有一定的价值。