前列腺干细胞抗原在前列腺癌诊断与治疗中的应用

人们对前列腺癌理想的诊断和治疗方式的探寻从未停止.近些年来,随着对前列腺干细胞抗原(prostate stem cell antigen,PSCA)研究地不断深入,特别是应用于前列腺癌诊治方面的新成果不断推出,使人们对PSCA充满期望.本文重点对PSCA的生物学特性及其在前列腺癌诊断方法和免疫治疗方面的新进展进行综述.     

经尿道前列腺切除术在前列腺癌早期诊断中的意义

目的 评价经尿道前列腺切除术(TURP)在前列腺癌早期诊断中的作用.方法 采用TURP方法对16例血清前列腺特异抗原(PSA)轻度升高(平均11.7 ng/ml),直肠指诊和前列腺穿刺活检阴性,但PSA持续升高或者合并有明显下尿路症状,或者PSA升高却不宜活检的可疑前列腺癌病例行TURP.6例通过病理学诊断确诊前列腺癌.其中3例又行双侧睾丸切除术加间断抗雄激素药物治疗,2例行药物去势加抗雄激素药物治疗,1例在新辅助内分泌治疗后行根治性前列腺切除术.结果 对6例经TURP诊断为前列腺癌的患者随访3个月～2年,全部生存.TURP使2例前列腺癌合并下尿路症状患者的症状得到缓解.结论 TURP对部分前列腺癌有早期诊断作用,同时可以缓解合并的下尿路症状.     

外周血中前列腺特异性抗原mRNA表达的临床意义

多年临床实践表明 ,前列腺特异性抗原 (prostaticspecificantigen ,PSA)在前列腺癌的诊断和治疗中有重要作用。但是PSA并不能协助前列腺癌的早期诊断 ,很多患者在确诊时已属晚期 ,这也是前列腺癌治疗效果不尽人意的重要原因之一。为寻找更为准确可靠的前列腺癌诊断指标 ,我们采用RT PCR技术对前列腺癌患者进行研究 ,为前列腺癌转移的分子生物学行为提供理论依据 ,并希望在前列腺癌的诊断方面有所突破。一、资料与方法1.临床资料 :病例组 :选取天津医科大学第二医院和天津市肿瘤医院 2 0 0 1年 2月～ 2 0 0 2年 5月住院前列腺癌患者3 3…     

前列腺癌功能磁共振成像的研究进展

目的:总结国内外关于功能磁共振成像在前列腺癌诊断中的研究进展.方法:应用PubMed及CNKI期刊全文数据库系统,以"前列腺癌、磁共振成像、弥散加权成像、磁共振动态增强和磁共振波谱"为关键词,检索1997-01-2010-02的相关文献.纳入标准:1)前列腺癌组织学特点;2)磁共振弥散加权成像在前列腺癌诊断中的研究;3)动态增强磁共振成像(MR)在前列腺癌诊断的研究;4)磁共振波谱(MRS)在前列腺癌诊断的研究.根据纳入标准分析28篇文献.结果:弥散加权像(DWI)、动态增强扫描和MRS等功能性MR技术不但清楚地显示前列腺癌解剖结构,而且描述活体器官的功能状态,在前列腺癌诊断、鉴别诊断、分期和治疗后的检测上有其独特的作用.但是,每项功能技术均存在一些不足.结论:研究功能MR技术在前列腺癌的应用具有重要意义,可以提高前列腺癌的准确诊断.     

转移性激素敏感性前列腺癌的诊疗进展

前列腺癌作为仅次于肺癌的全球男性第二高发肿瘤,其治疗是医疗界面临的一大挑战.但可喜的是前列腺癌的病死率在许多国家持续降低,这不仅得益于早期筛查诊断方法的改善,也得益于治疗方法的进展,使得某些已出现转移的患者推迟了因前列腺癌死亡的时间.转移性前列腺癌(mPC)大体可分为两种:未接受雄激素剥夺治疗(ADT)且对雄激素治疗敏感的mPC,即转移性激素敏感性前列腺癌(mHSPC)和对ADT不再敏感的mPC,即转移性去势抵抗性前列腺癌(mCRPC).本文重点关注的是对mHSPC诊疗中所取得的进展与面临的挑战.     

直肠指诊、血清PSA及经直肠穿刺活检联合诊断前列腺癌的评价(附49例分析)

前列腺癌的早期诊断对于选择有效的治疗方法至关重要.对我科1988年11月至1998年11月收治并明确诊断的49例前列腺癌的直肠指诊(DRE)、血清前列腺特异性抗原(PSA)及经直肠前列腺穿刺活检方法进行了分析,并探讨三种方法单独与联合对前列腺癌的诊断价值.     

AMACR在前列腺癌诊断与鉴别诊断中的应用

目的 探讨α-甲基酰基-辅酶A消旋酶(AMACR)的表达在前列腺癌和良性前列腺增生病理诊断中的应用价值.方法 采用免疫组织化学方法检测47例前列腺癌和29例良性前列腺增生组织标本中AMACR的表达.结果 AMACR阳性表达在前列腺癌和良性前列腺增生两组间差异有显著性(P＜0.01);前列腺癌Gleason评分分级与AMACR免疫表达无关.结论 检测AMACR可提高前列腺癌诊断的准确率,对前列腺癌的病理诊断具有重要意义.     

改良13点前列腺穿刺活检在前列腺癌诊断中的应用

目的 评价经直肠超声引导改良13点前列腺穿刺活检对诊断前列腺癌的临床价值.方法 对2015年10月至2016年10月在陕西省人民医院就诊的82例临床疑似前列腺癌患者的临床资料进行回顾性分析.所有患者均进行了经直肠超声引导改良13点前列腺穿刺活检及手术治疗,将穿刺病理结果与术后病理结果进行比较,并比较改良13点穿刺法和标准6点穿刺法诊断前列腺癌的准确性,分析改良13点前列腺穿刺活检术的并发症.结果 82例疑似前列腺癌患者中,26例经直肠超声引导下改良13点前列腺穿刺术诊断为前列腺癌,54例诊断为前列腺增生,此80例诊断结果与术后病理相符,另2例穿刺活检诊断为前列腺增生而术后病理证实为前列腺癌.改良13点穿刺法和标准6点穿刺法诊断前列腺癌的准确性分别为97.6％（80/82）和84.1％（69/82）,两者比较差异有统计学意义（P=0.023）.所有接受改良13点法前列腺穿刺活检术的患者无一例出现严重的并发症.结论 经直肠超声引导改良13点前列腺穿刺活检术是一种安全、有效的前列腺系统穿刺活检术式,值得在临床推广应用.     

前列腺癌相关分子生物标记的研究进展

随着前列腺癌发病率在我国的逐年升高,泌尿外科医生对此疾病的早期诊断与治疗也越来越关注。科研人员期望从分子水平上找到对前列腺癌诊断具有特异性的标记物并对分子靶向治疗提供有效的信息和资源。目前,对一些指标的发现和研究取得了一定的进展,本文对近年所关注的一些与前列腺癌有关的重要生物标记进行了综述。     

PCA3基因作为前列腺癌特异性标记物的研究进展

随着人口的老龄化和诊断水平的提高,前列腺癌的发病率和检出率越来越高,迫切需要一种对前列腺癌特异性和敏感性较高的标记物提高其早期检出率,PCA3的发现为前列腺癌的早期诊断带来了新的希望.     

老年乳腺癌的诊疗新进展

由于缺乏足够的科学证据,在诊断治疗方面,现行的乳腺癌诊疗指南并不完全适用于老年患者。如何进一步规范老年乳腺癌的诊治策略成为亟待解决的重要问题。本文就老年乳腺癌的诊断及治疗模式如手术、放化疗、内分泌、靶向治疗等结合近年的一些新进展做一述评,为临床工作提供参考。     

Treatment of esophageal cancer in elderly patients

During the last 30 years, the median survival time and 5-year survival rate of esophageal cancer have improved significantly. In recent years, two major factors have greatly contributed to improve the outcomes of treatment for esophageal cancer in Japan. One is the establishment of endoscopic diagnosis and treatment of superficial esophageal cancer, and another is the establishment of a standard surgical procedure, subtotal esophagectomy with dissection of three field lymph nodes. In an aging society like Japan, with the increased incidence, the diagnosis and treatment of esophageal cancer will become increasingly important in the future. The effectiveness and risk of surgical treatment, chemotherapy, radiotherapy and combination therapy for elderly patients with esophageal cancer will also become important. However, the average life expectancy has reached 79 years for Japanese men, and various evidence from clinical research on patients less than 75 years old is not longer sufficient. Care of elderly patients with esophageal cancer has relied on past experience. Now, clinical studies on elderly esophageal cancer must be improved.     

Le souhait d’aide psychologique des patients agés atteints d’un cancer

Background: Growing evidence suggests that when a treatment decision has to be made, at cancer diagnosis or when the disease progresses, the overall health of the elderly cancer patients should be assessed using Multimodal Geriatric Assessment (MGA) to detect unsuspected health problems, predict tolerance to treatment, and predict survival. However, little is known about distress of the elderly cancer patients and their relatives in this context, and their desire for psychological support in this context. This article aims to review the current knowledge about psychological distress of elderly patients facing cancer, psychological interventions devoted to them, and finally, their desire for psychological support. Preliminary results of a Belgian study, currently being conducted at a cancer center, investigating elderly cancer inpatients?? desire for psychological support when a treatment decision has to be made are also described.     

Do elderly people with lung cancer benefit from palliative radiotherapy?

The median age at diagnosis of patients with lung cancer is currently around 70 and is rising, yet the trials on which treatment is based included few elderly people. We conducted a prospective observational cohort study of 83 elderly patients (aged 75 and above) being treated with palliative radiotherapy for lung cancer, with a comparison group of 49 younger patients (aged 65 and under). Response to treatment was evaluated by patient-assessed symptom and quality of life scores using the EORTC QLQ-C30 and its companion lung module LC17. This is to date the largest prospective study of elderly lung cancer patients in routine practice. We found no significant differences in response or toxicity between the two groups. Elderly people with lung cancer should be offered palliative radiotherapy the same as younger patients, with the same expectation of benefit.     

Recent Advances in Cancer Pain Management

Appropriate management of pain in patients with cancer is based on accurate syndrome diagnosis and judicious selection of therapeutic modalities. This article provides guidelines for the etiological and pathophysiological understanding of cancer pain syndromes and for ways of tailoring treatment to the specific diagnosis. Neuropathic and breakthrough pains are two of the more difficult syndromes that are addressed. Pharmacological choices, the mainstay of cancer pain treatment, are discussed with special attention to pharmacodynamics and to side effects. Drug treatment in the elderly, the medically ill, and the difficult patient are covered. Psychosocial issues and a palliative care program round out the care of the cancer patient with pain.     

CT扫描联合肿瘤特异性标志物诊断老年肺癌的价值

目的:CT扫描联合肿瘤特异性标志物诊断老年肺癌的价值,为临床诊断及治疗提供参考。方法:回顾性分析本院于2016年2月至2018年2月收治的194例老年肺癌患者作为观察组,另选取同期来院参加体检的健康志愿者68例作为对照组。所有老年肺癌患者均采用SIEMENS 64排CT行胸部扫描,并同时采用电化学发光法测定血清癌胚抗原（CEA）、神经元特异烯醇化酶（NSE）、癌抗原19-9（CA19-9）、细胞角蛋白21-1（CYFRA21-1）等特异性标志物水平。对比两组患者及不同类型肺癌患者的含量变化,并研究CT联合特异性标志物诊断的灵敏度和特异度。结果:两组间相比,观察组患者的血清CEA、NSE、CA19-9及CYFRA21-1含量均高于对照组,差异有统计学意义（P<0.05）;不同类型肺癌患者相比,周围型肺癌组与中央型肺癌组血清CEA、NSE、CA19-9和CYFRA21-1含量相比差异无统计学意义（P>0.05）;就诊断效能而言,血清肿瘤特异性标志物联合CT扫描诊断的灵敏度94.6%,特异度96.3%,均高于单项诊断。结论:老年肺癌患者血清CEA、NSE、CA19-9及CYFRA21-1含量均升高,且周围型肺癌与中央型肺癌患者差异不显著,联合诊断的灵敏度及特异度较高,值得临床推广。     

Clinical assessment of elderly people with cancer

As the elderly population increases, the diagnosis of cancer will become more common than it is today, and difficult decisions about treatment will need to be made by various health-care providers. An important issue not only for patients but also for the whole health-care system is that only those who will benefit from therapy are treated. Individuals for whom treatment will add neither quantity nor quality to their lifespan should not be subjected to potentially harmful treatment. Many assessment scales are validated in elderly people but not used in elderly patients with cancer. Comprehensive geriatric assessment provides an overarching method of assessment before, during, and after treatment. The benefits and shortcomings of other assessment scales are discussed in this review, showing settings in which their use might be appropriate in the developing specialty of geriatric oncology.     

非侵入性检验方法在膀胱癌早期诊断中的研究进展

膀胱癌是泌尿系统最常见的恶性肿瘤之一,在泌尿系统中其发病率和病死率高,尤其在中老年男性中更为常见,因此在泌尿外科的诊疗中,早发现、早诊断、早治疗尤为重要。其中对早期膀胱癌的诊断是泌尿外科诊疗的重点和难点,若能提高膀胱癌早期的确诊率和术后复发检出率,将使患者最大获益。传统侵入性膀胱检查因有创性、痛苦体验、昂贵等无法作为常规体检项目应用而受限,导致许多早期膀胱癌不能及时发现。新型肿瘤标志物以及尿液、血液学分子差异改变检测技术等非侵入性诊断方法具有无痛苦、普适性好等特点而在膀胱癌的早期诊断和术后随访中更具有优势。     

Management and survival of colorectal cancer in the elderly in population-based studies

Colorectal cancer is a major problem in elderly patients. Most data on the management and survival of colorectal cancer has been provided by specialised hospital units and as such cannot be used as reference because of unavoidable selection bias. Cancer registries recording data on treatment and survival at a population level represent the best valuable resource to assess the management of patients. However, there is a paucity of reports published in the literature due to the difficulty to routinely collect such data. Relative survival rates in the elderly were lower than in younger patients. However, the gap that has separated younger from elderly patients is closing. Stage at diagnosis remains the major determinant of prognosis. There is also large variation in survival within countries: survival rates being dramatically lower in Eastern European countries, compared to Western European countries. Comorbidity, which is particularly frequent in the elderly, increases the complexity of cancer management and affects survival. Substantial improvement in the care of colorectal cancer in the elderly has been achieved (increase in the proportion of patients resected for cure, decrease in operative mortality, improvement in stage at diagnosis). Surgery should not be restricted on the basis of age alone. Further improvements can be made, in particular with respect to adjuvant therapy.     

COPD in cancer patients: higher prevalence in the elderly, a different treatment strategy in case of primary tumours above the diaphragm, and a worse overall survival in the elderly patient

The purpose of this study was to document the influence of chronic obstructive pulmonary diseases (COPD) on stage at diagnosis, treatment strategy, and survival for unselected cancer patients (35 years and older) diagnosed between 1995 and 2004 in the Eindhoven Cancer Registry. Follow-up of all patients was complete up to January 1st, 2006. Twelve percent of all cancer patients had COPD at the time of cancer diagnosis, being about 15% in elderly patients (65+) and up to 30% among lung cancer patients, middle-aged males and all females with oesophageal and laryngeal cancer, and middle-aged women with renal cancer. Stage at diagnoses was not significantly different between cancer patients with or without COPD, except for lung cancer patients who were diagnosed at an earlier stage. Nevertheless, non-small cell lung cancer (NSCLC) patients with COPD less frequently underwent surgery, and chemotherapy, and more often radiotherapy. In the presence of COPD, women with oesophageal cancer underwent surgery less often, and patients with laryngeal cancer received radiotherapy more often. The effect of COPD on the type of oncological treatment was not different for middle-aged (35-64 years) and elderly cancer patients. In a multivariate Cox-regression model, COPD was associated with a significantly worse survival, especially for elderly patients with colon, rectum, larynx, prostate or urinary bladder cancer. In conclusion, not surprisingly, COPD is related with age and smoking-associated tumours. Therapy of cancer patients with COPD was different for head and neck tumours and primary tumours in the chest organs (above the diaphragm), for whom radiotherapy, as an alternative treatment option, was available. As COPD, especially at older age, is frequently associated with a worse prognosis, further prospective investigation of interactions seems warranted. Further, closer involvement of pulmonologists and COPD nurses in elderly cancer patients might be warranted.