雷替曲塞联合奥沙利铂治疗晚期结肠、直肠癌的临床研究

目的评价雷替曲塞联合奥沙利铂（L-OHP）治疗晚期结肠、直肠癌的疗效和安全性。方法 40例晚期结肠、直肠癌患者分为2组：试验组20例,给予雷替曲塞联合奥沙利铂治疗,对照组20例,5-Fu/LV方案联合奥沙利铂治疗。观察2组的临床疗效及安全性。结果试验组RR为40.0%,DCR为80.0%,对照组RR为30.0%,DCR为70.0%,2组比较差异无统计学意义（P〉0.05）;试验组恶心呕吐、腹泻、口腔黏膜损害发生率明显低于对照组（P〈0.05）。结论雷替曲塞联合L-OHP方案较传统的以5-Fu为基础的联合化疗方案使用方便,缩短住院时间,并且在有效率方面不劣于以FU为基础的联合化疗,是值得推荐的治疗晚期结肠、直肠癌的化疗方案。     

FOLFOX4与XELOX方案治疗晚期结直肠癌的临床观察

目的比较FOLFOX4与XELOX方案治疗晚期结直肠癌的近期疗效和毒副反应。方法 56例晚期结直肠癌患者随机分为2组,FOLFOX4组28例,XELOX组28例,2组均化疗4个周期以上。按WHO标准评价客观疗效和不良反应。结果 56例患者中有2例因不能耐受不良反应而放弃,均为FOLFOX4组,余54例均可评价疗效,其中FOLFOX4组:完全缓解(CR)3例,部分缓解(PR)9例,稳定(SD)11例,进展(PD)3例,总有效率(RR)46.2%。XELOX组:CR 2例,PR 10例,SD 11例,PD 5例,RR 42.9%,两组近期有效率无明显统计学差异。不良反应比较,手足综合征以XELOX组显著(P<0.05),Ⅲ～Ⅳ级恶心呕吐发生率FOLFOX4组较高(P<0.05),余不良反应均无明显统计学差异。结论 FOLFOX4与XELOX方案相比在近期疗效上无明显差异,但XELOX组不良反应较低,耐受性较好。     

奥沙利铂为基础的方案治疗老年晚期结直肠癌的临床观察

目的探讨奥沙利铂为基础的方案治疗老年晚期结直肠癌的疗效及安全性。方法选择经病理学确诊的46例老年晚期结直肠癌患者,均采用奥沙利铂为基础的方案化疗,其中包括FOLFOX方案18例,XELOX方案25例,另有3例为奥沙利铂联合氟尿嘧啶方案。所有患者至少完成2个周期的化疗,观察客观有效率(RR)、疾病控制率(DCR)、中位疾病进展时间(TTP)、总生存时间(OS)和化疗相关不良反应。结果 46例患者中,RR及DCR分别为39.1%和80.4%,TTP和OS分别为7.0月和24.0月。化疗相关不良反应可以耐受,Ⅰ~Ⅱ度不良反应主要包括中性粒细胞减少、血小板减少、贫血等,Ⅲ~Ⅳ度不良反应少见,主要为中性粒细胞减少和腹泻。结论奥沙利铂为基础的方案治疗老年晚期结直肠癌安全有效,值得在老年人群中进一步研究推广。     

奥沙利铂和羟基喜树碱分别联合5-氟尿嘧啶/亚叶酸钙治疗晚期大肠癌的对照研究

目的 对照研究奥沙利铂(LOHP)和羟基喜树碱(HCPT)分别联合5-氟尿嘧啶/亚叶酸钙(5-Fu/CF)治疗晚期大肠癌的临床效果.方法 将符合入选条件的59 例晚期大肠癌患者随机分为观察组30例(含LOHP方案)及对照组29例(含HCPT方案),每3周重复,两组均完成3个疗程化疗.对照观察两组的近期疗效及不良反应.结果 观察组完全缓解(CR)1例,部分缓解(PR)12例,总有效率(CR+PR)为43.3%;对照组CR 0例,PR 7例,总有效率(CR+PR)为24.1%,差异有统计学意义(P<0.05).观察组神经毒性及腹泻发生率较高,对照组粒细胞减少发生率较高,但两组恶心、呕吐、脱发等不良反应发生率差异无统计学意义.结论 LOHP联合 5-Fu/CF是治疗大肠癌的有效化疗方案,特别适宜晚期大肠癌以及对 5-Fu 耐药的患者.     

恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌的多中心临床研究

目的评价重组人血管内皮抑素（恩度）联合FOLFOX4方案治疗晚期结肠癌、直肠癌的有效性和安全性。方法 2006年7月~2010年12月,58例晚期结肠癌、直肠癌患者接受恩度联合FOLFOX4方案：恩度7.5 mg/m2第1~7天,草酸铂85 mg/m2,静滴2 h,第1天;醛氢叶酸200 mg/m2,第1、2天;5-氟尿嘧啶（5-Fu）400 mg/m2,静推,第1、2天;5-Fu600 mg/m2,静滴22 h,第1、2天。2周重复,至少4周期。结果 17例获部分缓解,24例获病情稳定,总有效率为29.3%,临床受益率为70.7%,中位疾病进展时间（TTP）为8.6月,主要毒副反应为中性粒细胞减少（50.0%）,恶心/呕吐（39.7%）,神经毒性（39.7%）。结论恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌疗效确切,毒副反应可耐受。     

贝伐珠单抗与雷替曲塞联合伊立替康或奥沙利铂治疗难治性结直肠癌28例

目的探讨贝伐珠单抗与雷替曲塞联合伊立替康或奥沙利铂在晚期结直肠癌二线以上治疗中的效果及安全性。方法 28例晚期结直肠癌患者,二线以上治疗应用贝伐珠单抗＋雷替曲塞、或贝伐珠单抗＋雷替曲塞＋伊立替康、或贝伐珠单抗＋雷替曲塞＋奥沙利铂方案,均21d为1个周期,2个周期后评价疗效。结果 28例患者共完成76个周期化疗,均可评价疗效,其中部分缓解12例,稳定11例,进展5例,有效率为42.9%,疾病控制率为82.1%;中位无疾病进展时间为5.3个月（95%CI：3.7~6.8）,中位总生存期为10.8个月（95%CI：9.3~14.6）;常见不良反应有骨髓抑制、乏力、腹泻和腹痛、高血压等,Ⅲ~Ⅳ级不良反应以中性粒细胞减少（4例）、腹泻（3例）、乏力（3例）、高血压（2例）为主。结论贝伐珠单抗与雷替曲塞联合伊立替康或奥沙利铂方案用于晚期结直肠癌二线以上治疗可获得较高疾病控制率,不良反应可耐受。     

替吉奥胶囊联合伊立替康治疗晚期结直肠癌的临床观察

目的评价替吉奥胶囊联合伊立替康治疗晚期结直肠癌的临床疗效及不良反应。方法选择晚期结直肠癌一线治疗失败并有可评价病灶的患者54例,予以IRIS方案(伊立替康,替吉奥)化疗。评价客观疗效,并观察不良反应;观察治疗前后患者生存质量、外周血中自然杀伤(NK)细胞及T细胞亚群变化、外周血中血管内皮生长因子(VEGF)水平。结果全部54例患者均可评价疗效,有效率(RR)20.1%,疾病控制率(DCR)59.3%,疾病进展时间(TTP)为4.8月。不良反应主要是中性粒细胞减少、腹泻及胆碱能综合征,无毒性相关死亡病例。54例患者治疗后生存质量改善率为87.0%;治疗后NK细胞活性提高、CD4+/CD8+提高、血清VEGF水平降低。结论替吉奥胶囊联合伊立替康治疗晚期结直肠癌疗效较好,不良反应患者可耐受,可进一步研究推广。     

In vitro investigation of detectability of colorectal lymph nodes and diagnosis of lymph node metastasis in colorectal cancer using B-mode sonography

PURPOSE: The aim of this in vitro study was to assess the feasibility of using high-frequency sonography to identify colorectal lymph nodes and to diagnose colorectal lymph node metastasis. METHODS: In part 1 of this study, resected colorectal tissues from 13 patients with colorectal cancer were scanned in a water bath using B-mode sonography performed at high frequency (10 MHz) to identify lymph nodes. The colorectal tissues were then carefully dissected to remove all lymph nodes. Detectability was calculated as the ratio of the number of sonographically detected nodes to the total number of histopathologically confirmed nodes. Student's t test was performed to compare sizes between these groups; a p value of less than 0.05 was considered significant. In part 2, 4 features of lymph nodes identified on B-mode sonography--size, shape, border, and echogenicity--and their combinations were evaluated for their ability to diagnose lymph node metastasis. Discriminant and receiver operating characteristic curve analyses were performed. RESULTS: In part 1, B-mode sonography performed in vitro detected 79 (48%) of the 165 histopathologically identified lymph nodes and 34 (87%) of the 39 histopathologically identified metastatic nodes. The mean size, or mean longest axis (+/- standard deviation), of the sonographically detected nodes (6.4 +/- 2.9 mm) was significantly larger than that of undetected nodes (3.6 +/- 1.7 mm; p < 0.01). In part 2, the most effective feature distinguishing metastatic from nonmetastatic lymph nodes was echogenicity, followed by size, shape, and border. However, a combination of at least 2 features (eg, echogenicity and size) provided better distinction of nodes than did any 1 feature. In the receiver operating characteristic curve of the 4-feature combination, an increase in sensitivity is accompanied by a decrease in specificity: at a sensitivity of 100%, specificities decreased to 60% or less. However, even with the optimal combination of features, the sensitivity and specificity did not both reach 85% at any operating point. CONCLUSIONS: The results of this node-by-node in vitro study show the current limitations and potential of sonography for assessing colorectal lymph nodes. High-frequency sonography may be insufficient for identifying lymph node metastasis in colorectal cancer.     

两种药物联合治疗老年晚期结直肠癌的临床研究

目的观察国产替吉奥胶囊（S-1）联合奥沙利铂（L-OHP）治疗老年晚期结直肠癌的近期疗效和不良反应。方法 29例老年晚期结直肠癌患者采用L-OHP（130mg/m2静脉滴注2h,d1）;S-1（40mg/m2,2次/天,1～14d）,21d为1个周期。至少完成2个周期后评价疗效及不良反应。结果 29例患者均可评价疗效,完全缓解（CR）1例,部分缓解（PR）13例,稳定（SD）12例,进展（PD）3例,有效率（CR＋PR）48.3%,疾病控制率（CR＋PR＋SD）89.7%。总生存时间（OS）为6～21个月,随访1年生存17例（58.6%）。主要不良反应为消化道反应、骨髓抑制、周围神经毒性等,无治疗相关性死亡。结论 S-1联合L-OHP治疗老年晚期结直肠癌的疗效好,不良反应较轻,值得临床推广。     

XELOX方案联合华蟾素胶囊治疗晚期结直肠癌的临床效果及安全性

目的观察XELOX方案联合华蟾素胶囊治疗晚期结直肠癌(CRC)的临床效果及安全性。方法将62例晚期CRC患者随机分为对照组与治疗组,各31例。对照组单纯给予XELOX(卡培他滨+奥沙利铂)化疗方案,治疗组在对照组基础上给予华蟾素胶囊治疗。采用RECIST 1.1疗效评价系统比较两组临床疗效;比较两组治疗前、后CA199、CEA水平;按照CTCAE v 4.0对两组不良反应进行分级并评价;采用VAS评分比较两组患者疼痛缓解程度,采用KPS评分比较两组功能改善程度。结果治疗组ORR为67.74%,明显高于对照组的41.94%(P<0.05)。治疗后,两组血清CEA、CA199水平显著降低,且治疗组低于对照组(P<0.05)。治疗组Ⅰ~Ⅳ级胃肠道反应、骨髓抑制、肝功能损害、周围神经损害总发生率低于对照组(P<0.05)。治疗后,两组VAS评分明显降低,KPS评分明显升高,且治疗组优于对照组(P<0.05)。结论XELOX方案联合华蟾素胶囊治疗晚期CRC的临床效果明确,可降低毒副反应发生率,提升治疗的安全性,值得临床推广。     

系统化护理流程对晚期肠癌患者住院行爱必妥治疗的应用效果研究

目的 研究系统化护理流程对晚期肠癌患者住院期间行爱必妥治疗的效果; 方法 选择2018年1月—12月期间收入我科 的晚期肠癌患者短期住院(<24h)行爱必妥治疗的80例作为研究对象，随机分为对照组与试验组，每组40例。试验组实施系统化护理流程，对照组实施常规护理流程，对比两组患者的满意度，不良反应发生率。 结果 试验组的满意度，不良反应发生率优于对照组（p<0.05)。 结论 实施系统化护理流程能明显提高住院患者的满意度，降低不良反应的发生率，还能提高靶向药物治疗患者的用药安全性，提高护理人员的整体素质，值得临床推广。     

替吉奥联合奥沙利铂治疗晚期结直肠癌的疗效观察

目的评价替吉奥胶囊联合奥沙利铂治疗晚期结直肠癌的近期疗效及毒副反应。方法 52例晚期结直肠癌患者采用替吉奥联合奥沙利铂治疗,替吉奥胶囊80 mg/(m2.d),分2次餐后口服,d1~14。奥沙利铂130 mg/m2,静脉滴注,滴注时间3~6 h,d1。4周为1个周期。治疗3周期评价疗效。结果 52例患者总有效率为48.1%。完全缓解(CR)2例,占全部患者的3.8%;部分缓解(PR)23例,44.2%;稳定(SD)18例,34.6%;进展(PD)9例,17.3%。主要毒副作用为消化道反应、骨髓抑制,末梢神经炎等,无患者死亡。结论替吉奥胶囊联合奥沙利铂治疗晚期结直肠癌疗效好,毒副作用相对较低,值得临床推广。     

Image-guidedcryoablation in unresectable or recurrent advanced colorectal cancer: a retrospective study

Purpose: The present study retrospectively analyzed thesafety and efficacy of computed tomography (CT)-guided cryoablationin the treatment ofunresectable or recurrent advanced colorectal cancer, which did not respond well to or experienced progression with radiotherapy or chemotherapy.Materials and Methods: From January 2013 to April 2015, 31 lesions in 27 patients (16 males, 11 females; mean age of 57.2 years) with pelvic unresectableadvanced or recurrent colorectal cancer were included in the study. The tumor diameter was approximately 3.37 ±1.41 cm. The primary tumor included 25 rectal cancers, 1 sigmoid colon adenocarcinoma, and 1 ileocecal mucinous adenocarcinoma. Cryoablation was performed with 17-gauge cryoprobes and monitored by 64-slice spiral CT. Follow-up was carried out by contrast-enhanced magnetic resonance imaging (MRI). The treatment efficacy was evaluated by symptom palliation, decreased carcinoembryonic antigen (CEA) serum level, and tumor response.Results: The cryoablation procedure was well-tolerated in all patients without major complications or procedure-related mortality. Long-term complications included abscess formation (1 patient), skin frostbite and post-sacrum antrum formation (1 patient). Pain relief was satisfactory in patients with perineal pain (P<0.001), and the median time of pain relief was 3.0 months. Complete ablations were obtained in 22 lesions of 18 patients, while 9 lesions in 9 patients underwent incomplete ablation. The median time to local recurrence for lesions with complete ablations was 15.0 months, and that to the progression of tumors with incomplete ablation was 4.0 months.Conclusion: CT-guided cryoablation is a minimally invasive, safe, and effective therapeutic option for unresectableadvanced or recurrent colorectal cancer. The treatment is well-tolerated by patients, and pain relief is achieved rapidly.     

Cigarettes smoking habit may reduce benefit from cetuximab-based treatment in advanced colorectal cancer patients

Background: NF-κB is one of the nuclear effectors of EGFR activation. There are reports showing that NF-κB expression and activity is enhanced after nicotine treatment. Some data demonstrated that NF-κB activation plays a role in the induction of resistance to cetuximab and irinotecan in advanced colorectal tumors. The aim of this study was to evaluate the effect of cigarette smoking on cetuximab efficacy in advanced colorectal cancer patients. Methods: We retrospectively analysed the smoking habits of 200 patients treated with a variety of anticancer regimens containing cetuximab for advanced colorectal cancer. All patients were irinotecan-resistant and received an oxaliplatin-based first line treatment. We divided our patient population as follows: no previous smoking habit, previous smokers (any number of cigarettes), current smokers of less of 10 cigarettes/day, current smokers of more than 10 cigarettes/day. Results: Out of 200 patients 58 declared a history of cigarette smoking, 108 patients never smoked and the remaining 44 patients were cigarette smokers during cetuximab-based anticancer therapy. Of the 44 smokers, 18 smoked more than 10 cigarettes per day. No statistically significant differences in terms of response rate (RR) and time to progression (TTP) were identified between previous smokers and never smokers. RR in actual smokers was 13.6% and was lower than RR reported for non-smokers (27.1%; p = 0.023). In addition, the median TTP was 5.5 months in the non-smokers versus 2.8 months in the current smokers (p < 0.0001). A difference in terms of overall survival (OS) was detected between the two groups (p = 0.03). Comparing smokers of more than 10 cigarettes per day and smokers of less than 10 cigarettes per day no differences were detected in RR, TTP or OS. Conclusions: Our results suggest that cigarette smoking during anticancer treatment with a cetuximab-based regimen may be responsible for a decrease in RR and lead to a lower TTP.     

贝伐单抗联合FOLFOIRI方案治疗晚期结直肠癌的临床研究

目的观察贝伐单抗(bevacizumab)联合FOLFOIRI方案(伊立替康180mg/m2静脉滴注d 1,联合四氢叶酸/5-氟尿嘧啶)治疗晚期结直肠癌的疗效和安全性。方法将42例晚期结直肠癌患者分为实验组和对照组,实验组21例采用贝伐单抗联合FOLFOIRI方案,用贝伐单抗5 mg/kg静滴,第1天;伊立替康(180 mg/m2)静滴,第2天;亚叶酸钙(400 mg/m2)静滴,第2天;替加氟(400 mg/m2)静滴,第2天;替加氟(2400 mg/m2)第2天,微量泵泵入,持续46h,每21 d为1周期。对照组21例采用FOLFOIR方案,除不用贝伐单抗外,其它药物及剂量和方法同试验组。完成4周期后评价疗效。结果其中39例可评价疗效和毒性。试验组总有效率为65.0%,中位生存时间(TTP)为10.6个月,对照组总有效率为31.6%,TTP为7.4个月。试验组最常见的毒副反应主要有高血压、肝功能损害、出血、骨髓抑制和胃肠道反应。结论贝伐单抗联合FOLFOI方案治疗晚期结直肠癌的疗效可靠,毒副反应可以耐受。     

粪便中miRNA-424在结直肠癌诊断和筛查中的应用

目的研究miRNA(miR-150,miR-424,miR-29b,miR-96)在结直肠癌组织和粪便中的表达情况。方法纳入77例结直肠癌患者以及43名正常志愿者。运用实时定量PCR技术,对miRNA在结直肠癌患者与正常人群的粪便中的表达情况进行检测,并比较二者的差异。结果 miR-150在正常人群和结直肠癌患者粪便中表达有显著差异(P<0.05);miR-424在正常组中的表达量显著低于肿瘤组(P<0.05)。miR-29b和miR-96在两种人群粪便中的表达量无显著差异(P>0.05)。miR-424的曲线下面积为0.756,而miR-150的曲线下面积为0.661。结论 miR-424在结直肠癌患者和正常人群的粪便中表达存在明显差异。     

射频透热联合动脉持续灌注化疗治疗晚期肠癌的临床疗效

目的 观察射频热疗联合介入持续动脉化疗治疗21例晚期大肠癌患者的临床初步疗效。方法 对21例局部复发和伴有肝，肺，骨，腹腔。盆腔及腹股沟淋巴结转移的晚期大肠癌患者经射频热疗联合供养靶动脉介入灌注化疗每名患者至少进行2个周期的介入化疗联合热疗，化疗方案为第1-3天CF200g/m^2，静脉滴注；第1天DDP80mg/m^2。第1-3天如肾功能改变则改用Vp-1660mg/m^2加入超液化碘油10-30ml中进行肝动脉灌注栓塞，热疗频率40.68MHz。电容式加热，电极直径20-25cm，入射功率500-800W，反射功率20-40W，插管化疗第2天开始进行热疗，每72h1次，每次50-70min，每疗程化疗配合4-8次热疗结果 病灶近期疗效以CT或B超检查结果作为评价标准。CR0例。PR14例。总有效率为66.67%。患者化疗未出现严重的不良反应，热疗不良反应为局部疼痛和脂肪硬结。不需特殊处理。结论 射频热疗联合介入持续动脉化疗是治疗晚期大肠癌的安全，有效的治疗方法，能提高治疗效果和改善生活质量。     

国产奥铂联合化疗治疗晚期胃肠道肿瘤30例近期疗效观察

目的：观察国产奥铂联合化疗治疗晚期胃肠道肿瘤的临床疗效。方法： 奥铂130 mg/m^2静脉滴注2 h，亚叶酸钙200 mg静脉滴注2 h，5氟尿嘧啶350mg/m^2继亚叶酸钙应用后持续4 h静脉滴注。治疗2个周期后评定疗效。结果：30例中CR3例，PR11例，PD9例，总有效率CR＋PR47%。不良反应Ⅰ～Ⅱ度。结论： 国产奥铂联合化疗对晚期消化道肿瘤有较好的治疗效果，主要不良反应为一过性轻度粒细胞减少及感觉神经障碍。