进展期胃癌新辅助化疗期间伴急性上消化道出血患者的生存分析

目的:探讨进展期胃癌新辅助化疗期间合并急性上消化道出血(acute upper gastrointestinal bleeding,AUGB)患者的临床特征和生存预后。方法:回顾性分析河北医科大学第四医院自2015年1月至2017年1月行术前新辅助化疗的476例胃癌患者,筛选出新辅助治疗期间出现AUGB的患者,分析临床特征及影响预后的因素。结果:476例胃癌患者行新辅助化疗期间出现AUGB者35例(7.35%),其中经补液止血保守治疗好转者6例,内镜下成功止血者5例,血管造影栓塞术成功止血者7例,余17例患者均行剖腹探查手术止血。全组患者3年总生存率(overall survival,OS)为65.13%,3年无病生存率(disease-free survival,DFS)为60.71%。其中出现AUGB者3年OS为48.57%,3年DFS为42.86%,而未出现AUGB者3年OS、DFS分别为66.44%、62.13%,两组患者的3年OS、DFS差异均具有统计学意义(P=0.033、P=0.025)。Cox比例风险模型多因素分析发现,肿瘤组织学类型为低分化-未分化型(P=0.004、...     

胃癌合并上消化道大出血诊治体会

我院近５ａ来收治上消化道大出血２０５例，其中９例因胃癌所引起，占４．３９％，现报告如下。１临床资料１．１一般资料本组９例中，男性７例，女性２例。年龄３６～７２岁，中位年龄５９岁。呕血２例、便血３例、二者兼而有之４例。出血量８００～２０００ｍｌ。血红蛋...     

老年人胃癌术后生存分析研究

目的探讨老年人胃癌术后的生存情况及其影响因素。方法回顾性分析收治并行胃癌切除手术的96例患者的临床资料及随访资料。结果胃癌患者术后1、3、5年生存率分别为74.0%、57.3%和19.8%,所有患者的中位生存时间为46.4个月;Log-rank比较分析显示,年龄(2=2.96,P<0.05)、饮酒史(2=9.42,P<0.05)、胃癌转移(2=10.34,P<0.05)、组织学分化程度较高(2=8.83,P<0.05)、浸润程度到达浆膜(2=12.21,P<0.05)等因素对胃癌1、3、5年生存率具有显著影响;Cox回归模型分析显示,饮酒史(RR=1.86,95%CI:1.21².64)、胃癌转移(RR=1.89,95%CI:1.172.64)、胃癌转移(RR=1.89,95%CI:1.17².55)、组织学分化程度低(RR=2.02,95%CI:1.372.55)、组织学分化程度低(RR=2.02,95%CI:1.37².85)、浸润程度到达浆膜(RR=2.18,95%CI:1.292.85)、浸润程度到达浆膜(RR=2.18,95%CI:1.29³.01)是影响胃癌术后生存时间的独立因素。结论有饮酒史、术前癌症转移、组织分化程度低、浸润程度较深会影响老年人胃癌术后生存时间。     

不同化疗方案治疗胃癌的临床效果观察

目的：探讨治疗进展期胃癌的最佳治疗方案。方法：将９０例组织学证实的进展期胃癌随机分为３组：Ａ组采用ＥＡＰ方案，Ｂ组采用ＥＬＦＰ方案，Ｃ组采用ＡＬＦＰ方案。结果：三组ＣＲ率、ＲＲ率差异均无显著性（Ｐ〉０．０５），Ａ组方案副作用大，Ｂ组方案最为温和。结论：药物治疗进展期胃癌应遵循个体化原则，注意支持及对症治疗。     

74例胃癌术后患者的预后因素分析

[目的]分析胃癌预后因素。[方法]对1998年～2005年我院收治的74例胃癌术后患者进行回顾性分析,采用LifeTable法、Kaplan-Meier和Cox回归分析对胃癌预后的影响进行评价。[结果]单因素分析显示临床分期、浸润深度、淋巴结转移、术后化疗和肿瘤残留情况与预后明显相关(P<0.05)。多因素分析显示术后化疗、肿瘤残留情况及临床分期为预后的独立因素(P<0.05)。[结论]术后化疗、肿瘤残留情况及临床分期是胃癌术后患者预后的独立危险因素。Ⅲ期胃癌术后患者接受辅助化疗具有明显的生存优势。     

新疆地区164例胃癌根治术后患者预后因素分析

目的:研究新疆地区胃癌根治术后患者的临床因素以及术后治疗对预后产生的影响.方法:对2003-01-2009-12新疆医科大学第一附属医院收治的胃癌根治术后患者164例进行回顾性分析,采用Kaplan-Meier法计算患者的生存率,用Log-rank检验进行单因素分析,应用Cox模型进行预后的多因素分析.结果:共82例患者死亡,中位随访时间28.0个月,1年累积生存率为78.7％(129/164),3年为42.1％(69/164),5年为6.7％(11/164),中位生存时间40.1个月.单因素分析显示,性别、民族、临床分期、浸润深度、淋巴结转移、网膜转移、组织学分化、肿瘤部位、切缘残留、肿瘤大小、脉管侵犯和术后治疗情况与预后相关,P＜0.05;多因素分析证实,网膜转移(RR=8.564,P＜0.01)、淋巴结转移(RR=4.092,P＜0.01)、切缘残留(RR=3.282,P=0.002)、民族(RR=2.152,P=0.013)、浸润深度(RR=2.071,P=0.022)和肿瘤部位(RR=0.680,P=0.010)是影响胃癌预后独立的危险因子.结论:胃癌根治术后影响预后的独立因素按RR从高到低依次为网膜转移、淋巴结转移、切缘残留、民族、浸润深度和肿瘤部位.     

胃癌组织中Maspin表达及与化疗后生存时间的关系

[目的]探讨Maspin蛋白在胃癌组织中的表达以及与术后化疗后生存时间的关系。[方法]选取临床病理资料完整并随访3年以上的胃癌术后组织标本,将每例术后胃癌组织应用Maspin单克隆抗体进行SP免疫组化染色,定期随访患者。结合临床及病理形态学资料采用生存曲线和COX模型分析术后接受化疗患者胃癌组织Maspin表达与化疗后生存时间的关系。[结果]Maspin蛋白在胃癌组织中的阳性表达率为58．1％。Maspin表达阳性者化疗后生存时间明显延长。[结论]Maspin蛋白表达情况与胃癌术后化疗后生存时间有关。     

术中化疗对贲门腺癌预后的影响

从１９８０年１月至１９９０年６月共手术治疗贲门腺癌４０４例，切除３４２例。其中单纯手术组２３１例，１、３、５年生存率分别为８３．８％、３８．５％和２０．８％；１９８７年以后随机选取贲门腺癌手术病人术后化疗４７例，１、３、５年生存率分别为８９．４％、４６．８％和２９．８％；术中化疗５４例，１、３、５年生存率分别为８７．１％、６３．０％和３８．９％。结果显示：术后化疗的３、５年生存率虽高于单纯手术组，但无统计学意义；术中化疗的３年、５年生存率则显著高于单纯手术组（Ｐ＜０．０１）。临床病理分期研究显示：对临床Ⅱ期和有淋巴结转移的贲门腺癌，术中局部注射加全身化疗有重要的临床意义     

经胃镜止血的肝癌合并上消化道出血患者预后相关因素分析

摘 要：［目的］ 探讨影响经急诊胃镜止血的肝癌合并上消化道出血患者预后相关因素。 ［方法］ 根据转归情况将146例经急诊胃镜止血的肝癌合并上消化出血患者分为好转组和死亡组,对其相关临床资料进行回顾性分析。 ［结果］ 好转组135例,死亡组11例,两组患间红细胞比容（HCT）、血红蛋白（HGB）、白蛋白水平（ALB）、血小板计数（PLT）、术前出血量、手术方式、Child-Pugh分级、APACHE Ⅱ评分及存在门静脉血栓（PVT）的差异均有统计学意义（P均<0.05）。 ［结论］ 血常规指标、术前出血量、Child-Pugh分级、APACHE Ⅱ评分和门静脉血栓对肝癌并上消化道出血经急诊胃镜止血患者的预后评估可能有一定意义。     

Evaluation of Clinical Benefit of Chemotherapy in Patients with Upper Gastrointestinal Cancer

A new endpoint, the Clinical Benefit Response (CBR), was recently suggested as a means of measuring the effectiveness of palliative chemotherapy in patients with pancreatic cancer. We took advantage of extensive recordings of measurements of treatment effects in two trials in patients with gastrointestinal cancer in order to assess the relevance of CBR criteria. In 151 patients, 53 with pancreatic cancer, 37 with biliary cancer and 61 with gastric cancer, who were randomized between chemotherapy with best supportive care and best supportive care alone, CBR criteria were applied retrospectively to the evaluations of the effects on the patients' well-being made by the treating physician and by the patient in quality-of-life questionnaires, chiefly EORTC QLQ C-30. When compared with subjective response evaluations made by both the physician and the patients' questionnaire data, it was found that CBR overestimated the beneficial effects in certain patients and underestimated them in others. The reason for this overestimation was mainly that the adverse effects of the chemotherapy were not considered appropriately. The underestimation was mainly due to the fact that CBR in practice is dominated by pain assessment, and alterations in other symptoms are also clinically relevant. CBR did, however, show the same differences between the two randomized groups as the subjective response evaluations and the quality-of-life estimations. It is concluded that CBR can be used as a method of measuring the beneficial clinical impact of a treatment strategy in clinical trials, but its limitations in reflecting several important aspects influencing the overall well-being of patients do, however, restrict its use. The criteria designed for use in patients with pancreatic cancer cannot be immediately applied to patients with other cancer types.     

脑肿瘤术后急性胃粘膜病变出血41例临床分析

目的：探讨脑肿瘤术后急性胃粘膜病变出血的规律和特点。方法：从238例脑肿瘤术后病人中，选取并发急性胃粘膜病变出血患者41例的临床资料，对发病特点、出血发生几率、临床表现、防治效果等进行分析。结果：术后急性胃粘膜病变出血与肿瘤发生部位、深度、肿瘤体积和侵袭范围，以及手术切除范围等因素有密切关系，术后病情越重，发生出血几率越高，死亡率越大。结论：去除应激源是治疗急性胃粘膜损伤出血的基础，应从早期诊断、预防使用制酸剂和胃粘膜保护剂、稳定内环境等方面予以防治。     

脑肿瘤术后急性胃粘膜病变出血41例临床分析

目的:探讨脑肿瘤术后急性胃粘膜病变出血的规律和特点.方法:从238例脑肿瘤术后病人中,选取并发急性胃粘膜病变出血患者41例的临床资料,对发病特点、出血发生几率、临床表现、防治效果等进行分析.结果:术后急性胃粘膜病变出血与肿瘤发生部位、深度、肿瘤体积和侵袭范围,以及手术切除范围等因素有密切关系,术后病情越重,发生出血几率越高,死亡率越大.结论:去除应激源是治疗急性胃粘膜损伤出血的基础,应从早期诊断、预防使用制酸剂和胃粘膜保护剂、稳定内环境等方面予以防治.     

Changes in the Gastric Potential Difference During Chemotherapy in Patients with Metastatic Breast Cancer

Nausea and vomiting are frequent side-effects of intravenous cancer chemotherapy. How these complications were related to the gastric mucosal function was investigated by measuring the gastric mucosal potential difference (PD). Eight patients with metastatic breast cancer receiving chemotherapy were investigated. The liquid junction-corrected gastric PD and pH were measured with a newly developed microelectrode. The measurements started half an hour before chemotherapy and continued for 4-5 hours. Nausea, vomiting, psychological stress and sleeping episodes were registered. The initial PD values were —34mV±8mV (mean ± SD). During the observation period 6 of 8 patients had one or more episodes of nausea and vomiting. All episodes were preceded by a significant decline in PD. The magnitude of the decline in PD was unrelated to the time-lag between administration of chemotherapy and the occurrence of nausea and vomiting, and there was no correlation between the time for these episodes and the time for the administration of the chemotherapy. One patient had three episodes of severe psychological stress causing a marked decline in PD. The last patient experienced no nausea, vomiting or stress and had no changes in PD. During sleeping periods PD increased significantly.     

替吉奥化疗合并同步放疗治疗晚期局部胃癌的临床预后分析

目的 探讨替吉奥化疗合并同步放疗治疗晚期局部胃癌患者的临床预后.方法 选择80例老年局部晚期胃癌患者随机分为2组.实验组患者均实施替吉奥化疗合并同步放疗,对照组仅实施放疗.然后根据实体瘤的治疗效果标准进行评价,观察患者治疗后的不良反应以及1年后的生存率.结果 实验组缓解率为62.50％,对照组缓解率为45.00％,2组差异具有统计学意义(P＜0.05).实验组患者出现呕吐、恶心、肝肾功能异常、白细胞减少的比例均低于对照组,差异均具有统计学意义(P＜0.05);而四肢麻木以及便秘腹泻的比较,差异不具有统计学意义(P＞0.05).此外,实验组患者的1年生存率高于对照组,差异均具有统计学意义(P＜0.05).结论 替吉奥联合放疗可以显著提高临床缓解率以及1年生存率,同时通过降低患者的不良反应来提高老年患者治疗后的生活质量,值得临床推广使用.     

Tumor Markers for Diagnosis,Monitoring of Recurrence and Prognosis in Patients with Upper Gastrointestinal Tract Cancer

To evaluate the value of combined detection of serum CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA andTPS for the clinical diagnosis of upper gastrointestinal tract (GIT) cancer and to analyze the efficacy of thesetumor markers (TMs) in evaluating curative effects and prognosis. A total of 573 patients with upper GIT cancerbetween January 2004 and December 2007 were enrolled in this study. Serum levels of CEA, CA19-9, CA24-2,AFP, CA72-4, SCC, TPA and TPS were examined preoperatively and every 3 months postoperatively by ELISA.The sensitivity of CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA and TPS were 26.8%, 36.2%, 42.9%, 2.84%,25.4%, 34.6%, 34.2% and 30.9%, respectively. The combined detection of CEA+CA199+CA242+CA724 hadhigher sensitivity and specificity in gastric cancer (GC) and cardiac cancer, while CEA+CA199+CA242+SCCwas the best combination of diagnosis for esophageal cancer (EC). Elevation of preoperative CEA, CA19-9 andCA24-2, SCC and CA72-4 was significantly associated with pathological types (p<0.05) and TNM staging (p<0.05).Correlation analysis showed that CA24-2 was significantly correlated with CA19-9 (r=0.810, p<0.001). The levelsof CEA, CA19-9, CA24-2, CA72-4 and SCC decreased obviously 3 months after operations. When metastasisand recurrence occurred, the levels of TMs significantly increased. On multivariate analysis, high preoperativeCA72-4, CA24-2 and SCC served as prognostic factors for cardiac carcinoma, GC and EC, respectively. combineddetection of CEA+CA199+CA242+SCC proved to be the most economic and practical strategy in diagnosis of EC;CEA+CA199+CA242+CA724 proved to be a better evaluation indicator for cardiac cancer and GC. CEA andCA19-9, CA24-2, CA72-4 and SCC, examined postoperatively during follow-up, were useful to find early tumorrecurrence and metastasis, and evaluate prognosis. AFP, TPA and TPS have no significant value in diagnosis ofpatients with upper GIT cancer.     

老年人胃癌的浸润深度和术后化疗对预后的影响

目的探讨接受手术治疗的老年人胃癌临床病理因素与预后的关系。方法回顾性研究本院2002年1月至2005年12月胃癌手术患者,记录患者的年龄、性别、肿瘤位置、肿瘤大小、共存病（高血压及心脏病）、手术根治程度、胃切除范围、病理类型(WHO)、TNM分期、术后化疗情况,建立数据库。结果老年组中位生存时间为29月（平均44月）,明显低于中年组（78月,P=0.001）和青年组（72月,P=0.009）;老年患者原发肿瘤以T3/T4为主;较少的患者接受联合脏器切除;更多合并高血压及心脏病,而较少患者接受术后化疗。结论老年人胃癌手术患者原发灶的侵犯深度、术后较少接受化疗与预后差有关。     

晚期胃癌维持化疗的生存分析

目的 探讨晚期胃癌一线化疗后继续卡培他滨维持治疗对患者生存期的影响及其安全性。方法 102例初治晚期胃癌患者,以氟尿嘧啶类/奥沙利铂方案化疗4~8周期,达疾病控制患者分别进入维持组或观察组,维持组以卡培他滨单药化疗（1.0 g/m²,口服 2次/日,d1~14,3周重复）直至疾病进展或出现不可耐受的毒性,观察组单纯随访。结果 102例患者经一线化疗后,客观缓解率41.2%,疾病控制率77.5%。达到疾病控制患者共79例,其中44例进入维持组,35例进入观察组,随访期间两组客观有效率差异无统计学意义（P＞0.05）。维持组中位无进展生存时间7.8月,观察组5.8月,两组比较差异有统计学意义（P＜0.05）,维持组中位总生存时间17.1月,较观察组13.4月有所延长（P=0.041）。不良反应情况,维持组在手足综合征的发生上高于观察组（P＜0.05）,但仅1例患者停药,余经处理均可耐受;其他不良反应,包括骨髓抑制、恶心呕吐、腹泻、肝肾功能异常、外周神经毒性、口腔炎等,两组差异均无统计学意义（P＞0.05）。结论 氟尿嘧啶类/奥沙利铂方案一线化疗达疾病控制后以卡培他滨维持治疗能够延长晚期胃癌患者无进展生存期和总生存期。     

贲门癌急性大出血的诊断和手术治疗

作用自１９８０年１０月至１９９４年２月共手术治疗贲门癌并发大出血１４例，占同期手术治疗贲门癌的４．３３％（１４／３２１）。全组１４例术前出血量均在１０００ｍｌ以上，其中合并失血性休克者８例。在手术治疗的贲门癌大出血１４例中有５例行急诊手术。全组切除率为１００％（１１／１４）。术后无吻合瘘及其它并发症的发生。术后生存５年以上者２例（均健在），３年以上者４例（２例健在），２年以上者５例（均健在），１年以内３例（均健在）。作者认为：贲门癌大出血并非为癌肿的晚期佐证，故应积极手术治疗，其预后与一般贲门癌相同。