三种方法治疗原发性肝癌的疗效比较

148例肝癌患者随机分为三组。A组50例，单纯手术治疗；B组55例，行手术联合化疗泵化疗或术后肝动脉介入化疗（TACE）；C组43例，行手术联合复发灶内无水酒精注射（PEI）或射频消融（RFA）治疗。A、B、C三组1a生存率分别为62．52％、82．64％、81．09％，2a生存率分别为46．55％、73．82％、71．02％，B、C两组的1、2a生存率明显高于A组（P均〈0．05）。A、B组术后1a复发率分别为了49．36％、27．27％，2a复发率分别为68．62％、43．64％，B组1、2a复发率均低于A组（P均〈0．05）。认为以手术为主的综合疗法是原发性肝癌的首选治疗方法。     

18 F-FDG PET-CT 引导下同期推量调强放疗联合化疗治疗局部晚期鼻咽癌疗效观察

目的：观察18 F-氟代脱氧葡萄糖（18 F-FDG） PET-CT引导下同期推量调强放疗联合化疗治疗局部晚期鼻咽癌的临床疗效。方法67例局部晚期鼻咽癌患者随机分成A、B、C组,A组在CT引导下行均匀剂量调强放射治疗,B组在CT引导下行同步加量调强放射治疗,C组在18 F-FDG PET-CT引导下行同步加量调强放射治疗;3组放疗第1、4周同步采用TP或FP方案进行化疗,放疗结束后1个月均行原方案辅助化疗3～4个周期。治疗结束后评价其近期疗效、早期放射反应及生存情况。结果 A组总有效率为79．1％,B组为100％,C组为100％;B、C组总有效率与A组比较,P均＜0．05。 A、B、C组2 a局部无进展生存率分别为83．3％、95．5％、100％,2 a无远处转移生存率分别为83．3％、90．9％、100％;C组2 a局部无进展生存率和无远处转移生存率与A组比较,P均＜0．05。3组早期放射反应比较,P均＞0．05。结论18 F-FDG PET-CT引导下同期推量调强放疗联合化疗治疗局部晚期鼻咽癌安全、有效。     

艾迪注射液联合化疗治疗非小细胞肺癌的临床观察

目的观察艾迪注射液联合多两他赛＋顺铂的化疗方案治疗晚期非小细胞肺痛（NSCLC）的疗效及毒副反应。方法50例晚期NSCLC患者随机分为两组,治疗组为艾迪注射液＋化疗组（A组）,对照组为单纯化疗组（B组）,观察比较两组间治疗有效率、生活质量及化疗毒副反应。结果A、B两组有效率（CR＋PR）分别为40．0％和36．0％（P〉0．05）。两组生活质量提高率分别为52．0％和28．0％（P〈0．05）。A组化疗严重毒副反应明显减少。结论艾迪注射液联合化疗治疗晚期NSCLC,具有减轻化疗毒副反应,改善晚期NSCLC患者的生活质量等作用,值得临床推广应用。     

FOLFOX、XELOX、SOX 方案用于局部进展期胃腺癌的疗效及安全性比较

目的：比较FOLFOX、XELOX、SOX方案用于局部进展期胃腺癌患者新辅助化疗的临床疗效及安全性。方法将106例局部进展期胃腺癌患者随机分为A、B、C三组,分别给予FOLFOX（奥沙利铂＋甲酰四氢叶酸钙＋5-氟尿嘧啶）、XELOX（奥沙利铂＋卡培他滨）、SOX（奥沙利铂＋替吉奥胶囊）进行化疗,化疗2个周期后复查胃镜及64排螺旋CT,比较其临床疗效及不良反应。结果 A、B、C组的总有效率分别为51．43％、62．86％、66．67％,B、C组的总有效率均高于A组（P均＜0．05）,B、C组比较无统计学差异（P＞0．05）。 B、C组药物不良反应发生率较A组降低,特别是Ⅲ度以上不良反应发生率更低（P均＜0．05）,B、C组比较无统计学差异（P＞0．05）。结论 FOL-FOX、XELOX、SOX方案用于局部进展期胃腺癌患者新辅助化疗均有效、安全,XELOX、SOX方案的疗效更佳,安全性更高。     

化疗结合中药治疗老年急性髓细胞白血病近期疗效观察

目的 观察化疗结合中药治疗老年急性髓细胞白血病（AML）的近期疗效。方法 将26例老年AML患者随机分为化疗结合中药组（治疗组）与化疗组（对照组）。每组13例。比较2组的近期疗效。结果 治疗组有效率92．3％，对照组有效率46．2％，2组有效率比较，差异有显著性（X^2=4．51，P〈0．05），2组间不良反应发生率和严重程度差异无显著性。结论 老年AML化疗疗效较差，化疗结合中药治疗有较好的疗效，值得临床进一步探讨。     

复方苦参注射液在晚期恶性肿瘤化疗中的作用

目的 评价复方苦参注射液在晚期恶性肿瘤化疗中的作用。方法回顾性分析142例晚期恶性肿瘤患者,按年龄、性别、病情轻重及化疗周期配对分组,A组采用化疗联合复方苦参注射液,B组单纯化疗。21d为1个周期,2个周期后,对比分析两组患者化疗不良反应、KPS评分及疼痛改善情况。结果A组恶心、呕吐,自细胞、血红蛋白下降,腹泻、黏膜炎发生率低于B组（P〈0．01）;KPS评分、有效率及疼痛缓饵率高于B组（P〈0．05）。结论复方苦参注射液配合化疗,能明显减轻化疗毒副作用,提高患者对化疗的耐受能力,提高生活质量。     

3D—CRT与GF化疗方案同期与序贯治疗局部晚期胰腺癌疗效观察

目的观察三维适形放射治疗（3D—CRT）联合吉西他滨（GEM）加氟尿嘧啶（5-FU）（GF方案）同期与序贯化疗治疗局部晚期胰腺癌（LAPC）的疗效和毒性反应。方法应用化疗＋3D—CRT治疗LAPC,化疗予GEM、5-FU,应用5-FU前常规予以亚叶酸钙。放疗前（序贯组）和放疗中（同步组）使用,共2个周期;放疗予3D—CRT,常规分割,每次2Gy,每周5次。两组患者放疗结束后继续巩固化疗2个周期。结果两组总有效率有统计学差异（P〈0．05）。两组中位生存时间分别为12．3个月（95％凹8．8—15．8）和9．6个月（95％C15．9—13．4）;1a生存率比较有统计学差异（P=0．020）。治疗前CA19-9〈400U／ml的患者23例、t〉400U／ml的患者16例,两者的中位生存时间分别为12．3个月（95％c,11．6—12．9）和7．8个月（95％CI6．1—9．6）,1a生存率比较有统计学差异（P=0．021）。同步组的血液毒性、胃肠道毒性与序贯组比较无统计学差异。结论3D-CRT加GF同期化疗治疗LAPC疗效优于序贯治疗,治疗前CA19-9高水平提示胰腺癌预后不良。     

双径路化疗联合放疗治疗非小细胞肺癌MPE的疗效

目的观察双径路化疗联合三维适形放疗治疗NSCLC恶性胸腔积液的疗效、患者的生活质量及毒副作用。方法36例确诊为NSCLC恶性胸腔积液的患者,按治疗方法随机分为A、B组,每组18例,A组：双径路化疗联合三维适形放疗;B组：单纯双径路化疗,两组患者均给予相同常规支持对症治疗,观察并比较两组的疗效、毒副作用及患者的生活质量。结果A组有效率为94．4％,B组有效率61．1％（P〈0．01）;两组不良反应发生率差异无统计学意义（P〉0．05）;A组Kamofsky评分较B组有显著提高（P〈0．05）;A组总生存期较B组有显著延长（P〈0．05）。结论双径路化疗联合三维适形放疗治疗NSCLC恶性胸腔积液的短期疗效优于单纯双径路化疗。     

晚期非小细胞肺癌神经内分泌表达的化疗效果和预后分析

目的探讨伴有神经内分泌化倾向的晚期非小细胞肺癌化疗近期疗效及远期生存率的特点。方法采用免疫酶标法（ELISA）测定NSE值，将病例分为A、B两组，对比两组的临床特征，化疗的近期疗效及远期生存率。结果A组的近期化疗有效率63．9％，疗效持续时间2．5个月，一年生存率25．0％；B组的近期化疗有效率42．6％，疗效持续时间4．6个月，一年生存率38．3％。结论伴有神经内分泌化倾向的晚期非小细胞肺癌对化疗相对较为敏感，但疗效持续时间短，易于复发转移，预后较差，测定晚期非小细胞肺癌的血清NSE水平，可以作为预测化疗有效率及判断预后的指标之一。     

益气养阴清热解毒方剂联合化疗治疗晚期NSCLC疗效分析

目的观察益气养阴清热解毒法联合化疗对晚期非小细胞肺癌（NSCLC）的治疗作用。方法将48例NSCLC患者分为中药加化疗组（联合组）和单纯化疗组（化疗组）,各24例。联合组口服益气养阴清热解毒中药加化疗,化疗组单纯化疗,比较两组疗效。结果联合组和化疗组中医证候改善有效率分别为50．0％及20．8％（P〈0．05）,生活质量评分（KtX3）提高率分别为83．3％及41．7％（P〈0．05）。两组近期治疗有效率分别为45．8％、37．5％（P〉0．05）,联合组疾病控制率及治疗后血清CD3^＋;CD4^＋;水平及CD4^＋／CD8^＋;显著高于化疗组（P均〈0．05）,不良反应发生率显著低于化疗组（P〈0．05）。结论益气养阴清热解毒方剂能明显提高晚期NSCLC患者疾病控制率和细胞免疫功能,改善生活质量。     

Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study

BACKGROUND/AIMS: To evaluate, the early and long-term results of mono-bloc spleno-pancreatic and vascular resection for advanced carcinoma of the head of the pancreas, with portal-mesenteric venous invasion. METHODOLOGY: In a prospective, randomized trial, fifty-six patients with advanced carcinoma of the head of the pancreas with vascular invasion were studied. Patients were randomly divided in two groups A and B. Group A patients underwent an en-bloc spleno-pancreatic and vascular resection. Group B patients underwent a palliative gastro-biliary bypass. Patients in both groups were subjected to adjuvant locoregional chemoimmunotherapy, through an arterial catheter introduced into the superior mesenteric artery via a jejunal arterial branch. RESULTS: The 2- and 5-year survival rates for Group A patients were 81.8% and 18.5%. The respective percentages for disease-free survival were 60.6% and 0%. Two-year survival for group B was nil. CONCLUSIONS: Mono-bloc spleno-pancreaticoduodenectomy and regional vascular resection and reconstruction, with adjuvant locoregional chemoimmunotherapy leads to substantial prolongation of survival and optimization of quality of life.     

Extranodal Cancer Deposit at the Primary Tumor Site and the Number of Pulmonary Lesions Are Useful Prognostic Factors After Surgery for Colorectal Lung Metastases

PURPOSE: This study was undertaken to identify prognostic factors that can be used to predict prognosis after surgery for lung metastases from colorectal carcinoma. METHODS: We reviewed retrospectively the clinical course of 37 patients who underwent surgical resection of primary colorectal cancer and metastatic lung disease at the National Defense Medical College Hospital between September 1986 and July 1999. We analyzed the prognostic factors with special reference to the clinicopathologic factors of primary tumors. RESULTS: Multivariate analysis indicated that the existence of an extranodal cancer deposit in the primary lesion (hazard ratio = 4.55, P = 0.009) and three or more lung metastases (hazard ratio = 2.9, P = 0.04) were significant indicators for poor prognosis. We divided the patients into two groups: Group A (n = 12) had neither of these two parameters, and Group B (n = 25) comprised all other patients. This two-ranked classification was significantly related to both survival rates (3-year and 5-year survival rate, 90.9 and 90.9 percent in Group A and 16.1 and 8.1 percent in Group B, respectively; P = 0.0003) and disease-free survival after thoracotomy (3-year and 5-year disease-free survival rate, 52.9 and 39.7 percent in Group A and 5.3 and 5.3 percent in Group B, respectively; P = 0.002). CONCLUSION: An extranodal cancer deposit at the primary tumor site is a new significant prognostic factor after resection of lung metastases from colorectal cancer. A two-ranked classification by extranodal cancer deposit and the number of pulmonary lesions can provide useful prognostic information for the treatment of lung metastasis. Surgical resection of pulmonary metastasis is expected to be very useful for patients in Group A.     

内镜下射频热疗联合局部化疗治疗晚期大肠癌的随机对照研究

目的：探讨射频加局部化疗治疗晚期大肠癌的疗效,并与单纯射频治疗比较。方法选择晚期大肠癌失去手术切除时机患者55例行射频加局部化疗或单纯射频治疗,随机分为射频加局部化疗组（A组）27例、射频组（B组）28例,观察两组患者5年内肠梗阻缓解率、再转移率、生存率。结果 A组与B两组1～5年肠梗阻缓解率分别为88.9%vs 70.8%、95.8 vs 70%、89.5%vs 52.9%、100%vs 33.3%、100%vs 0,具有统计学差异（P＜0.05）;5年内再转移情况,A组27例无一例出现再转移,再转移率为0（0/27）,B组11例出现了新的转移病灶,再转移率为39.3%（11/28）,有统计学差异（P＜0.05）;A组5年生存率为44.4%（19/27）,B组为无一例生存,有统计学差异（P＜0.05）。结论内镜下射频热疗联合局部化疗能显著提高晚期大肠癌患者5年内肠梗阻缓解率和5年生存率,显著降低再转移率。     

局部晚期非小细胞肺癌化疗与放化联合治疗观察

目的比较放化联合治疗与单纯化疗对局部晚期非小细胞肺癌（NSCLC）的临床疗效及安全性。方法回顾性分析68例不能手术的NSCLC患者,纯化疗组30例（A组）,放化联合组38例（B组）,两组均予长春瑞滨联合顺铂方案化疗两周期,疾病无进展者,A组继给予多西他赛联合顺铂方案化疗两周期,B组给予常规放疗60Gy后再予多西他赛联合顺铂方案化疗两周期,对比两组疗效及安全性。结果A组治疗有效率、中位生存期及1、3年生存率、分别为33.3%、8.9月、36.7%和0。B组分别为68.4%、12.6月、68.4%和5.3%,B组较A组明显提高,差异有显著性（P〈0.05）。主要毒副反应为骨髓抑制及肝功能异常。A组白细胞减少、血小板减少及肝功能异常发生率分别为63.3%,16.7%和66.7%,B组分别为78.9%、18.4%和68.4%,两组相比差异均无显著性（P〉0.05）。结论对局部晚期NSCLC放化联合治疗优于单纯化疗,毒副反应能耐受。     

Multimodality approach towards advanced rectal carcinoma. "Its efficacy and safety"

BACKGROUND/AIMS: To evaluate the efficacy and safety of multimodality approach towards advanced rectal cancer. METHODOLOGY: In a prospective, randomized trial, two hundred and ten patients with advanced carcinoma of the rectum were studied. Patients were randomly divided in two groups A and B. Patients in group A underwent total mesorectal excision (TME) with adjuvant systemic chemotherapy and radiotherapy. Group B patients underwent TME with adjuvant stop-flow perfusion along with systemic chemotherapy RESULTS: The five-year survival for Group A patients was 72% and for Group B patients the overall five-year survival was 92% and the disease-free survival was 87%. CONCLUSIONS: Multimodality approach to advanced rectal cancer leads to substantial prolongation of survival and optimization of quality of life.     

紫杉醇单药及联合顺铂治疗老年晚期非小细胞肺癌的临床观察

目的观察紫杉醇（TAX）单药与TAX＋顺铂（DDP）治疗老年晚期NSCLC的疗效和不良反应。方法经病理学或细胞学证实的58例晚期非小细胞肺癌随机分为两组，A组：应用TAX单药化疗，B组：TAX＋DDP联合化疗，21天为一个周期，均治疗2周期以上。观察经两方案治疗后的缓解率（RR）、临床获益率（CR＋PR＋SD）、1年生存率和不良反应。结果A组及B组的有效率分别为31．0％和37．9％（P=0．22）；临床获益率（CR＋PR＋SD）分别为72．4％和79．3％（P=0．73）；1年生存率分别为43．3％和46．4％（P=0．52）；单药组的消化道毒性、骨髓毒性及肾脏损伤均显著低于联合组（P〈0．05）。结论紫杉醇单药或联合顺铂均是治疗老年晚期NSCLC的较好方案，二者疗效相似，单药紫杉醇毒副反应更少见，较易为老年患者接受。     

Outcome of colorectal carcinoma in patients under 40 years of age

AIMS: Colorectal carcinoma in patients under 40 years of age usually has a poor prognosis. Controversies still exist regarding the features and the prognosis of colorectal cancer in young patients. METHODS: The records of 45 patients with histologically confirmed colorectal carcinoma treated between 1992 and 2002 at the Division of Oncology at Taipei Veterans General Hospital were reviewed. The relevance of sex, duration of symptoms, tumor site, histological type, lymph node involvement, Karnofsky performance status (KPS), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) levels at the diagnosis and tumor stage to overall survival (OS) were determined by univariate analysis, and their independent significance were tested by multivariate analysis. RESULTS: Most patients presented with an advanced tumor stage (24% Dukes' C and 66% Dukes' D). Colon carcinoma constituted 76% of the colorectal tumors. Family history was present in two patients and did not affect the OS. Two patients were found to have colon carcinoma during pregnancy. The 5-year survival rate in patients with Stage B, C, and D were 25, 16 and 0%, respectively. With aggressive treatment, patients with early stage carcinoma achieved longer survival. Eleven patients received resection of metastatic carcinoma of the liver, lung and ovary. Adjuvant chemotherapy with irinotecan/5-fluorouracil-based chemotherapy seemed to improve the OS in such patients, though the OS was still poorer than in patients with early stage tumors. In univariate analysis, KPS (P = 0.0001), lymph node involvement (P = 0.0024), CEA (P = 0.0423) and LDH levels (P = 0.0126) at the diagnosis and tumor stage (P = 0.0122) proved to be significant predictors of overall survival. Multivariate analyses revealed that KPS > or =70% (P = 0.007) and normal LDH levels at diagnosis (P = 0.004) were predictive of overall survival in this population. CONCLUSIONS: The present study shows that performance status and preoperative LDH levels were the major determinants for survival in patients with colorectal carcinoma under 40 years of age and the present series also suggests that surgical resection of metastatic colorectal carcinoma followed by adjuvant chemotherapy might be beneficial in certain patients. The data also suggests that current treatment modalities for young patients with advanced colorectal cancer might not be effective and more effective therapeutic regimens might be needed. Thus, it is important for surgeons to recognize the potential for colorectal cancer in young patients and to take an aggressive approach to the diagnosis and early treatment of the disease.     

Should patients over 85 years old be operated on for colorectal cancer?

BACKGROUND: The aim of this study is to evaluate risk factors for mortality, morbidity, and long-term survival in very old patients with colorectal cancer compared with old patients. METHODS: Patients operated on with colorectal cancer aged 75 years old or older were divided into 2 groups: Group A (75-84 years, n = 93) and Group B (>or=85, n = 21). RESULTS: The serum albumin level, oxygen pressure in arterial blood gases, and forced expiratory volume in 1 second in Group B were significantly lower than in Group A, respectively (P = 0.0094, 0.0264, 0.0363). Pulmonary complications were developed significantly more frequently in Group B than in Group A (P = 0.0019). Group B had a significantly higher mortality rate than Group A (P = 0.0477). There was no significant difference between the 2 groups in the 2- and 5-year survival rates. CONCLUSIONS: Very old patients with colorectal cancer should not be denied surgery on account of chronological age alone, although the perioperative risks for the very old are very high.     

The adequacy of peritoneal dialysis in a single Chinese center

ObjectiveTo assess the adequacy of peritoneal dialysis in Chinese by analyzing the relationship between weekly urea kinetics (Kt/V) and clinical outcomes.MethodsA total of 146 patients on continuous ambulatory peritoneal dialysis for more than 6 months in the Shanghai Renji Hospital between July 1997 and March 1999 were enrolled into this study. They were assigned to three groups according to weekly Kt/V: Group A, Kt/V less than 1.7; Group B, Kt/V between 1.7 and 2; and Group C, Kt/V greater than 2. Patient and technique survivals were analyzed by using the log rank method.ResultsThe overall 2-year actuarial patient and technique survivals were 90% and 76%, respectively. The 2-year actuarial patient survival was 78% for Group A, 97% for Group B, and 96% for Group C (p<0.05). The 2-year technique survival was 56% for Group A, 88% for Group B, and 88% for Group C. Both actuarial patient and technique survivals in Group A were significantly lower (p<0.05) compared with the other two groups.ConclusionThe study showed that clinical outcomes in Groups B and C patients were similar. However, patients with weekly Kt/V values less than 1.7 had poorer clinical outcomes compared with patients from groups B and C. We conclude that Chinese patients who were receiving peritoneal ambulatory dialysis may benefit from weekly Kt/V greater than 1.7.     

替吉奥联合腹腔热灌注顺铂、甘露聚糖肽对晚期胃癌合并腹腔积液患者的疗效观察

目的研究替吉奥联合腹腔热灌注顺铂、甘露聚糖肽对晚期胃癌合并腹腔积液患者的疗效。方法选取2012年2月至2015年3月在深圳市第四人民医院接受治疗的晚期胃癌合并腹腔积液患者84例,以数字法随机分为A、B、C组,每组各28例。A组予替吉奥口服联合腹腔热灌注顺铂+甘露聚糖肽,B组予腹腔热灌注顺铂+甘露聚糖肽,C组予腹腔热灌注顺铂化学治疗,对比3组的疗效。结果 A组治疗有效率、生活质量总改善率显著高于B组和C组,A组患者6个月生存率显著高于B组(P均0.05)。结论替吉奥联合腹腔热灌注顺铂、甘露聚糖肽对晚期胃癌合并腹腔积液患者的疗效显著,且预后较好。