卡铂多相脂质体腹腔注射对615小鼠U14移植瘤腹膜后淋巴结和肺…

采用小鼠子宫颈癌１４号（Ｕ１４）给６１５近交系小鼠后肢肌肉内移植建立腹膜后淋巴结和肺的双向转移模型，将小鼠随机分为３组。脂质体组每次给予腹腔注射卡铂多相脂质体０．５ｍｇ／０．５ｍｌ；水剂组每次腹腔注射卡铂水剂０．５ｇ／０．５ｍｌ；对照组每次仅注射生理盐水０．５ｍｌ，每组隔日注射。肿瘤移植后第１４￣１７天，对照组均发生腹膜后淋巴结转移和９２．３１％的肺转移；水剂组淋巴结转移率为９０．９１％，肺转移率     

卡铂多相脂质体对移植U_（14）腹水瘤小鼠生存期的影响

将小鼠宫颈癌瘤株１４号（Ｕ１４）移植至Ｋｍ小鼠腹腔形成腹水瘤模型并随机分为３组。脂质体组一次性腹腔注射卡铂多相脂质体１．５ｍｇ／０．７５ｍｌ，水剂组一次性腹腔注射卡铂水剂１．５ｍｇ／０．７５ｍｌ，对照组腹腔注射０．７５ｍｌ生理盐水。结果表明，对照组自移植后第５天开始死亡，平均生存９．８６天；水剂组第８天开始死亡，平均生存１１．４３天；脂质体组第１０夫开始死亡，平均生存１４．１４天。脂质体组与对照组生存期比率（Ｔ／Ｃ）为１４３．４１％（Ｐ＜０．０２５），接近显效标准；水剂组Ｔ／Ｃ为１１５．９２％（Ｐ＞０．２），未达有效标准。用药７天后脂质体组小鼠腹围增长率与其它两组比较为最低。提示卡铂多相脂质体腹腔注射对小鼠腹腔内移植瘤抑制作用明显，能显著延长荷瘤小鼠的寿命。     

卡铂腹腔化疗腹膜后淋巴结内的药物浓度

对２３例卵巢恶性肿瘤患者，分别于术前不同时间进行腹腔穿刺并灌注卡铂（３００ｍｇ／ｍ￣２），手术清扫腹膜后淋巴结，同时切取盆腔腹膜和髂外淋巴结周围脂肪结缔组织各１ｇ，用无火焰原子吸收光谱法分别测定上述３种组织的总铂浓度，并监测３例患者给药后２４小时内的血浆总铂浓度，以及观察化疗后腹膜后淋巴结的病理改变。结果显示，腹膜后淋巴结内总铂浓度在腹腔给药后１２小时达到高峰，峰值为１３．４±１．９～２１．６±７．８μｇ／ｇ。腹主动脉旁淋巴结、盆腔淋巴结、淋巴结周围脂肪结缔组织和盆腔腹膜总铂浓度的药时曲线下面积（ＡＵＣ＿（０～２４ｈ））分别为２１６．８±９．２、２４６．４±３２．９、１１５．６±４０．９和１３５１．３±６９６．５μｇ·ｈ／ｇ。血浆总铂浓度的峰值及ＡＵＣ＿（０～２４ｈ）分别为６．７±１．０μｇ／Ｌ和６１．５±２．４μｇ·ｈ／Ｌ。提示卡铂腹腔给药分布于腹膜后淋巴结组织中的药物浓度较血药浓度明显为高。病理检查可见化疗后的腹膜后淋巴结有变性改变。     

~(18)F-FDG PET/CT检测妇科恶性肿瘤腹膜后淋巴结转移的临床价值

目的:探讨以18F-氟代脱氧葡萄糖(18F-FDG)作为示踪剂的正电子发射断层与X线计算机断层成像(18F-FDG PET/CT)对常见妇科恶性肿瘤腹膜后淋巴结转移的诊断及临床意义。方法:选择拟行手术治疗的妇科恶性肿瘤患者30例,所有患者术前均行18F-FDG PET/CT检查,然后行根治性手术。以手术病理结果作为对照,分别在患者水平和区域淋巴结水平计算18F-FDG PET/CT诊断妇科恶性肿瘤腹膜后淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果:30例患者术后病理证实原发灶均为妇科恶性肿瘤,12例患者存在腹膜后淋巴结转移,18F-FDG PET/CT正确诊断7例;在切除的199个区域淋巴结组中,经病理确认30个腹膜后淋巴结组发生转移,18F-FDG PET/CT正确诊断16个区域淋巴结组。在患者水平分析,18F-FDG PET/CT诊断腹膜后淋巴结转移的敏感性为58.3%,特异性为100.0%,阳性预测值为100.0%,阴性预测值为78.3%,准确性为83.3%;在区域淋巴结水平,上述指标分别为53.3%、98.8%、88.9%、92.3%和92.0%。发生淋巴结转移时,原发肿瘤的最大标准摄取值(SUVmax)要高于未发生淋巴结转移时,但两者差异无统计学意义(P=0.586)。结论:术前18F-FDG PET/CT显像诊断腹膜后淋巴结转移具有中度敏感性,不能代替全面手术病理分期;18F-FDG PET/CT诊断腹膜后淋巴结转移的高阳性预测值对是否进行全面手术分期有提示意义;较高的阴性预测值在选择不需要腹膜后淋巴结切除的患者时,也有一定的临床价值。     

Early-stage granulosa cell tumor with pelvic recurrence and lung metastasis 16 years later: A case report and review of the literature

ObjectiveOnly a few cases of early-stage ovarian granulosa cell tumor (GCT) with lung metastasis have been previously documented in the literature. We present a case of stage IA adult-type ovarian GCT with late pelvic recurrence and lung metastasis and review the relevant literature.Case reportA 71-year-old female who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for an ovarian GCT in her early 50s presented with pelvic recurrence 16 years later. Lung metastasis was accidentally discovered during a preoperative computed tomography scan of the pelvic tumor. The patient received surgical resection and adjuvant chemotherapy. She remains alive and healthy without evidence of disease after 12 months of follow up.ConclusionThis case illustrates the importance of long-term follow-up for early-stage GCTs. It also highlights the requirement of extended examination for possible extra-abdominal/pelvic tumors.     

Establishment and characterization of a cell line [GCH-1 (m)] highly metastasizing to the lung in nude mice

A new cell line having the ability to metastasize to the lungs in nude mice was established from GCH-1 (human choriocarcinoma cell line). Twenty CD-1 nude mice were injected with GCH-1 cells subcutaneously. A solitary metastatic pulmonary nodule appeared in only one of these mice. The pulmonary nodule was removed and minced, and the dissociated cells obtained were transplanted subcutaneously into new mice. By repeating this process, metastatic pulmonary nodules were seen clearly to have grown in size and number by the 4th transplantation. An in vitro cell line originating in the pulmonary lesion of the 5th transplantation was designated GCH-1 (m). Pulmonary metastasis occurred in all of the mice inoculated with GCH-1 (m) grown in vitro. The doubling time of the parent line GCH-1 and its subline GCH-1 (m) was 22.6 and 36.2 hours, respectively. GCH-1 (m) cells seemed to be heterogeneous in their size and shape compared with GCH-1 cells. GCH-1 (m) secreted more hCG and beta-hCG into the culture medium than GCH-1. By the immunoperoxidase technique using poly- or monoclonal antibodies, GCH-1 (m) showed a clear positive reaction but GCH-1 was only slightly positive for hCG and beta-hCG. Both GCH-1 and GCH-1 (m) were weakly positive for HLA-A, B,C and negative for HLA-DR, SP1 and hPL. Addition of the extracts from mouse lungs to the culture medium obviously promoted the growth of GCH-1 (m) but not of GCH-1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic significance of lymph node metastasis and clear cell histology in ovarian carcinoma limited to the pelvis (pT1M0 and pT2M0)

BACKGROUND: The prognostic significance of lymph node (LN) metastasis in clinically early-stage (pT1M0 or pT2M0) ovarian carcinoma has not yet been fully elucidated. METHODS: From 1988 to 1997, 94 patients with ovarian carcinoma of pT1M0 (n = 78) or pT2M0 (n = 16) classification underwent surgery including systematic pelvic and paraaortic LN dissection. We investigated the prognostic factors of intraperitoneally determined early-stage ovarian carcinoma focusing on LN metastasis. RESULTS: LN metastasis was seen in 5.1% of pT1M0 and in 31.3% of pT2M0 tumors. Univariate analysis of grade, histology (clear cell vs others), size of primary tumor, peritoneal cytology, and LN metastasis revealed that histology (P < 0.01), size of tumor (P < 0.05), and LN metastasis (P < 0.0005) were related to patient survival of early-stage ovarian carcinoma. Peritoneal cytology (P = 0.053) and grade (P = 0.059) had marginal statistical significance. A multivariate Cox regression analysis showed that clear cell histology (P < 0.05) and LN metastasis (P < 0. 005) are significant independent prognosticators of patient survival. Three (two with clear cell adenocarcinoma and one with mucinous adenocarcinoma) of nine patients with LN metastasis had died of the disease by the time of the present analysis. Two of the three deceased patients had recurrent tumors in distant organs (bone and brain/liver), one had pleural and peritoneal carcinomatosis, and no patients had retroperitoneal recurrence. This suggests that LN metastasis indicates that tumor cells may have already spread systemically at the time of treatment and, at the same time, retroperitoneal lymph node dissection (RPLND) may be effective in eradicating retroperitoneal metastasis in some instances of ovarian carcinoma. CONCLUSION: Clear cell histology and LN metastasis are indicators of poor prognosis for patients with tumors limited to the pelvis. Therapeutic significance of systematic RPLND for pT1M0/pT2M0 ovarian carcinomas needs to be further investigated by randomized studies.     

p~(53)与C-erbB_2、C-ras、C-myc在卵巢粒层细胞瘤中的过度表达及其临床意义

目的：了解ｐ５３及Ｃ－ｅｒｂＢ２、Ｃ－ｒａｓ、Ｃ－ｍｙｃ在卵巢粒层细胞瘤中的表达及与此瘤发生、发展的关系。方法：采用单克隆抗体免疫组化技术，对２５份卵巢粒层细胞瘤组织进行ｐ５３、Ｃ－ｅｒｂＢ２、Ｃ－ｒａｓ及Ｃ－ｍｙｃ表达的检测，分析基因表达与临床－病理指标及患者预后的关系。结果：２５例卵巢粒层细胞瘤中ｐ５３、Ｃ－ｅｒｂＢ２、Ｃ－ｒａｓ、Ｃ－ｍｙｃ的过度表达率分别为５６％、５６％、４８％、４８％。Ⅲ～Ⅳ期ｐ５３的过度表达高于Ⅰ～Ⅱ期；有残余瘤者较无残余瘤者显著增高。Ⅲ～Ⅳ期的Ｃ－ｅｒｂＢ２过度表达率显著高于Ⅰ～Ⅱ期者。高分化组的Ｃ－ｒａｓ基因过度表达率显著高于低分化组。未发现Ｃ－ｍｙｃ的表达与临床－病理各指标有关。两种及两种以上基因同时表达者显著高于单基因表达者。ｐ５３与Ｃ－ｅｒｂＢ２及Ｃ－ｍｙｃ过度表达间呈正相关。临床分期及Ｃ－ｅｒｂＢ２的过度表达是独立影响患者预后的因素。结论：ｐ５３及Ｃ－ｅｒｂＢ２、Ｃ－ｒａｓ、Ｃ－ｍｙｃ的表达对卵巢粒层细胞瘤的发生、发展及患者预后有一定的影响。     

Initial experience with repetitive transarterial chemoembolization (TACE) as a third line treatment of ovarian cancer metastasis to the liver: indications, outcomes and role in patient's management

Objective

To evaluate local tumor control and survival data after transarterial chemoembolization (TACE) with different drug combinations in the palliative third-line treatment of patients with ovarian cancer liver metastases.

Methods

Sixty-five patients (mean age: 51.5 year) with unresectable hematogenous hepatic metastases of ovarian cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. The local chemotherapy protocol consisted of Mitomycin (group 1) (n = 14; 21.5%), Mitomycin with Gemcitabine (group 2) (n = 26; 40%), or Mitomycin with Gemcitabine and Cisplatin (group 3) (n = 25; 38.5%). Embolization was performed with Lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST criteria. Survival data were calculated according to the Kaplan-Meier method.

Results

The local tumor control was: partial response (PR) in 16.9% (n = 11), stable disease (SD) in 58.5% (n = 38) and progressive disease (PD) in 24.6% (n = 16) of patients. In group 1, we observed SD in 78.6% (11/14), and PD in 21.4% (3/14) of patients. In group 2, PR in 7.7% (2/26), SD in 57.7% (15/26), and PD in 34.6% (9/26) of patients. In group 3, PR in 36% (9/25), SD in 48% (12/25), and PD in 16% (4/25) of patients. Survival rate from the start of TACE was 58% after 1-year, 19% after 2-years, and 13% after 3-years. The median and mean survival times were 14 and 18.5 months without statistically significant difference for the 3 groups of patients (p = 0.502).

Conclusion

Transarterial chemoembolization is effective palliative treatment in achieving local control in selected patients with liver metastases from ovarian cancer.     

异搏定等药物对耐阿霉素人卵巢癌细胞系逆转耐药性的研究

目的：探讨异搏定、潘生丁、丹参、黄体酮、环孢菌素Ａ和他莫西芬等药物对耐阿霉素人卵巢癌细胞系Ａ２７８０／ＡＤＭ逆转的耐药性。方法：用ＭＴＴ法和高效液相色谱仪测定异搏定等６种药物分别对阿霉素耐药细胞的敏感性和耐药细胞内阿霉素的剂量。结果：单用异搏定等６种药物对Ａ２７８０／ＡＤＭ几乎无体外抑制作用。异搏定和环孢菌素Ａ对Ａ２７８０／ＡＤＭ有明显的增效作用，可增加ＡＤＭ在Ａ２７８０／ＡＤＭ细胞内的潴留浓度。结论：除丹参外，其它５种药物均能增强ＡＤＭ对Ａ２７８０／ＡＤＭ耐药细胞细胞毒作用，并克服ＡＤＭ的耐药性，可作为ＡＤＭ的增效剂用于临床治疗卵巢癌患者     

The duration of pituitary suppression by means of intranasal gonadotropin hormone-releasing hormone analogue administration does not influence the ovarian response to gonadotropin stimulation and success rate in a gamete intrafallopian transfer (GIFT) program

The aim of the study was to compare the ability to prevent endogenous luteinizing hormone interferences, ovarian response, and success rate between two groups of patients undergoing GIFT procedures and treated with the same stimulatory protocol but with a different timing in the administration of the gonadotropin hormone-releasing hormone analogue (GnRH-a). The former underwent a concomitant administration of gonadotropin and analogue; the latter started stimulation only after the achievement of complete hypogonadotropinism. The analogue was always given intranasally and stimulation was identical in the two groups. Our results showed that (1) prevention of premature luteinization is obtained with both approaches and (2) no significant difference in terms of length of stimulation, gonadotropin doses, ovarian response, and success rate was recorded between the two groups.