经直肠超声联合血清淀粉样蛋白A术前评估中低位直肠癌与手术决策的随机对照试验

目的 探讨经直肠超声检查(TRUS)联合血清淀粉样蛋白A(SAA)术前评估中低位直肠癌的临床价值和对手术决策的意义.方法 前瞻性纳入2008年6月至2009年2月期间于四川大学华西医院肛肠外科住院的中低位直肠癌患者130例,随机均分为TRUS联合SAA组和TRUS组.TRUS联合SAA组术前行TRUS和SAA联合评估,TRUS组术前只行TRUS评估.将术前直肠癌分期和预测手术方案分别与术后病理分期和实际手术方案比较.结果 本研究实际纳入病例118例,TRUS联合SAA组与TRUS组各59例,2组基线情况基本一致.TRUS联合SAA组术前T、N分期的准确度分别为79.7%(47/59)和77.8%(42/54), TRUS组术前T、N分期的准确度分别为86.4%(51/59)和57.7%(30/52);2组间T分期的准确度比较差异无统计学意义(P=0.609),N分期的准确度比较差异有统计学意义(P=0.027).2组手术方案的预测符合率分别为96.6%(57/59)和83.1%(49/59),差异亦有统计学意义(P=0.015).分析直肠癌手术方案的选择与多种临床病理因素的关系发现,术前T分期在不同手术方案之间的差异有统计学意义(P=0.037).结论 TRUS联合SAA术前评估中低位直肠癌患者的策略可以提高术前分期的准确性,并因此提高了中低位直肠癌手术方案预测的符合率.     

多模式术前评估系统对中低位直肠癌手术方案选择的价值：一项随机对照试验

目的 探讨多学科协作模式下经直肠超声(TRUS)联合64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(SAA)检测的多模式术前评估系统对中低位直肠癌诊疗的临床价值和对手术方案选择的影响.方法 前瞻性纳入2008年11月至2009年3月期间于四川大学华西医院肛肠外科住院的中低位直肠癌患者150例(肿瘤下缘距齿状线≤10 cm),随机均分为MPE组(术前行TRUS、MSCT和SAA联合评估)和MSCT+SAA组(术前行MSCT和SAA联合评估),将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较,并分析手术方案选择与临床病理因素的关系.结果 本研究实际纳入病例146例,其中MPE组74例,MSCT+SAA组72例,2组基线情况一致.术前T、N、M和TNM分期的准确度,MPE组分别为94.6%(70/74)、85.1%(63/74)、100%(74/74)和82.4%(61/74),MSCT+SAA组分别为77.8%(56/72)、84.7%(61/72)、100%(72/72)和81.9%(59/72);2组间术前N、M和TNM分期的准确度比较差异均无统计学意义(P>0.05),而2组间术前T分期的准确度比较差异有统计学意义(P=0.003).2组手术方案的预测符合率分别为95.9%(71/74)及88.9%(64/72),差异无统计学意义(P==0.106).分析中低位直肠癌手术方案的选择与多种临床病理因素的关系发现,病理学T(r=0.216,P=0.009)、N(r=0.264,P=0.001)及TNM(r=0.281,P=0.001)分期,术前血清SAA水平(r=0.252,P=0.002)及肿瘤下缘距齿状线距离(r=-0.261,P=0.001)与中低位直肠癌手术方案的选择相关.结论 多模式术前评估系统可以实现准确的中低位直肠癌术前分期,为手术方案的预测提供可靠的客观依据.     

64排多层螺旋CT和血清淀粉样蛋白A联合评估下段直肠癌对手术方案选择的影响

目的 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(serum amyloid A protein, SAA)联合术前评估下段直肠癌的临床价值和对手术方案选择的影响.方法 前瞻性纳入2007年7月至2008年9月期间在四川大学华西医院肛肠外科住院的下段直肠癌患者130例(肿瘤下缘距齿状线≤7 cm),随机均分为: MSCT+SAA组(术前行MSCT和SAA联合评估)和 MSCT组(术前只行MSCT评估).将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较.结果 本研究实际纳入病例119例,MSCT+SAA组58例,MSCT组61例,2组基线情况基本一致.MSCT+SAA组术前T、N、M和TNM分期的准确度分别为89.66%、79.31%、100%和77.59%; MSCT组的术前T、N、M和TNM分期的准确度分别为86.89%、70.49%、100%和65.57%.2组手术方案的预测符合率分别为93.10%和80.33%,差异有统计学意义(P=0.041).分析下段直肠癌手术方案的选择与多种临床病理因素的关系发现,临床分期(P=0.001)、术前T分期(P=0.000)、术前M分期(P=0.016)、术前TNM分期(P=0.013)和SAA水平(P=0.029)与手术方案的选择有关.结论 64排MSCT和SAA联合评估下段直肠癌患者的策略可以提高术前分期的准确性,并且提高肛肠外科医师预测手术方案的符合率.     

多层螺旋CT联合纤维蛋白原或血清淀粉样蛋白A对直肠癌外科决策的随机对照研究

目的 探讨多学科协作模式 (MDT)下血清淀粉样蛋白A(SAA)或纤维蛋白原(FIB)和64排多层螺旋CT(MSCT)联合评估对于直肠癌手术方式选择的影响和意义.方法 前瞻性纳入2009年2～6月期间四川大学华西医院肛肠外科住院的直肠癌患者240例,随机均分为MSCT+SAA组(术前行MSCT和SAA联合评估)和MSCT+FIB组(术前行MSCT和FIB联合评估),将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较,并分析手术方案选择与临床病理因素的关系.结果 本研究实际纳入病例234例, MSCT+SAA组118例,MSCT+FIB组116例,2组基线情况一致(P>0.05).MSCT+SAA组的术前T、N、M和TNM分期的准确度分别为72.9%、83.1%、100%和80.1%; MSCT+FIB组的术前T、N、M和TNM分期的准确度分别为68.1%、75.0%、100%和74.1%.2组术前各分期准确度差异均无统计学意义(P>0.05).2组手术方案的预测符合率分别为99.6%及96.6%,差异无统计学意义(P>0.05).分析直肠癌手术方案的选择与多种临床病理因素的关系发现,pT分期(P＜0.001)、pN分期(P＜0.001)、pTNM分期(P＜0.001)、术前血清SAA水平(P＜0.001)、术前血清FIB水平(P＜0.001)和肿瘤下缘距齿状线距离(P＜0.05)与直肠癌手术方案的选择相关.结论 MSCT联合FIB可以提高直肠癌术前分期和手术方案预测的准确度,但其临床价值可能并不优于MSCT联合SAA.     

多层螺旋CT联合血清淀粉样蛋白A术前评估直肠癌在外科决策中的价值

目的 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(SAA)联合术前评估进行直肠癌术前分期的准确性及其临床应用价值.方法 前瞻性纳入2007年10月至2008年10月期间住院的225例直肠癌患者,将患者随机分为MSCT组和MSCT与SAA联合组,联合组术前行MSCT和SAA联合评估,MSCT组术前只行MSCT评估.分别将两组术前T、N、M、TNM分期准确度进行比较,并比较两组手术方案的预测符合率.结果 本研究实际纳入病例225例,MSCT和SAA联合组110例,MSCT组115例,两组基线情况具有可比性.联合组术前T、N、M和TNM分期的准确度分别为87.3%、85.2%、100%和86.4%,MSCT组的准确度分别为85.2%、67.0%、100%和66.1%;两组术前N分期和TNM分期准确度差异具有统计学意义(P=0.009、0.001).两组手术方案的预测符合率分别为94.7%和81.7%,差异具有统计学意义(P=0.003).结论 MSCT和SAA联合评估的策略可以提高直肠癌患者术前分期N、TNM的准确性,并可提高预测手术方案的符合率.     

64排多层螺旋CT和血清淀粉样蛋白A联合评估结肠癌对手术方案选择的影响

目的 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(SAA)联合术前评估结肠癌的临床价值和对手术方案选择的影响.方法 前瞻性纳入2007年11月至2008年11月期间于四川大学华西医院肛肠外科住院的110例结肠癌患者,随机均分为MSCT+SAA组和MSCT组,MSCT+SAA组术前行MSCT和SAA联合评估,MSCT组只进行MSCT评估,将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较.结果 本研究实际纳入病例99例,MSCT+SAA组49例,MSCT组50例,2组基线情况一致.MSCT+SAA组的术前T、N、M及TNM分期的准确度分别为81.6%、79.6%、100%及77.6%; MSCT组的术前T、N、M及TNM分期的准确度分别为82.0%、60.0%、98.0%及62.0%.MSCT+SAA组和MSCT组在N分期之间的差异有统计学意义(χ2=4.498,P=0.034).MSCT+SAA组手术方案的预测符合率为95.9%(47/49),MSCT组手术方案的预测符合率为82.0%(41/50),2组间预测符合率差异具有统计学意义(χ2=4.854,P=0.028).结肠癌手术方案选择与多种临床病理因素如术前N分期(P=0.008)、术前M分期(P=0.010)、术前TNM分期(P=0.009)和SAA水平(P=0.004)有关.结论 MSCT和SAA联合评估结肠癌患者的策略可以提高术前分期的准确性,并且提高肛肠外科医师预测手术方案的符合率.     

胃癌患者中血清淀粉样蛋白A的测定及临床意义

目的利用蛋白质组学技术研究胃癌血清淀粉样蛋白A的变化及临床意义。方法应用表面加强激光解析（SELDI）技术检测胃癌血清中相对分子质量11100-11900的一簇蛋白蜂,采用高效液相色谱（HPLC）技术分离该簇蛋白,用基质辅助激光解吸电离飞行时间质谱技术（MALDI-TOF-MS）分析该簇蛋白的肽指纹图,经数据库搜索进行鉴定分析。结果分析显示。相对分子质量11100-11900的一簇蛋白峰在胃癌患者血清中明显高于健康组（P〈0.01）,同时该蛋白峰的表达水平术后显著下降,经鉴定该簇蛋白峰为血清淀粉样蛋白A（SAA）。采用ELISA方法进一步验证了胃癌血清中SAA的表达。结论胃癌患者SAA对于监测胃癌具有重要意义,可能成为胃癌诊断和病情监测一个新的生物学标志物。     

直肠癌术前64排螺旋CT评估与手术方案选择

目的 探讨直肠癌术前应用64排螺旋CT评估对于手术方案选择的指导意义.方法 纳入病理确诊为直肠癌的患者188例,所有患者术前行64排螺旋CT评估,记录术前CT分期,与术后病理分期进行比较,并分析临床病理因素与手术方案选择的关系.采用Kappa值检验诊断一致性试验,相关性检验采用等级Spearman相关.结果 64排螺旋CT术前评估得到CT-TNM分期准确度为75.5%,与病理TNM分期一致(Kappa值=0.641,P<0.001).直肠癌手术方案的选择与CT-T分期(r=0.307、P<0.001)、CT-M分期(r=0.148,P=0.043)、CT-TNM分期(r=0.208、P=0.004)和肿瘤厚度(r=0.524、P<0.001)具有相关性.结论 64排螺旋CT行术前评估直肠癌,可以得到肿瘤厚度、CT-M分期和CT-T分期三个影响手术方案选择的客观指标,为外科医师预测直肠癌手术方案提供依据.     

胃癌患者中血清淀粉样蛋白A的测定及临床意义

目的 利用蛋白质组学技术研究胃癌血清淀粉样蛋白A的变化及临床意义.方法 应用表面加强激光解析(SELDI)技术检测胃癌血清中相对分子质量11 100～11 900的一簇蛋白峰,采用高效液相色谱(HPLC)技术分离该簇蛋白,用基质辅助激光解吸电离飞行时间质谱技术(MALDI-TOF-MS)分析该簇蛋白的肽指纹图,经数据库搜索进行鉴定分析.结果 分析显示.相对分子质量11 100～11 900的一簇蛋白峰在胃癌患者血清中明显高于健康组(P<0.01),同时该蛋白峰的表达水平术后显著下降,经鉴定该簇蛋白峰为血清淀粉样蛋白A(SAA).采用ELISA方法进一步验证了胃癌血清中SAA的表达.结论 胃癌患者SAA对于监测胃癌具有重要意义,可能成为胃癌诊断和病情监测一个新的生物学标志物.     

胃癌患者中血清淀粉样蛋白A的测定及临床意义

目的 利用蛋白质组学技术研究胃癌血清淀粉样蛋白A的变化及临床意义.方法 应用表面加强激光解析(SELDI)技术检测胃癌血清中相对分子质量11 100～11 900的一簇蛋白峰,采用高效液相色谱(HPLC)技术分离该簇蛋白,用基质辅助激光解吸电离飞行时间质谱技术(MALDI-TOF-MS)分析该簇蛋白的肽指纹图,经数据库搜索进行鉴定分析.结果 分析显示.相对分子质量11 100～11 900的一簇蛋白峰在胃癌患者血清中明显高于健康组(P<0.01),同时该蛋白峰的表达水平术后显著下降,经鉴定该簇蛋白峰为血清淀粉样蛋白A(SAA).采用ELISA方法进一步验证了胃癌血清中SAA的表达.结论 胃癌患者SAA对于监测胃癌具有重要意义,可能成为胃癌诊断和病情监测一个新的生物学标志物.     

低位局部进展期直肠癌新辅助放化疗后完全缓解的后续手术治疗效果

目的 探讨低位局部进展期直肠癌新辅助放化疗后完全缓解病例的进一步治疗方案及效果。方法 回顾性分析江苏省中医院肿瘤外科2008年1月至2010年5月期间行新辅助放化疗后初步判断达到病理完全缓解（pCR）的14例低位局部进展期直肠癌患者的临床资料。结果 14例患者中接受手术者10例,术后真正达到pCR者5例;术后2例复发或转移,其中死亡1例,1例带瘤生存,余8例患者均无瘤生存。未行手术的4例患者中,有3例复发或转移,其中2例死亡,1例带瘤生存;余1例无瘤生存。 4例未行手术病例中CEA水平正常者（＜5 μg/L）2例（1例复发或转移）,CEA升高的2例均发生转移;10例手术病例中CEA水平正常者6例（均无瘤生存,4例真正达到pCR）,升高者4例（1例真正达到pCR,2例复发或转移）。结论 接受新辅助放化疗后初步判断达到pCR的病例,尤其是CEA值高于正常者,应接受规范的全直肠系膜切除（TME）手术以达到根治的目的。     

Postoperative Morbidity Following Chemoradiation for Locally Advanced Low Rectal Cancer

Background  Postoperative morbidity remains a significant clinical problem and may alter long-term outcome particularly after neoadjuvant chemoradiation in patients with locally advanced low rectal cancer. The aim of the present study was to identify a potential long-term effect of postoperative morbidity. Methods  Analysis of prospectively collected data of 90 consecutive patients who underwent neoadjuvant chemoradiation and curative mesorectal excision for locally advanced (cT3/4, Nx, M0/1) adenocarcinoma of the mid and lower third of the rectum during a 7-year period (1996–2002). Results  Major postoperative complications occurred in 17.8% and minor complications in 26.6% of patients. Hospital mortality and 30-day mortality was 0%. Infectious complications were seen in 34.5%. The leading causes of infectious complications were anastomotic leakage and perineal wound infection. Postoperative morbidity was statistically significantly associated with gender (P < 0.05), pre-therapeutic haemoglobin level (P < 0.05), ASA score (P < 0.05), hospitalisation (P < 0.001) and clinical long-time course (P < 0.01). Moreover, early postoperative morbidity was proven as an independent prognostic factor concerning disease-free (P < 0.05) and overall survival (P < 0.05). Conclusion  Early postoperative morbidity in patients with preoperative chemoradiation due to locally advanced low rectal cancer is demonstrated as an independent prognosticator. Gender, pre-therapeutic haemoglobin level and ASA score indicate patients at risk for early postoperative complications and may therefore serve as predictive features.     

术前放化疗结合全直肠系膜切除在低位进展期直肠癌治疗中的应用

目的 分析术前放化疗结合全直肠系膜切除术(TME)治疗低位进展期直肠癌的疗效.方法 回顾性分析笔者所在医院2009年1月至2011年12月期间行术前放化疗联合TME的31例低位进展期直肠癌患者的临床资料.放疗采用常规分割放疗,总剂量50 Gy/25 f;化疗采用mFOLFOX6或CapeOX方案.临床-病理对照记录疗效,并评价保肛患者的肛门功能.结果 全部患者均接受TME手术治疗,手术并发症发生率为12.9％(4/31),死亡率为3.2％ (1/31).经术前放化疗,肿瘤直径平均缩小21.9％;48.4％ (15/31)的患者出现T分期下降,阳性淋巴结患者比例由83.9％ (26/31)降至38.7％ (12/31),5例(16.1％)患者获得病理学完全缓解,总有效率达74.2％ (23/31);Ⅲ～Ⅳ度不良反应发生率为6.5％ (2/31),保肛患者肛门功能良好率达84.6％ (22/26).结论 从本组有限的病例看,对低位进展期直肠癌采用术前放化疗结合TME手术能够达到部分肿瘤的病理学完全缓解,缩小原发肿瘤,降低局部淋巴结转移率,从而达到降低肿瘤分期、提高手术疗效的目的.     

Locally Advanced Mid/Low Rectal Cancer with Synchronous Liver Metastases

Background  

Management of patients with T3/4 and/or N+ mid/low rectal cancer with synchronous liver metastases is not codified. The aim of this study was to analyze outcomes of our approach which consists of neoadjuvant chemotherapy or chemoradiotherapy, according to liver disease extension, followed by simultaneous rectal and liver resection.     

Preoperative Paclitaxel and Radiotherapy for Locally Advanced Breast Cancer: Surgical Aspects

Introduction: Approximately 15% of breast cancer patients present with large tumors that involve the skin, the chest wall, or the regional lymph nodes. Multimodality therapy is required, to provide the best chance for long-term survival. We have developed a regimen of paclitaxel, with concomitant radiation, as a primary therapy in patients with locally advanced breast cancer.Methods: Eligible patients had locally advanced breast cancer (stage IIB or III). After obtaining informed consent, patients received paclitaxel (30 mg/m² during 1 hour) twice per week for 8 weeks and radiotherapy to 45 Gy (25 fractions, at 180 cGy/fraction, to the breast and regional nodes). Patients then underwent modified radical mastectomy followed by postoperative polychemotherapy.Results: Twenty-nine patients were enrolled. Of these, 28 were assessable for clinical response and toxicity, and 27 were assessable for pathological response. Objective clinical response was achieved in 89%. At the time of surgery, 33% had no or minimal microscopic residual disease. Chemoradiation-related acute toxicity was limited; however, surgical complications occurred in 41% of patients.Conclusions: Preoperative paclitaxel with radiotherapy is well tolerated and provides significant pathological response, in up to 33% of patients with locally advanced breast cancer, but with a significant postoperative morbidity rate.Presented at the 52nd Annual Meeting of Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

术前新辅助化疗联合同步放化疗对局部进展期直肠癌预后及血清标志物影响

目的:探讨术前同步放化疗联合氟尿嘧啶+亚叶酸钙+奥沙利铂(FOLFOX4)新辅助化疗对局部进展期直肠癌患者血清血清脂肪酸合成酶(FAS)、肿瘤型M2丙酮酸激酶(Tu M2-PK)表达的影响,为直肠癌的临床治疗方案提供参考.方法:选取100例进展期直肠癌患者为研究对象,以抽签法随机分为试验组和对照组,各50例.试验组术前...     

Quality of Life after Potentially Curative Treatment for Locally Advanced Rectal Cancer

Background  Patients with locally advanced rectal cancer have a poor prognosis and the early and late postoperative morbidity is high. The aim of this study was to assess health-related quality of life (HRQL) in patients treated with extensive surgical resections for locally advanced rectal cancer and to compare the results with those in patients treated for primarily resectable rectal cancer. Methods  Between 1991 and 2003, 142 patients with locally advanced rectal cancer had an extensive resection at the Karolinska Hospital in Stockholm, Sweden. A HRQL assessment with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires was performed in patients alive and disease free in 2005. The results were compared with an age- and sex-matched reference group of patients with primarily resectable rectal cancer having had total mesorectal excision alone. Results  The study group of 43 patients (81% of eligible) scored clinically and statistically significantly lower in global quality of life, role function, physical function, social function, and body image and reported a higher degree of pain and fatigue compared with the reference group of 80 patients. In the study group, men scored lower than women in global quality of life, role functioning and social functioning and reported more problems with fatigue. Conclusion  Several aspects of HRQL are impaired in disease-free patients treated for locally advanced rectal cancer. This knowledge may be useful in the preoperative counselling and postoperative support of these patients.     

Relationship Between Pathologic T-Stage and Nodal Metastasis After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer

Background We investigated the relationship between pathologic T-stage and mesorectal metastases after preoperative chemoradiotherapy (CRT) for clinical stage II to III rectal carcinoma.Methods The records of consecutive patients with clinical stage II to III carcinoma of the mid or low rectum who underwent surgery after CRT were reviewed. Indications for preoperative CRT were cancer up to 11 cm from the anal verge, Eastern Cooperative Oncology Group performance status of 0 to 2, age 18 to 75 years, and clinical tumor-node-metastasis stage II or III.Results The study group consisted of 235 patients (148 men and 87 women; median age, 61 years). The pretreatment tumor-node-metastasis stage was as follows: I, n = 1; II, n = 96; and III, n = 138. Radiotherapy was delivered at a median dose of 50.4 Gy. A pathologic complete response on the rectal wall was found in 24% of patients, and nodal metastases were found in 20% of patients. According to the pT stage, the rate of node positivity was 2% for pT0, 15% for pT1, 17% for pT2, 38% for pT3, and 33% for pT4 cases. At multivariate analysis, the best model for predicting pathologic node involvement included young age, positive pretreatment N status, and pT status. On considering pT stage alone, the odds ratio was in the region of 10 for pT1/2 and >20 for pT3/4 patients.Conclusions In patients with pT0 after preoperative CRT for clinical stage II to III mid or low rectal cancer, the risk of nodal metastases is very low. More conservative surgery (local excision) may be considered in these cases.Presented at the 57th Annual Cancer Symposium of the Society of Surgical Oncology, New York, New York, March 18–21, 2004.