直肠癌扩大根治术及远期疗效

本文介绍了直肠癌淋巴转移规律的研究结果，主张以此规律进行扩大根治手术，并指出了该手术的操作要点及并发症等。结果表明，扩大根治术的五年及十年生存率分别为６８％及４７％，与一般根治术相比，差异具有显著意义。由于扩大根治术充分进行了游离及解剖输尿管、血管，因此没有因手术范围的扩大而增加出血量及输尿管的损伤。但手术范围的扩大造成了术后由于植物神经损伤所至的排尿及性功能障碍的增加，为了减少这种副作用的发生，开展了保存植物神经的扩大根治术，即保证了生存率，又改善了术后生存质量。     

胃癌宿主脾脏免疫状态对扩大根治术的影响

为能够清扫脾门及脾动脉干周围转移之淋巴结,以求手术的彻底性,联合胰腺体尾及脾切除作为胃癌扩大根治术的重要组成部分已有40余年历史,这一手术的开展曾为提高胃癌外科疗效起了巨大的促进作用.近10年来,由于免疫学理论与技术的不断进展,使日益增多的肿瘤临床工作者开展了胃癌(或其它肿瘤)宿主脾脏免疫状态的研究,祈能阐明(1)胃癌宿主脾脏究竟起正性或负性免疫作用;(2)合并脾脏切除与否对胃癌患者免疫状态及其预后起何影响,从而为合理地开展胃癌扩大根治术充实免疫学基础.本文仅就国内外在这一领域的研究概况与我们的研究结果概述如下.     

直肠癌根治术的远期疗效

目的：分析我院直肠癌根治术后远期效果和影响手术疗效的各种因素。方法：收集我院１９６４年４月～１９８９年１２月根治性切除直肠癌６３８例资料。用生命表法计算生存率，生存曲线用Ｇｅｈａｎ方法作显著性检验。结果：全组手术死亡率０．８％，随访率９８．８％。术后５、１０、１５、２０、２５年生存率为５８．７％、４９．８％、４８．０％、４７．３％和４４．２％。结论：直肠癌术后生存率与年龄、肿瘤部位、大小、侵占肠腔周径、大体和组织学类型、淋巴结转移、病期等有关。其中，淋巴结转移和病期是影响术后生存率的最主要因素。     

两种腹腔镜辅助胃癌根治术的临床疗效观察

目的分析两种腹腔镜辅助胃癌根治术的临床应用效果。方法 2012年4月至2014年3月间收治的行腹腔镜胃癌根治术的胃癌患者50例,随机分为两组,分别实施腹腔镜下缝合重建的D2胃癌根治切除术(观察组)和腹腔镜辅助D2胃癌根治切除术(对照组)。结果 18例行腹腔镜下缝合重建的D2胃癌根治切除术,32例患者行腹腔镜辅助D2胃癌根治切除术,未出现中转开腹病例。观察组的手术时间显著长于对照组,差异有统计学意义(P<0.05)。两组的术中出血量和清扫淋巴结数目比较,差异均无统计学意义(均P>0.05)。观察组的术后镇痛时间和术后首次下床活动时间均显著短于对照组,差异均有统计学意义(均P<0.05);但两组的住院时间、术后住院时间、术后排气时间、并发症发生情况差异均无统计学意义(均P>0.05)。术后随访,两组患者均未见复发现象。结论与腹腔镜辅助D2胃癌根治切除术比较,腹腔镜下缝合重建的D2胃癌根治切除术具有可以接受的手术时间和并发症发生率。     

延迟辅助化疗对乳腺癌患者生存期的影响(英文)

Objective: The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. It is usually prescribed within 2-3 months after definitive surgery. The aim of this retrospective study was to assess the impact of adjuvant chemotherapy (CT) delay beyond 3 weeks ( 21 days) in premenopausal patients with ER-absent tumors being treated for early stages breast cancer on overall survival (OS) and disease-free survival (DFS). Methods: This retrospective study was conducted through revision of medical records of premenopausal patients diagnosed with early stage Ⅰ-ⅢA breast cancer and ER-absent tumors who received adjuvant CT after definitive surgery at the Department of Clinical Oncology, Ain-Shams University Hospitals. Results: Between 2005 and 2008, 105 patients were retrospectively analyzed and included. Patients were divided into 2 groups: Group A including 48 patients who started adjuvant CT<21 days of surgery and group B which included 57 patients who had CT delay ≥ 21 days. Both groups were matched demographically. Comparisons of overall survival, and disease-free survival between group A and group B patients all favored group A. At 5-year the OS rates were 87% and 73% for groups A and B respectively (P=0.001), while DFS rates were 85% and 64% in groups A and B respectively (P=0.001). Analysis of other prognostic factors (age, T, N, grade, HER2 status, surgery type, CT type, local radiotherapy received) were analyzed. Only nodal status predicted for worse DFS (P=0.05) and OS (P=0.006). Conclusion: Delay in initiating adjuvant chemotherapy for early stage breast cancer patients with ER-absent tumors was associated with a decrease in both OS and DFS rates.     

进行期胃癌新的辅助化疗

进行期胃癌新的辅助化疗王娟博士研究生综述陈峻青审校中国医科大学第一临床学院肿瘤科（１１０００１）尽管人们对进展期胃癌在根治性手术基础上，术后进行积极的辅助化疗，但并没有得到十分满意的效果。近年，国外学者把研究的热点集中在术前化疗方面，可望与术后化疗起...     

新辅助化疗联合腹腔镜远端胃癌D2根治术治疗进展期胃癌的临床疗效

目的探讨新辅助化疗联合腹腔镜远端胃癌D2根治术治疗进展期胃癌的临床疗效及安全性。方法选取2013年8月至2017年7月间咸阳彬州市人民医院收治的100例进展期胃癌患者,按随机抽签法分为观察组和对照组,每组50例。观察组患者采用新辅助化疗联合腹腔镜远端胃癌D2根治术治疗,对照组患者采用腹腔镜远端胃癌D2根治术治疗,比较两组患者的根治性切除率、手术情况、恢复情况、淋巴结清除数量、并发症情况及生存质量。结果观察组患者根治清除率为88. 0%(44例),高于对照组的70. 0%(35例),两组比较,差异有统计学意义(P <0. 05)。两组患者术中失血量、手术时长和淋巴结清除数量比较,差异无统计学意义(P> 0. 05)。两组患者下床活动时间、排气时间及住院天数比较,差异无统计学意义(P> 0. 05)。两组患者并发症发生率比较,差异无统计学意义(P> 0. 05)。治疗前,两组患者生存质量评分比较,差异无统计学意义(P> 0. 05);治疗后,观察组患者评分高于对照组,差异有统计学意义(P <0. 05)。结论进展期胃癌患者采用新辅助化疗联合腹腔镜远端胃癌D2根治术治疗,在不影响手术及术后恢复的情况下,可提高根治性切除率,改善生存质量,且不增加并发症。     

进展期胃癌术后化疗方案选择的远期疗效对比临床观察

我院1975年7月—1985年12月收治130例胃癌术后化疗病人,男107例,女23例。全部病理证实,其中腺癌60例,低分化腺癌25例,印戒细胞癌5例,粘液腺癌22例,未分化癌6例,溃疡恶变2例,Ⅰ期22例,Ⅱ期3(?)例,Ⅲ期3(?)例,Ⅳ期32例。手术后3—4周开始化疗,化疗方案MFV方案49例,MF方案66例,其它方案15例。治疗结果:本组病人随访率为95.3％(124/130),五年生存率为40.8％(53/130),MFV方案五年生存率为30.6％(15/49),MF方案五年生存率为51.5％(34/66),其它方案五年生存率为26.7％(4/5).MF方案其五年生存率同MFV方案及其它方案比较有统计学意义(P<0.01)。MF方案具有给药时间短,毒副作用小,疗效好的优点。     

从胃癌术后5,10年生存率观察影响及提高远期疗效的因素探讨

从胃癌术后５、１０年生存率观察影响及提高远期疗效的因素探讨张殿忠，隋雨辰，陈庆玉哈尔滨医科大学肿瘤医院外科教研室（哈尔滨市１５００４０）自８０年代国内开展胃癌根治Ⅲ式手术以来，明显提高了胃癌术后５年生存率，但对１０年生存率的影响尚未见报道。现总结我院...     

腹腔镜胃癌根治术对患者术后自然杀伤细胞比例的影响

目的探讨腹腔镜胃癌根治术对患者术后自然杀伤(NK)细胞比例的影响。方法选取行胃癌根治术的患者152例,根据手术方式不同,将患者分为腹腔镜组(行腹腔镜胃癌根治术,74例)和开腹组(行开腹胃癌根治术,78例),通过流式细胞仪检测胃癌患者外周静脉血中NK细胞的比例,分析两组患者术前1 d、术后2 d、术后1周及术后2周NK细胞比例的变化,探讨不同手术方式对机体免疫功能的影响。结果腹腔镜组患者的手术时间、术中出血量、肛门排气时间及住院时间均明显少于开腹组,差异有统计学意义(均P<0.05)。术后2 d与术前1 d比较,腹腔镜组和开腹组患者NK细胞比例均明显下降,差异有统计学意义(P<0.05);腹腔镜组患者术后1周NK细胞比例恢复近术前水平,而开腹组患者术后1周NK细胞比例仍处于低水平,术后2周才恢复近术前水平;腹腔镜组和开腹组患者NK细胞比例变化比较,差异有统计学意义(P<0.05)。结论与传统开腹胃癌根治术相比,腹腔镜胃癌根治术对机体损伤小,能够保护机体免疫功能,术后患者恢复快,值得临床推广应用。     

胃癌根治术患者术后化疗期间营养状况及相关因素分析

目的研究胃癌根治术后患者化疗期间营养状况,分析影响患者营养状况的相关因素,为制订合理的干预措施提供科学依据。方法回顾性分析行胃癌根治术且接受完整化疗的150例胃癌患者的临床资料,采用整体营养状况主观评估量表(PG-SGA)评估患者术后化疗期间的营养状况,胃癌根治术患者术后营养不良相关影响因素采用Logistic逐步回归分析。结果胃癌根治术患者术后PG-SGA量表平均得分为(6.21±2.17)分,其中营养不良85例,占56.7%;营养良好65例,占43.3%。Logistic回归分析结果显示,初中、小学及以下文化程度,居住地为农村,家庭月收入≤5000元,化疗期间未进行肠外营养支持和有早饱感是胃癌根治术患者术后发生营养不良的独立危险因素。结论应重点关注文化程度低、收入低等胃癌根治术患者的营养状况,加强其化疗期间肠外营养支持,制订个体化饮食指导方案,改善患者的营养状况。     

Dose intensity of mitomycin C in adjuvant cancer chemotherapy for patients with gastric cancer

Using a cohort of macroscopic curative resections of gastric cancer at stages II, III, and IV, a randomized controlled trial was performed to elucidate the dose efficacy of intensive adjuvant cancer chemotherapy with mitomycin C. Between June 1983 and December 1986, 336 patients with gastric cancer from 31 institutes were enrolled in the study. The cohort was stratified randomly by the telephone method into two arms. Group A received 20 mg and 10 mg of mitomycin C per body intravenously (IV) on postoperative days 0 and 1, respectively, and then tegafur at 600 mg/body daily perorally (PO) from postoperative week 2 for 1 year. Group B also received 0.2 mg of mitomycin C per kg IV at 3, 6, 9, and 12 months after surgery. The background factors in groups A and B were essentially identical, and the adverse effects were tolerable in both groups. The total administered doses of mitomycin C were significantly higher in group B than in group A, according to the protocol. Although no significant differences were observed in the actuarial overall survival rates between groups A and B at stages II, III, and IV, favorable survival was observed in group B, which received histologically absolute curative resection. This dose-intensive adjuvant cancer chemotherapy would be useful for gastric cancer patients treated by histologically curative surgery. © 1994 Wiley-Liss, Inc.     

Adjuvant chemotherapy in elderly patients with pancreatic cancer

Background:

Adjuvant chemotherapy improves survival for patients with resected pancreatic cancer. Elderly patients are under-represented in Phase III clinical trials, and as a consequence the efficacy of adjuvant therapy in older patients with pancreatic cancer is not clear. We aimed to assess the use and efficacy of adjuvant chemotherapy in older patients with pancreatic cancer.

Methods:

We assessed a community cohort of 439 patients with a diagnosis of pancreatic ductal adenocarcinoma who underwent operative resection in centres associated with the Australian Pancreatic Cancer Genome Initiative.

Results:

The median age of the cohort was 67 years. Overall only 47% of all patients received adjuvant therapy. Patients who received adjuvant chemotherapy were predominantly younger, had later stage disease, more lymph node involvement and more evidence of perineural invasion than the group that did not receive adjuvant treatment. Overall, adjuvant chemotherapy was associated with prolonged survival (median 22.1 vs 15.8 months; P<0.0001). Older patients (aged ⩾70) were less likely to receive adjuvant chemotherapy (51.5% vs 29.8% P<0.0001). Older patients had a particularly poor outcome when adjuvant therapy was not delivered (median survival=13.1 months; HR 1.89, 95% CI: 1.27–2.78, P=0.002).

Conclusion:

Patients aged ⩾70 are less likely to receive adjuvant therapy although it is associated with improved outcome. Increased use of adjuvant therapy in older individuals is encouraged as they constitute a large proportion of patients with pancreatic cancer.     

胃癌辅助化疗的研究进展

胃癌一直是肿瘤死亡的主要原因,手术根治性切除是治愈的唯一手段。胃癌辅助化疗是在根治性手术后减少局部和远处复发的方法。许多Ⅲ期临床研究试图证实辅助治疗的疗效,但至今仍没有确立标准的治疗方案。本文就辅助治疗在胃癌中的进展作一总结。     

Adjuvant chemotherapy in gastric cancer: 5-year results of a randomised study by the Italian Trials in Medical Oncology (ITMO) Group.

BACKGROUND: The aim of this study was to determine the efficacy of the EAP regimen (etoposide, adriamycin and cisplatin) followed by the Machover schedule (fluorouracil and folinic acid) given as adjuvant treatment to patients with poor prognostic factors (N+ or T3/4). PATIENTS AND METHODS: Before randomisation, the subjects were stratified on the basis of node involvement (N+ or N-) and the time from surgery to randomisation (< or = 21 days or > 22 days). The surgical procedures for sub-total or total gastrectomy with D2 dissection were standardised among the participating centres. RESULTS: Between December 1992 and December 1997, 274 patients were enrolled: 137 in the treatment arm and 137 in the control arm. The majority of the patients (90%) were N+. After a median follow up of 66 months (range 2-83), the 5-year overall survival (OS) was 52% in the treatment arm and 48% in the control arm [hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.65-1.34]; the 5-year disease-free survival (DFS) was 49% and 44%, respectively (HR: 0.83; 95% CI 0.59-1.17). Among the patients with N-/N+ (1-6), the 5-year OS was 61% in the treatment group and 60% in the control group; in those with N+ (1-6), it was 42% and 22%. The treatment was completed by 87% of patients. Drug-related grade 3/4 WHO toxicities included leukopenia (21%), nausea and vomiting (14%), mucositis (9%), neutropenia (3%) and thrombocytopenia (2%). There were two deaths due to sepsis. CONCLUSIONS: Although our results are not statistically significant, there was a limited relative risk reduction in the patients receiving adjuvant therapy (17% in DFS and 7% in OS). The data suggest that D2 surgery may have a favourable impact on OS.     

Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer

BACKGROUND AND OBJECTIVES: We analyzed in a retrospective analysis whether adjuvant chemotherapy with mitomycin (MMC) alone or with Tegafur (TG) is associated with long-term survival benefit in resected gastric cancer. Other prognostic factors are compared. METHODS: From 1977 to 1998, 314 consecutive totally resected gastric adenocarcinoma patients have been included in a survival study. In 151 patients no adjuvant therapy was given. In 163 patients, four courses of adjuvant chemotherapy was given, 109 of them with MMC, 10-20 mg/m(2) i.v. every 6 weeks and the other 54 with MMC plus TG, 500 mg/m(2) p.o. day for 42 consecutive days. Univariate and multivariate survival analyses were performed. RESULTS: Survival benefit was seen in patients who had received adjuvant chemotherapy compared with the controls (52% vs. 30% alive at the end of the study, relative risk = 0.46, 95% CI: 0.33-0.62, P < 0.0001), women (52% vs. 35%, RR = 0.83, 95% CI: 0.71-0.98, P = 0.0342) and increment of staging IB, II, IIIA, or IIIB (80, 56, 24 vs. 13%, respectively, RR = 1.83, 95% CI: 1.42-2.35, P < 0.0001). Better prognosis of node-negative patients was observed only in univariate analysis. CONCLUSIONS: After curative surgery, adjuvant chemotherapy with mitomycin C, both alone or combined with Tegafur, improved the long-term cure rate over no postoperative chemotherapy in locally advanced gastric cancer patients. This benefit was not influenced by other prognostic factors.     

Adjuvant chemotherapy for bladder cancer

Radical cystectomy is a standard treatment for patients with muscle-invasive bladder cancer. The presence of occult micrometastatic disease is responsible for both local and distant failure after radical surgery. Postoperative administration of chemotherapy in bladder cancer patients can theoretically give the same survival advantage demonstrated in patients with breast and colon cancer. Studies evaluating adjuvant chemotherapy in patients with pT3–pT4 and/or pN+ M0 disease have major deficiencies in terms of sample sizes, early stopping of patient entry, statistical analyses, reporting of results and drawing conclusions. A recent meta-analysis including all previously published randomized trials concludes that, currently, there is insufficient evidence to reliably recommend adjuvant chemotherapy. The results of appropriately sized randomized trials are needed before any definitive conclusions can be drawn.     

603例胃癌根治术的预后因素分析

背景与目的：胃癌在消化道肿瘤的发病率中居首位,总体疗效尚不理想,因此本研究对胃癌患者预后的影响因素做一分析。方法：回顾性分析我院603例行根治性切除术的胃癌患者的临床和病理资料,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：性别和年龄对胃癌的预后无显著影响（P〉0.05）。胃癌的组织学类型、大体分型（Borrmann分型）、肿瘤所处的部位、浸润深度和淋巴结转移度与胃癌的预后相关（P〈0.01）。胃癌的Cox模型多因素分析发现,胃癌的组织学分型、肿瘤所处的部位、浸润深度和淋巴结转移度是影响胃癌预后独立的危险因子。结论：影响胃癌预后的因素较多,以肿瘤的TNM分期与预后的关系最密切,其中淋巴结转移度对预后的影响比肿瘤浸润深度更大。     

胃癌术后辅助化疗前患者贫血发生情况的调查

目的探讨胃癌术后辅助化疗前患者贫血发生的危险因素、临床特点和发病规律。方法回顾性分析近1年住院接受辅助化疗胃癌患者的临床资料。统计贫血的发生率及贫血的发病程度，从单因素、多因素两个层面针对年龄、性别、临床分期、手术方式、病理组织类型、血清白蛋白水平等诸方面对贫血发生发展的影响进行分析。结果232例胃癌术后辅助化疗前患者，贫血发生率53．5％。单因素，分析：年龄≥60岁的贫血构成比显著高于年龄〈60岁的患者（P〈0．05）；女性患者贫血构成比显著高于男性患者（P〈0．05）；Ⅲ、Ⅳ期患者的贫血构成比明显高于Ⅰ、Ⅱ期患者（P〈0．05）；不同手术方式贫血发生率差异存在统计学意义（P〈0．05）；血清白蛋白水平低于35g／L的患者贫血发生率明显高于不低于35g／L的患者（P〈0．05）。Logistic多因素逐步回归分析表明年龄[比数比（OR）26．422，95％可信区间（CI）5．716～122．129]、血清白蛋白（OR4．987，95％CI1．840～13．514）、病理分期（OR4．590，95％CI1．488。14．163）、手术方式（OR9．440，95％CI2．313～38．535）是胃癌术后辅助化疗前患者合并贫血的独立危险因素。结论胃癌术后辅助化疗前贫血的发生与年龄、血清白蛋白、手术方式、分期等因素有相关性。高龄、营养不良、全胃切除、中晚期患者更易发生贫血。