我国食管癌放射治疗的进展

众所周知，食管癌是我国最常见的恶性肿瘤＊一，其死亡率为23．4／10万人．1980年调查，在恶性肿瘤死亡中，仅次于胃癌，排入第二，按性别分时：男性为第二，女性为第三．1996年排列在第四位，我国有些地区，食管癌发病特别高，如河南林县是世界上最高地区，其死亡率比全国平均数高10倍，是美国白人的100倍．食管癌的首选治疗是手术切除，但常常由于病期太晚，或由于内科原因，往往大多数的患者须进行放疗．化疗对食管癌尚无肯定的疗效．中国医学科学院肿瘤医院1958／1986共治疗食管癌9104例，其中单一手术947例（10．4％），术前放疗加手术…     

老年人食管癌三维适形放射治疗疗效分析

目的 探讨老年食管癌患者三维适形放射治疗(放疗)的疗效及其预后相关因素.方法 回顾性分析2001年1月至2007年8月在我院接受三维适形放疗的89例65岁及以上老年食管癌患者的临床资料,分析生存率及预后的影响因素. 结果 全组1、2、3和4年局部无复发生存率分别为65.2%、43.0%、27.3%和22.3%.全组1、2、3和4年生存率分别为68.5%、48.8%、36.8%和25.2%,中位生存期21.5个月.单因素分析显示影响预后的因素有:放疗前进食情况(χ~2=6.26,P=0.012)、T分期(χ~2=8.80,P=0.003)、N分期(χ~2=4.33.P=0.038)、临床分期(χ~2=7.88,P=0.005)、CT显示瘤体最大直径(χ~2=10.88,P=0.004)、近期疗效(χ~2=5.28,P=0.022)、化疗(χ~2=5.49,P=0.019);而性别(χ~2=0.74,P=0.390)、年龄(χ~2=1.89,P=0.170)、食管造影显示病变长度(χ~2=2.38,P=0.123)、CT显示病变长度(χ~2=2.69,P=0.101)、原发肿瘤部位(χ~2=2.12,P=0.146)、并存症(χ~2=0.03.P=0.874)、照射方式(χ~2=0.04.P=0.847)和放疗剂量(χ~2=0.24,P=0.627)与预后无关.Cox多因素分析显示治疗前进食情况(P=0.002)、临床分期(P=0.007)和化疗(P=0.011)为独立的预后影响因素.89例中发生0、1、2、3级急性期放射性食管炎分别为20、30、32、7例.发生0、1、2、3和5级急性放射性肺炎分别为57、20、8、2和2例.至随访结束已死亡60例,死于局部复发或病情未控制29例(48.4%)、死于远处转移11例(18.3%)、死于局部复发伴远处转移者5例(8.3%),其他原因死亡15例(25.0%). 结论 老年食管癌患者三维适形放疗是安全有效的,放疗前进食梗阻轻、临床分期早,三维适形放疗预后好;反之预后差.联合化疗可以提高放疗疗效.     

后程加速超分割三维适形放射治疗食管癌的临床观察

目的 观察后程加速超分割三维适形放疗(3 DCRT)对食管癌的近远期疗效、不良反应及失败原因.方法 将126例食管鳞癌患者随机分至后程加速超分割三维适形放疗组(后超组)和后程常规分割一维适彤放疗组(对照组).放疗方法 :两组前2/3疗程均为普通模拟机定位常规放疗40Gy,后1/3疗程后超组改为CT模拟定位加速超分割三维适形放疗(1.5Gy/次,24～30Gy,总剂量64～70Gy,36～40次,全疗程38～42 d);对照组常规分割三维适形放疗至上述相当剂量.结果 后超组和对照组5年生存率分别为34%和15%,后超组生存率显著高于对照组(P=0.029).后超组中位复发时间也显著长于对照组(11.0、7.0个月,P<0.01).3、4、5年无瘤生存率分别为36%、34%、32%和19%、16%、15%,后超组无瘤生存率均显著高于对照组(P值均<0.05).后超组和对照组1、2、3、4、5年局部控制率分别为78%、74%、64%、62%、61%和59%、38%、30%、28%、26%.后超组局部控制率均显著高于对照组(P值均<0.05).Cox回归分析显示颈段、胸上段食管癌的疗效明显优于胸中段、胸下段食管癌,蕈伞型优于其他类型(P值均<0.01).结论 常规放疗后进行后程加速超分割三维适形放疗可作为颈段、胸上段和蕈伞型食管癌的首选方法 之一,它可提高局部控制率和远期生存率,且不会明显增加反应.     

慢性重型肝炎患者的预后因素分析及预后模型的建立

目的研究影响慢性重型肝炎预后的各种因素，建立预后判断模型。方法选择1998年12月至2003年10月住院确诊为慢性重型肝炎的385例患者的临床指标和随访资料，用Cox比例风险模型进行单因素和多因素分析，建立生存模型。用独立的临床肝病资料进行验证，评价模型判断能力。结果本组慢性重型肝炎患者的中位生存时间为47d，1、3、6个月的生存率分别为66．2％、32．9％、26．9％，1、3年生存率分别为22．9％、17．7％。Cox回归分析结果显示年龄、肝性脑病、总胆红素和凝血酶原活动度是独立影响预后的因素。84例独立样本的验证结果显示模型可以准确地预测3个月的生存情况。结论本预后判断模型对评估慢性重型肝炎患者的预后及指导临床选择治疗方法有一定价值。     

影响重型肝炎患者预后的危险因素研究

目的 研究影响重型肝炎患者预后的危险因素。方法收集75例重型肝炎患者（存活组39例,死亡组36例）28项临床指标,采用Cox比例风险模型研究影响重型肝炎患者生存的危险因素与生存状态及生存时间的综合性量化关系。结果白细胞、血小板、总胆红素、碱性磷酸酶、胆固醇、凝血酶原活动度、透明质酸、肝性脑病、肝肾综合征、电解质紊乱、腹水、感染在存活组和死亡组之间差异有统计学意义（P〈0．05）。Cox模型分析显示,凝血酶原活动度、肝性脑病、感染是影响重型肝炎患者预后的主要危险因素（相对危险度分别为0．963、4．107、0．258,P〈0．05）。结论重型肝炎预后影响因素众多,凝血酶原活动度、肝性脑病和感染为主要危险因素,可望用于重型肝炎的预后判断。     

食管癌锁骨上淋巴结转移放射治疗111例分析

目的探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素．方法复习1984－09／1992－12收治初诊食管癌并锁骨上淋巴结转移111例，病变长度位于胸上段20例，胸中段82例，胸下段9例；锁骨上淋巴结单侧转移90例，双侧转移21例；病理诊断98例，余13例为临床诊断．全部采用钻-60外照射，食管DT60GY～66GY，锁骨上健侧照射50GY，患侧60GY—66GY．结果治疗后的一、三、五年生存率分别为49．6％，10．8％，6．3％．病变长度＜5．0cm的5a生存率为15％，比＞5．1cm的疗效好（P＜0．05）．疗终X线表现为基本消失的5a生存率为12．5％，而部分消失的5a生存率为1．8％（P＜0．05）锁骨上淋巴结＞3cm的25例，均在3a内死亡．结论食管癌锁骨上淋巴结转移应积极治疗；病变长度食短，预后愈好；疗终X线表现为基本消失的预后较好；锁骨上淋巴结＜3cm的预后较好．     

75岁及以上老年人脉压与阿尔茨海默病危险的关系

老年人增大的脉压(PP)是动脉血管僵硬和广泛动脉粥样硬化的标志。中老年的PP已被证实与心脑血管事件显著相关。该文通过对一平均随访6年的队列人群资料进行分析,旨在探讨老年人中PP对总痴呆症包括阿尔茨海默病(AD)发生的预测价值。 方法 对1270例年龄≥75岁未患痴呆症的老年人于1987年进行基线调查,测量两次坐位休     

食管癌的放射治疗和化学治疗

食管癌有早期扩散和转移的倾向,资料表明即使临床或手术认定为局限性癌肿者(T1～T3,N0～N1,M0)也有40%～75%已发生亚临床转移或邻近器官受累[1-3].单纯手术或放射治疗(放疗)虽可消除局部肿瘤,但复发率甚高,约40%～50%由于肿瘤位置高或瘤体过大不能根治,5年生存率仅6%～10%[2,6].单纯化学治疗(化疗)更有其局限性,不能达到根治目的.因此,以手术为核心的综合治疗是当前食管癌治疗的主流,而放疗和化疗占有重要地位.     

IA期非小细胞肺癌的肿瘤大小对其预后的影响

目的探讨IA非小细胞肺癌肿瘤的大小对预后的影响。方法回顾地分析自1995年1月至2003年12月．我院胸外科手术治疗IA非小细胞肺癌142例，Kaplan—Meier生存曲线统计不同肿瘤大小的生存率，并对其发病的年龄、性别、病理类型、肿瘤的大小、手术方式及是否接受放化疗进行Cox回归比例风险模型多因素分析。结果全组病变≤2．0cm60例．2．1～3．0cm 82例。全组3年生存率为80．53％；5年生存率为64．50％。其中病变≤2．0cm5年生存率为88．00％和74．09％．病变2．1～3．0cm为74．79％和57．14％。单因素分析及多因素分析，肿瘤的大小均为独立的预后因素。结论肿瘤大小作为IA期非小细胞肺癌的独立预后因素，要求我们要进一步提高影像学的诊断水平．使病人获得更早期的治疗。     

中药加放射治疗300例食管癌

目的中草药加放射治疗与单纯放射治疗中晚期食管癌效果比较.方法应用中草药(党参、白术、黄芪、山豆根、半枝连、白花蛇舌草等14味中药)加60钴放射治疗150例中晚期食管癌与同期单纯60钴放射治疗150例中晚期食管癌的治疗效果进行比较分析.其中放射治疗配合中草药组男86例,女64例,平均年龄51.5岁;食管癌中段癌91例,上段癌31例,下段癌28例,在放疗同时煎服中药,早晚各一次,直到放疗结束.单纯放射治疗组男92例,女58例,平均年龄53岁,食管中段癌95例,上段癌31例,下段癌24例.两组病变长度均为5cm～14cm,病理证实均为鳞癌.均采用60钴前一野垂直照射,后两斜野照射,前野6cm宽,后野5cm宽,长度按病长度上下各延长3cm～4cm,每周照射5次,周剂量10GY,总剂量62GY～70GY,治疗出院后对患者随访5a以上,随访率达91%,计算1,3,5年存活率进行比较分析.结果病例随访5a以上,随访率达90%,计算其1,3,5年存活率.中草药组与单纯放疗组的1年生存率分别为61.3%和54%(P>0.1),3年生存率分别为40.7%和23.3%(P<0.005),5年生存率分别为22%和12.7%(P<0.05).结论中草药加放射治疗食管癌的效果明显优于对照组.     

Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy

AIM: To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.METHODS: Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.RESULTS: Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P ＜ 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1,3 and 5 years was 48.28% (42/87), 19.54% (17/87)and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis.In patients whose serum TGFβ1 level decreased after RT,the survival rate at 1, 3 and 5 years was 61.02% (36/59),28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P ＜ 0.01).CONCLUSION: Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.     

器械吻合在胸中下段食管癌手术中应用231例

目的:总结胸中下段食管癌切除术后胸内食管胃端侧器械吻合的经验和体会.方法:使用国产WH-Y型胃肠吻合器对231例胸中下段食管癌患者进行胸内器械吻合.231例患者术前均经上消化道钡餐造影及纤维胃镜病理检查明确诊断为食管鳞癌.其中胸中段食管癌51例,下段食管癌180例.病变长度0.512cm.本文回顾性分析2005-01/2009-12食管癌患者231例的临床资料.结果:本组231例中,吻合口瘘3例,发生率1.30%(3/231),其中死亡1例,为术后4d出现吻合口瘘.余2例为术后10d出现吻合口瘘,均经通畅引流、营养支持等内科保守治疗治愈.术后4w发生吻合口狭窄2.16%(3/231),均予以胃镜下球囊扩张后治愈.本组手术平均耗时160min,出血平均为500mL,术后平均住院15d.术后随访207例,1、3、5年生存率为53.1%、27.5%、18.4%.结论:应用器械吻合行胸内食管胃端侧吻合术效果可靠,操作方便.     

Log-normal censored regression model detecting prognostic factors in gastric cancer: a study of 3018 cases

AIM:To investigate the efficiency of Cox proportional hazard model in detecting prognostic factors for gastric cancer.METHODS:We used the log-normal regression model to evaluate prognostic factors in gastric cancer and compared it with the Cox model.Three thousand and eighteen gastric cancer patients who received a gastrectomy between 1980 and 2004 were retrospectively evaluated.Clinic-pathological factors were included in a log-normal model as well as Cox model.The akaike information criterion (AIC) was em...     

肝细胞癌患者外科手术根治术后生存分析

目的 探讨肝细胞癌（HCC）患者行外科手术切除后5年生存情况的独立影响因素。方法 收集我院2008年10月~2010年10月收治的112例接受外科手术治疗的HCC患者的临床资料,行腹部CTA检查,观察患者相关临床指标,运用Cox风险比例回归模型进行单因素和多因素分析,得出独立影响因素,运用Kaplan-Meier 法和Log-Rank 检验比较这些因素在生存曲线分布上的变化情况。结果多因素Cox回归模型分析结果 显示,微血管浸润、肿瘤数目、肿瘤大小、肿瘤细胞分化程度和术后行肝动脉灌注化疗栓塞术（TACE）为影响此类患者生存情况的独立影响因素,其OR值分别为2.61、2.57、2.01、1.37、0.31,Kaplan-Meier 法和Log-Rank 检验显示38例TACE治疗组1 a、3 a、5 a累计生存率分别为90.6%、83.2%、80.5%,显著高于74例未行TACE治疗组的88.2%、41.5%、30.9%（P<0.05）。结论 肝癌根治术后给予TACE治疗可提高HCC患者生存率,延长生存期,有助于改善患者预后。     

食管癌术后呼吸机相关性肺炎23例病原体及耐药性分析

目的 调查重症监护病房（ICU）应用人工气道进行机械通气的食管癌患者伴呼吸机相关性肺炎（VAP）的致病菌群及探讨治疗对策。方法 对23例建立人工气道的机械通气伴VAP的食管癌患者痰培养分离出的54株致病菌进行分析。结果革兰阳性菌占18．52％。革兰阴性菌占74．07％，分别列前2位的是铜绿假单胞菌（29．63％）、不动杆菌属（25．93％）。所有革兰阴性菌对抗菌药物的耐药率呈上升趋势，革兰阳性菌以耐药金葡菌为主（40％）。结论 食管癌患者术后VAP的致病菌多为耐药菌，为避免耐药率的升高，临床需要合理使用抗生素并给予患者综合治疗。     

Prognostic and survival analysis of 837 Chinese colorectal cancer patients

AIM:To develop a prognostic model to predict survival of patients with colorectal cancer (CRC). METHODS:Survival data of 837 CRC patients undergoing surgery between 1996 and 2006 were collected and analyzed by univariate analysis and Cox proportional hazard regression model to reveal the prognostic factors for CRC. All data were recorded using a standard data form and analyzed using SPSS version 18.0 (SPSS, Chicago, IL, United States). Survival curves were calculated by the Kaplan-Meier method. The log rank test was used to assess differences in survival. Univariate hazard ratios and significant and independent predictors of disease-specific survival and were identified by Cox proportional hazard analysis. The stepwise procedure was set to a threshold of 0.05. Statistical significance was defined asP < 0.05. RESULTS:The survival rate was 74% at 3 years and 68% at 5 years. The results of univariate analysis suggested age, preoperative obstruction, serum carcinoembryonic antigen level at diagnosis, status of resection, tumor size, histological grade, pathological type, lymphovascular invasion, invasion of adjacent organs, and tumor node metastasis (TNM) staging were positive prognostic factors (P < 0.05). Lymph node ratio (LNR) was also a strong prognostic factor in stage Ⅲ CRC (P < 0.0001). We divided 341 stage Ⅲ patients into three groups according to LNR values (LNR1, LNR ≤ 0.33, n = 211; LNR2, LNR 0.34-0.66, n = 76; and LNR3, LNR ≥ 0.67, n = 54). Univariate analysis showed a significant statistical difference in 3-year survival among these groups:LNR1, 73%; LNR2, 55%; and LNR3, 42% (P < 0.0001). The multivariate analysis results showed that histological grade, depth of bowel wall invasion, and number of metastatic lymph nodes were the most important prognostic factors for CRC if we did not consider the interaction of the TNM staging system (P < 0.05). When the TNM staging was taken into account, histological grade lost its statistical significance, while the specific TNM staging system s     

Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.     

Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy

AIM To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.METHODS Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.RESULTS Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P ＜ 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1,3 and 5 years was 48.28% (42/87), 19.54% (17/87)and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis.In patients whose serum TGFβ1 level decreased after RT,the survival rate at 1, 3 and 5 years was 61.02% (36/59),28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P ＜ 0.01).CONCLUSION Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.