小细胞肺癌的手术治疗

1962到1983年22年间共手术治疗小细胞肺癌50例,其中27例切除(包括4例姑息切除),1例手术死亡。手术切除后4例5年以上健在(其中3例10年健在)。剖胸探查者无5年健在病例。Ⅰ期患者的5年生存率为17.6％,10年生存率为11.8％;Ⅱ期无2年以上生存者;Ⅲ期仅1例10年以上健在。无淋巴结转移的预后优于有转移者。症状期超过半年者切除率甚低。凡术前病理已证实为小细胞未分化癌,尤其是中心型。不适于手术治疗。作者认为辅助放疗和化疗,确能延长患者的生存期,故根治术后皆应辅助放疗和化疗,以期提高疗效。     

非小细胞肺癌的手术治疗

我院自1960年至1983年24年间住院手术治疗非小细胞肺癌276例,其中鳞癌134例(48.6％),腺癌100例(36.2%)、大细胞癌20例(7.2%)、腺鳞癌3例(1.1％)和未定型癌19例(6.9%)。手术切除180例(包括6例死亡),切除率为65.2％。根治性切除163例中Ⅰ期114例(70％)、Ⅱ期42例(25.7％)和Ⅲ期7例(4.3％)。能评价疗效者157例,其5年生存率为42.5％,10年生存率29.4％。淋巴结无转移的5年生存率为47％,10年为35.4％;有转移的5年生存率为29.4%,10年为15％。Ⅰ期的5年生存率为48.4％,Ⅱ期为23.3％。不同病理类型的预后有较大区别,本组鳞癌的预后优于腺癌。癌瘤位于上叶或下叶对预后影响不明显,以中叶肺癌的预后为最差,手术标本支气管断端肉眼所见正常,但並微镜下见癌细胞者12例,半数术后良好,死于癌者亦未见残端复发癌。     

外科治疗小细胞肺癌109例报告

1961～1988年应用外科治疗小细胞肺癌109例。手术切除89例,剖胸探查20例,手术切除率81.7％,切除组1、3、5、10年生存率为64.4％、23.0％、19.5％、6.9％,剖胸探查组2年生存率10％,无1例活到3年。随意取1980～1982年非外科治疗小细胞肺癌41例对照,1年生存率9.8％,无1例活过2年。TNM分期5年生存率Ⅰ期75％、Ⅱ期23.3％、Ⅲ期5.9％、Ⅳ期0,证实外科治疗小细胞肺癌有一定疗效。外科切除结合其他治疗可取得更好效果。     

食管小细胞癌与小细胞肺癌凋亡生物学特性的研究

[目的]探讨原发性食管小细胞癌(primary esophageal small cell carcinoma,PESC)和小细胞肺癌(small cell lung carcinoma,SCLC)凋亡生物学特性。[方法]采用免疫组织化学SP法检测survivin,caspase-3,bcl-2,mtp53在PESC和SCLC中的表达。[结果]PESC和SCLC中survivin,caspase-3,bcl-2,mtp534种蛋白的阳性分布无统计学差异(P>0.05)。在PESC和SCLC survivin阴性组中,caspase-3阳性表达率分别为72.41%和62.07%,均明显高于survivin阳性组(30.00%和25.00%,P<0.05)。在这两种小细胞癌中,survivin与caspase-3表达呈负相关;bcl-2与mtp53的表达呈正相关;bcl-2与caspase-3或survivin之间无相关性。[结论]食管小细胞癌和小细胞肺癌的抗凋亡通路存在诸多相同之处,survivin,bcl-2和mtp53均参与了两种小细胞癌的发生发展。     

The Role of Surgical Resection in the Management of Small Cell Carcinoma of the Lung

To assess the role of surgical resection in the management ofsmall cell carcinoma of the lung, experience with 118 patientswho were treated between 1973 and 1985 was reviewed. Twenty-fivepatients underwent surgical resection followed by combinationchemotherapy in all except one. The remaining 93 pa tients weretreated by combined chemotherapy and radiation therapy. The 5-year survival rate for patients with stage I disease undergoingsurgical resection was 50.8%. For all 25 patients operated on,the 5-year survival rate was 30.7%. In the patients not operated on, only those with complete responsehad long-term survival, for whom the 5-year survival rate was11.9% We consider that surgical resection is definitely indicatedin patients with stage I disease. If the response to initialchemotherapy is very good, patients with stage 11 or T3N0M0disease also probably should receive resection. Patients withN2 disease are not candidates for resection, unless distantmetastases are controlled completely by intensive chemotherapy.     

肺小细胞癌的X线诊断

本文分析了260例肺小细胞癌临床X线表现,通常分为3种亚型:(1)肺门纵隔型(62％),为最常见的典型表现对称或一侧性肺门纵隔增大及肿块,(2)气道阻塞型(23％),肺门及纵隔变化轻而缺乏肿块,以肺炎或肺不张表现明显。(3)周边肿块型(15％),X线显示肺内结节或肿块,并且肺门纵隔早期转移。本组有10例为特殊表现类似纵隔肿瘤极易误诊,建议为第4亚型即纵隔肿瘤型。另外CT检查在显示支气管继发阻塞性改变方面优于常规X线检查,故对诊断有困难时推荐CT检查是有益的。     

小细胞肺癌内窥镜、病理学及免疫组织化学研究

 目的 研究218 例肺小细胞癌的纤维支气管镜、临床病理及免疫组织化学特征。方法 分析纤维支气管镜、病理特征并选择80 例作免疫组织化学观察。结果 纤维支气管镜检以不规则结节状隆起物和管腔狭窄最为常见。80 例免疫组织化学染色结果显示： CK69 例、EMA74例、NSE72 例、5-HT56 例呈阳性反应, 表明它们向上皮和神经内分泌方向分化。结论 肺小细胞癌向上皮和神经内分泌方向分化, 表明肺小细胞癌来自多能干细胞。     

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma(ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC,evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affectinglymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwenttransthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed.The χ2 test or Fisher’s exact test were used to detect factors related to lymph node metastasis. Univariate andmultivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females witha median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computedtomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients withcarcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumoursand 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph nodemetastases in the follow-up. The 5- and 10-year overall survival rates were 81.4% and 70.1%, respectively. Onlyhistologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph nodemetastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independentprognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade andpT category affected the presence of lymph node metastases and were independent prognostic factors for earlyESCC.     

药物治疗非小细胞肺癌新进展

近年来世界各地非小细胞肺癌（NSCLC的发病率一直呈上升趋势。据不完全统计,仅1998年的发病即已超过 60万人1。由于就诊时 90％的病例有肿瘤播散,化疗是不可缺少的治疗手段。但因其药物敏感性较低,疗效并不显著。90年代以前,初治有效率达15％的药物即可选用,故顺铂（DDP、异）环磷酰胺CTXIFO、长春碱类VLBVDS、鬼臼毒素类VP－16VM－26和丝裂霉素MMC等药物一直占主导地位2。以DDP 为主的化疗可将术后患者的5年生存率提高约5％、也可延长Ⅲ～Ⅳ期患者的生存时间,但不良反应较重1。…     

小细胞肺癌内科个体化治疗的临床研究

目的 探讨针对小细胞肺癌患者个体化治疗的临床疗效.方法 将小细胞肺癌患者100例随机分为对照组和观察组,每组各50例.对照组采用传统一线化疗方案进行治疗;观察组患者通过PCR检测患者体内各基因表型,针对性选择每个患者潜在的敏感化疗药物进行治疗.统计各组患者客观缓解率、疾病控制率、无进展生存时间、总生存时间和安全性分析.结果 与对照组相比,观察组患者总生存时间明显延长,其复发率较低.与对照组相比,观察组患者KPS评分明显较高.结论 通过检测与肿瘤药物相关的基因,可以指导临床针对性用药,从而避免无效化疗,减少患者痛苦,同时显著提高临床疗效.     

Surgical Treatment of Metastatic Renal Cell Carcinoma

The survivals of 174 patients who underwent nephrectomy forrenal cell carcinoma were analyzed to evaluate the influenceof the surgical treatment of metastases on their prognosis.For 34 of the 174 patients, surgical resections of the metastaseswere performed concurrently with nephrectomy. For 38 patients,44 surgical resections of metastases were performed in the follow-upperiod after nephrectomy. Apparently curative resections ofmetastases, at the time of nephrectomy or after nephrectomy,were significantly correlated with good survivals after surgery,irrespective of the number of metastatic foci. Aggressive surgicaltreatment was beneficial in patients with a longer tumor-freeperiod after nephrectomy or with stable disease for about sixmonths after surgical treatment, although this might simplybe a reflection of a longer natural disease course in this specificgroup of patients.     

Systemic Treatment of Small Cell Lung Cancer

Small cell lung cancer (SCLC) accounts for 20–25% of all lung cancer and is characterized by an aggressive clinical course with early dissemination and extremely high risk of recurrence. Chemotherapy has been the cornerstone of treatment, with high response rates including complete responses. Despite the sensitivity of this disease to cytotoxic drugs, the majority of patients will face recurrence and die of the disease within two years. For more than thirty years, investigators have conducted numerous trials using different drug regimens and schedules, as well as different therapeutic modalities. The combination of cyclophosphamide, doxorubicin (adriamycin) and vincristine (CAV) was one of the first widely accepted regimens for the treatment of SCLC. Later, CAV and its hybrids were replaced by the similarly effective but less toxic regimen of cisplatin and etoposide (PE). Clinical investigators have tried different approaches to improve the efficacy of these regimens, such as alternating CAV/PE; consolidation and maintenance therapy; intensive treatment with high-dose chemotherapy; increased frequency of drug administration; or high dose therapy with stem cell support — all with no definitive successes, leaving PE as the standard treatment for patients with SCLC. The recent arrival of new chemotherapy agents such as topotecan, irinotecan, and taxanes may represent a step forward in the treatment of this disease. The most promising regimen is the combination of irinotecan and cisplatin which, according to Japanese investigators, achieves a significantly better survival than standard PE. If validated by confirmatory trials, this combination could well become the new standard treatment for extensive chemotherapy-naïve SCLC. Biological agents are also being widely investigated, including vaccines, matrix metalloproteinase inhibitors, anti-sense therapy, and monoclonal antibodies. Advances in molecular biology will hopefully contribute to progress in the treatment of this lethal disease.     

Response of Small Cell Carcinoma of Pancreas to a Small Cell Lung Cancer Regimen: A Case Report

Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.