胰腺癌:姑息性手术治疗(旁路术/切除术)

Objective:We compare the outcome of palliative pancreaticoduodenectomy and palliative surgical bypass in patients with advanced pancreatic carcinoma in our hospital. Recent published related articles are also reviewed. Methods:A respective analysis was performed comparing the perioperative parameters and outcome of 20 patients who underwent pancreaticoduodenectomy with a gross suspected cancer residue and 30 patients who underwent a surgical bypass, all of the patients were diagnosed as in advanced stages intra-operatively. Results:The two groups were comparable with patient characteristics, including age, gender, initial symptoms and concomitant major organ diseases. Tumors are similar in size and intra-operatively diagnosed as in advanced stages in both groups. All of the patients in the resection group were microscopically proved having cancer residue. One postoperative mortality occurred in the resection group (5%), zero in the bypass group (P ＞ 0.05). Overall complications were significantly higher in the resection group (30% vs. 0, P ＜ 0.01), including 2 patients developed Acute Respiratory Distress Syndrome (ARDS), zero in the bypass group (P ＜ 0.01); hemorrhage and transfusions in the resection group were much more than that in the bypass group (P ＜ 0.05). Hospital stay after resection was significantly longer than bypass (20 vs. 12 days, P ＜ 0.01). Hospital fee after resection was 4 times more than after bypass (median 61.500 vs. 15. 300 yuan, P ＜ 0.01). Survival was significantly longer after resection (median 12.2 vs. 7.1 months, P ＜ 0.01). Conclusion:Our results show that palliative resection in advanced pancreatic carcinoma lengthens the survival time of the patients, but this is paid for significantly higher complications than bypass.     

术前同期放化疗治疗肺上沟瘤的疗效分析

Objective: To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy (CT/RT)with radiotherapy (RT) alone in patients with superior sulcus lung tumor. Methods: Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups: twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy (navelbine 15-18 mg/m2 on the 1st and 8th day, cisplatin 60 mg/m2 on the 1 st day). Results: The rate of complete resection in the CT/RT group was significantly higher than that in the RT group (92.3% vs 80%, P ＜ 0.05). The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group (P ＜ 0.01, P ＜ 0.01). The incidences of grades Ⅲ-Ⅳ radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group (23.1% and 23.1% vs 6.7% and 0, P ＜ 0.01, P ＜ 0.01). Conclusion: Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new "standard treatment" for this malignant tumor.     

晚期恶性肿瘤血清VEGF含量测定的临床意义

Objective: To elucidate the clinical significance of serum vascular endothelial growth factor (VEGF) level in patients with advanced cancer. Methods: Enzyme linked immunosorbent assay (ELISA) was used to determine the serum VEGF concentration in 40 patients with advanced cancer [non-small cell lung cancer (NSCLC), esophageal cancer (EC) and nasopharyngeal carcinoma (NPC)] before and after chemotherapy and 10 healthy volunteers as control group. Results: The serum VEGF concentrations in 40 cases of advanced cancer patients were significantly higher than those of 10 healthy control cases [(477.07 ± 374.10 ) pg/mL vs (139.09 ± 133.41 ) pg/mL; P = 0.016]. The serum VEGF concentrations in patients with NSCLC, EC and NPC were (518.53 ± 378.99) pg/mL, (399.21 ± 393.69) pg/mL and (500.68 ± 348.48) pg/mL, respectively. The differences were all statistically significant as compared with healthy control group (P values were 0.011,0.044 and 0.019, respectively). The serum VEGF concentrations of the patients in response to chemotherapy was significantly lower than those of the same patients before they undergoing chemotherapy [(400.41 332.84) pg/mL vs (777.10 ± 666.01) pg/mL; P = 0.034]. Conclusion: The serum VEGF level might be a novel and promising tumor marker of advanced malignancies and a predictor of disease progression, prognosis and therapeutic efficacy.     

"Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P＜0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P＜0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

应用前列腺特异抗原筛查诊断前列腺癌的临床意义

Objective To evaluate the clinical significance of prostate-specific antigen(PSA)screening in early detection of prostate cancer in Chinese men.Methods PSA screening was performed in 8562 asymptomatic men who had been enrolled for health checkup and all were ≥50 years old.Prostate biopsy was recommended for those with a serum PSA level≥4.0 ng/ml.The pathological and clinical features of the patients with prostate cancer detected by the PSA screening were compared with that of 82 clinically diagnosed prostate cancer patients during the same period.Results Of the 8562 asymptomatic men,719 had PSA levels ≥4.0 ng/ml and biopsy was performed in 295 of them.Fifty-eight prostate cancers were detected.The biopsy rate was 41.0% and positive detection rate was 19.7%.The overall age distribution in the screening group and the clinical groups was not significantly different(P = 0.176).However,41.4%(24/58)of the patients in screening group were ＞75 years old,and significantly more than that in the clinical group(25.6%,P = 0.0491).The proportion of the patients with PSA levels ≥20 ng/ml in the screening group was significantly less than that in the patients of the clinical group(44.8% vs.75.6%,P = 0.0002).Whether in the patients whose age was ＞ 75 years old(P ＜ 0.05)or ≤75 years old (P = 0.0002),the patients in the screening group had significantly lower Gleason scores ＜ 7(60.3% vs.34.1%,P =0.002),more T1 or T2 tumor(87.9% vs.26.8%,P ＜0.0001)and more chance to receive radical prostatectomy(50.0% vs.18.3%,P ＜ 0.0001)than the patients in the clinical group did.However,the distributions of PSA levels at diagnosis and biopsy Gleason scores were not significantly different between the above mentioned two groups(P ＞ 0.05).Conclusion Prostate-specific antigen (PSA)screening is useful for early detection of prostate cancer in Chinese men aged ≥ 50 years.The patients detected by PSA screening usually show a lower PSA level,Gleason scores and early clinical stage disease,and have more chance for radical prostatectomy than the clinically diagnosed patients.     

思他宁在晚期胃肠道肿瘤患者合并恶性肠梗阻治疗中的应用

Objective:To investigate the effectiveness of stilarnin in malignant bowel obstruction (MBO) due to advanced gastrointestinal carcinoma patients.Methods:62 patients with MBO due to gastrointestinal carcinoma were randomly divided into two groups:routine therapy group (control group 30 patients) and stilamin group (32 patients).Stilamin group received routine therapy combined with stilamin (6 mg/d) by 24 hours continuous infusion for three to twelve days.The curative effectiveness was observed and compared between the two groups.Results:After treatment,the clinical symptoms of abdominal distention and abdominal pain were relieved significantly in stilamin group compared with the control group (84.4% vs 57.6%;P＜0.05).The exhaust of anus was more earlier (62.1% vs 25.6%;P＜0.05),and the average volume of gastrointestinal decompression reduced more rapidly in stilamin group compared with the control group [(216 ± 158) mL/d vs (522 184) mL/d;P＜0.001),smaller and less fluid-air in the intestinal and in the colon at the 81.3% of patients plain abdominal radiography were observed in stilamin group.Quality of life,evaluated with Kamofsky score (57 ± 7 vs 45 ± 9;P＜0.01),was improved significantly.Conclusion:The administration of stilamin,in combination with routine treatment can be very effective in the management of MBO.It can effectively relieve the symptoms of MBO and improve the quality of life in patients.     

经尿道膀胱肿瘤整块切除术治疗初发非肌层浸润性膀胱癌的安全性及疗效分析

Objective　To evaluate the safety and efficacy of transurethral en bloc resection of bladder tumor (ERBT) in the treatment of primary non-muscular invasive bladder cancer (NMIBC). Methods　The clinical data of 67 patients with primary NMIBC were analyzed retrospectively, including 31 cases of ERBT and 36 cases of TURBT. The operation time, hospital stay, indwelling catheter time, bladder muscle layer, bladder perforation, obturator nerve reflex and recurrence-free survival rate were compared between the two groups. Results　The operation time of ERBT group and TURBT group was (39.8±9.76) min vs. (30.4±8.25) min (P=0.001), the hospital stay was (3.6 ±1.0) days vs. (4.3 ±0.9) days (P=0.003), and the indwelling catheter time was (2.4 ±0.7) days vs. (2.8 ±0.6) days (P=0.010), respectively. The existence rate of bladder muscle layer in ERBT group was 96.8%, which was significantly higher than that in TURBT group (77.8%)(P=0.031). The incidence of intraoperative obturator nerve reflex in the ERBT group was 0%, which was significantly lower than that in the TURBT group (16.7%)(P=0.027). There was 1 case of bladder perforation in ERBT group and 4 cases in TURBT group, and there was no significant difference between the two groups (P=0.363). The 1-year recurrence-free survival rate (RFS) of the ERBT group was 88.7%, while that of the TURBT group was 82.5%, but the difference was not statistically significant (P=0.397). Conclusion　ERBT has shorter hospitalization time and catheter indwelling time, lower incidence of obturator nerve reflex, better safety and remarkable curative effect in patients with newly diagnosed NMIBC, which is worthy of clinical promotion.     

恩度肝动脉灌注联合介入化疗栓塞治疗中晚期肝癌的临床观察

Objective:To study the efficacy and safety of hepatic arterial infusion of Endostatin(YH-16,Endostar),combined with transcatheter arterial chemoembolization(TACE) on advanced hepatocellular carcinoma.Methods:Thirty patients with advanced hepatocellular carcinoma were enrolled in the study.The patients received hepatic arterial infusion of Endostar combined with TACE.The efficacy was evaluated strictly after 1-2 cycles according to RECIST criteria and the value of AFP;quality of life(QOL) was evaluated according to Karnofsky scores.Adverse effects were evaluated too.Results:29 cases' efficacy was evaluated among the total 30 cases.The KPS were significantly increased after the treatment(80.39 ± 8.37 vs 73.93 ± 9.22,P = 0.002).Compared with control group,the objective response rate(CR and PR) and the rate of AFP negative changed were significantly higher(P = 0.021,P = 0.046).The adverse effects were not obvious.Conclusion:The QOL and preliminary efficiency of patients of advanced hepatocellular carcinoma may be improved by hepatic arterial infusion of Endostar combined with TACE,the rate of AFP negative changed were significantly higher too,and there are little of adverse effects.It is worthy to clinical generalization and further clinical observation.     

Clinical Analysis of Bisphosphonates Treatment on Bone Metastases and Hypercalcemia of Malignancy in Advanced Solid Tumor

Objective:To evaluate the efficacy and toleration of bisphosphonates therapy in patients with bone metastases and hypercalcemia of malignancy in advanced solid tumor.Methods:Patients with histologically or cytologically confirmed cancer and hypercalcemia with bone metastases were designed to open treatment with either 4mg zoledronic acid or 90mg pamidronate.The primary efficacy parameters were pain scores(NRS),Corrected serum calcium(CSC)and CSC effective rate.The vital signs,biochemical and hematological parameters were determined.Results:Twenty patients were enrolled in this study,twelve patients in zoledronic acid group and eight in pamidronate group.Zoledronic acid and pamidronate significantly palliated pain.Pain scores were significantly lower at end-point after Zoledronic acid or pamidronate infusion(5.92 vs 3.25,P<0.01;6.13 vs 4.38,P<0.01,respectively).The mean CSC level decreased significantly after Zoledronic acid or pamidronate infusion from 12.86 to 10.28mg/dl and 13.19 to 10.36mg/dl respectively.The CSC effective rate was about 90% at 14 days after infusion in two groups.There was no statistical significance for all primary efficacy parameters in zoledronic acid group compared with pamidronate group.An adverse reaction was mild fever after pamidronate infusion and then completely reversible.Conclusion:Zoledronic acid and pamidronate disodium were well tolerated and effective for bone metastases and hypercalcemia of malignancy in advanced solid tumor.     

弥漫大B细胞淋巴瘤化疗耐药与细胞因子白细胞介素-6、-10水平的相关性

Objective To investigate the correlation between expression levels of serum cytokines IL-2,IL-6, IL-8, IL-10, TNF-α and IFN-γ in patients with diffuse large B-cell lymphoma(DLBCL) and chemotherapy resistance. Methods 30 cases of DLBCL patients with chemotherapy resistant, 30 cases of DLBCL patients with chemotherapy sensitive and 20 cases of healthy individuals as normal control group were enrolled. The levels of serum cytokines IL-2, IL-6, IL-8, IL-10, TNF-α and IFN-γbefore, during and after treatment in both DLBCL groups and normal control group were detected by ELISA assay. Results The expression level of serum IL-6 and IL-10 before treatment in DLBCL patients with chemotherapy resistance was significantly higher than that in DLBCL patients with chemotherapy sensitive and normal control group (P ＜ 0.05), however,that after treatment in DLBCL patients with chemotherapy resistance was significantly lower than that before treatment (P = 0.02, P = 0.015). The level of serum IL-6 and IL-10 in patients with DLBCL recurrence into drug resistance was higher than that during of remission (P = 0.004, P ＜0.001). Before treatment, the expression level of serum IL-6 in patients with Ⅲ-Ⅳ stage in chemotherapy resistant group was significantly higher than that in ones with Ⅰ - Ⅱ stage(P ＜0.05). Levels of IL-2, IL-8, TNF-α and IFN-γin chemotherapy resistant group, chemotherapy sensitive group and the normal control group were no differences (P ＞0.05).Conclusion The expression levels of the serum IL-6 and IL-10 were closely correlated with the chemotherapy efficacy of DLBCL, they may be involved in drug resistance of DLBCL.     

The influence of autologous cytokine-induced killer cell treatment on the objective efficacy and safety of gefitinib in advanced non-small cell lung cancer

Objective The aim of the study was to observe the influence of autologous cytokine-induced killer cell(CIK) treatment on the objective efficacy and safety of gefitinib in advanced non-small cell lung cancer(NSCLC).Methods Sixty-six patients with NSCLC received gefitinib as second-line treatment. They were randomly divided into 2 groups, and informed consent forms were signed before grouping. Gefitinib was administrated to the control group, and autologous CIK treatment was added to the observation group. The objective treatment and adverse reactions were evaluated in both groups. Results The objective response rate(ORR) and the disease control rate(DCR) of the observation group were slightly higher than those of the control group, although no statistical differences were found between the 2 groups(P > 0.05). The incidences of diarrhea, fatigue, anorexia, oral ulcers, and myelosuppression in the observation group were much lower than those in the control group(P < 0.05). However, there were no statistical differences between the incidences of skin rash, and liver and kidney toxicities(P > 0.05). Conclusion Autologous CIK in combination with gefitinib is effective as second-line treatment for advanced NSCLC, and can significantly reduce adverse reactions and improve the objective efficacy.     

“Three-Grade Criteria” of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the “Three- Grade Criteria” for radical resection of primary liver cancer （PLC） and to evaluate its clinical significance. METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade Ⅰ： complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ： on the basis of Grade Ⅰ, additional 4 requirements were added： （1） the tumor was not more than two in number; （2） no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; （3）no hilar lymph nodes metastases; （4）no extrahepatic metastases. Grade Ⅲ ： in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level （with positive AFP before surgery） within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups： Grade Ⅰ radical group, Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group, Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups. RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment （P〈0.01）. Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively （P〈0.01）. CONCLUSION The “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

Jinlong capsule decreases adverse reactions after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma

Objective The aim of this study was to analyze whether Jinlong capsule could decrease adverse reactions after transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma. Methods Eighty-two patients with hepatocellular carcinoma were randomly divided into the control group and experimental group. On the first day after TACE, the experimental group started receiving four Jinlong capsules orally three times daily, whereas the control group did not receive the treatment.Results The incidences of erythropenia and thrombocytopenia in the experimental group was lower than those in the control group(P = 0.040 and 0.033, respectively). The differences in serum levels of aminotransferase, albumin, potassium, and sodium between the two groups were significant(P = 0.034, 0.034, 0.013, and 0.044, respectively). The mean durations of stomachache and abdominal distension in the experimental group was significantly shorter than those in the control group(P = 0.004 and 0.021, respectively). However, there were no significant differences in the incidences of nausea, fever, and vomiting between the two groups(P = 0.490, 0.495, and 0.585, respectively). Conclusion The reduction in the incidence rate and duration of partial adverse reactions after TACE was observed in hepatocellular carcinoma patients treated with Jinlong capsule compared to untreated patients, suggesting possible beneficial effects exerted by Jinlong capsule on the reduction of TACE-induced liver damage, thereby improving liver function and, consequently, the quality of life.     

A multicenter,retrospective epidemiologic survey of the clinical features and management of bone metastatic disease in China

Background: Bone metastases are common in patients with advanced cancer. Bisphosphonates (BPs) could prevent or delay the development of skeleton-related events (SREs). The present study aimed to identify the clinical features of and treatment strategies for Chinese patients with bone metastases. Methods: Consecutive cancer patients who had bone metastases and received BP treatment were enrolled. A ques-tionnaire was developed to collect the patients’clinical data, as well as information on the diagnosis and manage-ment of bone metastases. Physicians’awareness of the guidelines and knowledge of the application of BP were also assessed. Results: A total of 3223 patients with lung cancer (36.5%), breast cancer (30.9%), prostate cancer (8.5%), and gas-trointestinal cancer (5.7%) were included in this study. The sites of bone metastases were the thoracic spine (56.0 %), lumbar spine (47.1%), ribs (32.6%), and pelvis (23.2%). The SRE frequency was the highest in patients with multiple myeloma (36.6%), followed by those with lung cancer (25.9%), breast cancer (20.2%), prostate cancer (18.2%), and gas-trointestinal cancer (17.3%). Irradiation to the bone was the most frequent SRE (58% in lung cancer patients, 45% in breast cancer patients, and 48% in prostate cancer patients). Our survey also showed that 45.5% of patients received BP within 3 months after their diagnosis of bone metastases, whereas the remaining 54.5% of patients did not receive BP treatment until at least 3 months after their diagnosis of bone metastases. The SRE frequency in the former group was significantly lower than that in the latter group (4.0% vs. 42.3%, P < 0.05). In patients with more than 6 months of continuous BP treatment, the mean time to the first SRE was significantly longer than that in patients with less than 6 months of continuous BP treatment (7.2 vs. 3.4 months, P < 0.05). In addition, 12.2% of the physicians were not aware of the efcacy of BP in preventing and delaying SRE. Only half (52.3%) of the physicians agreed that the BP treatment should persist for at least 6 months unless it was intolerable. Conclusions: Our study suggested that prompt and persistent BP treatment was associated with a reduced risk of SREs. However, our survey also revealed that the proper application of BP was not as common as expected in China.     

Evaluation of the safety and efficacy of glucocorticoid therapy for hyperbilirubinemia in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization

Objective The aim of this study was to analyze the safety and efficacy of glucocorticoid treatment for hyperbilirubinemia in patients with hepatocellular carcinoma(HCC)who have undergone transcatheter arterial chemoembolization(TACE).Methods We conducted a retrospective analysis of the clinical data of 198 patients with HCC who were admitted to The Fifth Medical Center of PLA General Hospital from June 2014 to August 2019 and underwent TACE therapy.The patients were divided into glucocorticoid(GCC)treatment group and control group.Standard liver-protecting procedures were used in both groups.The treatment group also received intravenous injections of methylprednisolone sodium succinate for 3–5 days.Reduction in bilirubin concentration,mean duration of hospitalization,and complications were compared between the two groups to investigate the safety and efficacy of GCCs for treatment of hyperbilirubinemia after TACE treatment.Results Bilirubin concentrations were significantly lower in the treatment group than in control group on days 3 and 5 after GCC/conventional liver-protecting treatment(P<0.05).The treatment group had significantly shorter durations of total post-surgery hospitalization,and recovery time than the control group(14.5±4.6 days vs.17.5±6.6 days,P<0.001;9.2±3.3 days vs.11.8±5.4 days,P=0.001;7.0±3.3 days vs.9.3±4.6 days,P<0.001).No GCC-associated complications were detected in the treatment group.Conclusion Short-term use of GCCs to treat hyperbilirubinemia in patients with HCC who have undergone TACE is safe and associated with rapid decline in bilirubin concentration and shorter hospital stay compared with patients who did not receive GCCs.     

大剂量维生素 C 在肿瘤患者应用的安全性观察

Objective Dynamic detection of urinary Livin mRNA expression in patients with bladder cancer before and after operation and its clinical value in early diagnosis of bladder cancer. Methods Urine of 30 patients with initially diagnosed BTCC was collected before operation and one week, one month, three months, six months and 18 months after operation. Urine of 30 healthy volunteers and 30 Non-urological cancer patients was collected. Expression of survivin mRNA in urine exfoliated cells was detected by real-time PCR. Results Livin mRNA was highly expressed in the urine of 30 patients before operation, and the relative copy number was (96.33±35.79), and the expression level increased with the clinical stage and grade of the tumor from low to high; 2 of 30 patients in the control group showed high expression, the relative copy number was 43.17 and 47.52, the other was low expression, and the expression level was low. The copy number was (16.25±7.81); 30 cases in normal group were low expression, and the relative copy number was (13.74±1.57). The expression of Livin mRNA in urine of the case group was significantly higher than that of the control group and the normal group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the control group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the normal group (P<0.05); there was no significant difference between the control group and the normal group (P>0.05). Follow-up to 18 months after surgery, 5 patients with recurrence before reoperation (98.27±26.55) and 6 months after the initial operation were significantly different (P<0.05). Conclusion Dynamic detection of urinary Livin mRNA expression with high specificity and sensitivity can be used as an important noninvasive marker for early diagnosis of bladder cancer.     

Prospective,single-center cohort study analyzing the efcacy of complete laparoscopic resection on recurrent hepatocellular carcinoma

Background: Laparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). How?ever, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efcacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence. Methods: We conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31)underwent laparoscopic hepatectomy, and the control group (n tion time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient= 33) underwent conventional open surgery. Opera?could walk, anal exsufation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse?free survival was compared between the two groups. Results: All surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differencesbetween the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraopera?tive blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6vs. 2.2 ± 0.8 days, P < 0.05), anal exsufation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days,P= 0.014). During the 1?year postoperative follow?up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse?free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recur?rence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was signifi?cantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence. Conclusions: For the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraop?erative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.     

维吾尔族和汉族局部晚期子宫颈癌患者治疗前后血清VEGF的变化及意义

Objective To determine the change of serum vascular endothelial growth factor (sVEGF) in Han and Uighur patients with locally advanced cervical cancer before and after treatment, and to investigate its pathological and clinical significance. Methods sVEGF levels were detected by ELISA in 44 patients with stage IIb-IV a cervical cancer before and after treatment. sVEGF levels were also measured in 22 healthy subjects as controls. Group t test and paired t test were used for analysis. Results sVEGF level [(745.78 ± 321. 20) ng/L] in patients before treatment was significantly higher than that in healthy controls [(169.79 ± 123. 17)ng/L, P < 0. 001]. sVEGF level in patients before treatment was associated with FIGO stage, lymph node metastasis at diagnosis, tumor size and recurrence status (all P < 0.05), but not associated with the ethnic background, age, menopausal status, histological types and degree of differentiation (all P > 0.05). sVEGF level before treatment [(745.78 ± 321. 20) ng/L] was significantly higher than that after treatment [(361. 12 ±307. 32) ng/L,P <0. 001]. For patients in CR + PR who were sensitive to treatment, including to radiotherapy or concurrent radiochenotherapy sVEGF level decreased significantly after treatment (P <0. 001); while for those in NC and PD who were resistant to treatment sVEGF level was not significantly changed (P > 0.05). The reduction of sVEGF level was more marked in patients with concurrent radiochemotherapy [(470.65±281. 33)ng/L] than that in patients with radiotherapy alone [(316. 84 ± 186.71)ng/L,P<0.05]. Conclusion The change of serum VEGF may be an effective indicator to predict the therapeutic efficacy for patients with locally advanced cervical cancer. sVEGF level decreases more in patients with concurrent radiochemotherapy than in those with radiotherapy alone.     

Correlation of prothrombin time with clinicopathological features and prognosis of patients with osteosarcoma北大核心CSCD

Objective: To investigate the correlation of prothrombin time (PT) with clinicopathological features and prognosis of the patients with osteosarcoma. Methods: The activated partial thromboplastin time (APTT), PT, fibrinogen (FIB) and D-dimer in peripheral blood of 111 patients with osteosarcoma and 35 concurrent healthy volunteers (as the control) from May 2011 to May 2018 were tested. The correlation of PT with clinicopathological features and prognosis of the patients with osteosarcoma was analyzed. Results: The median survival time of 111 patients with osteosarcoma was 25 months, and the one-and two-year survival rates were 76.6% and 51.4%, respectively. The levels of D-dimer and FIB in the patients with osteosarcoma were higher than those in the control group (both P < 0.01), and the PT was shorter than that in the control group (P < 0.01), while the APTT was not statistical different between these two groups (P > 0.05). The PT was longer in the patients with osteosarcoma younger than 20 years old (P = 0.002), while PT had no correlation with gender, tumor size, clinical stage, tumor location and metastatic status (all P> 0.05). The overall survival time of the patients with osteosarcoma in PT ≥ 10.4 s group was shorter than that in PT < 10.4 s group (P = 0.024), the progression-free survival time of the patients with osteosarcoma had no significant difference between these two groups (P= 0.594). The overall survival time and progression-free survival time of the patients with osteosarcoma in metastasis group were shorter than those in non-metastasis group (both P< 0.001). The overall survival time (P= 0.004) and progression-free survival time (P= 0.013) of the patients with osteosarcoma in stage I / II group were longer than those in stage EI/IV group. The clinical stage, PT and metastasis status were related with the prognosis of patients with osteosarcoma (all P< 0.05). The PT and metastasis status were independent predictive factors for the prognosis of patients with osteosarcoma (both P < 0.05). Conclusion: The changes of PT may provide a reference for monitoring the condition and prognosis of patients with osteosarcoma. © 2019 by TUMOR. All rights reserved.     

Long-term outcomes after laparoscopic colectomy

AIM:To evaluate long-term outcomes in a large series of patients who randomly received laparoscopic or open colorectal resection.METHODS:From February 2000 to December 2004,six hundred sixty-two patients with colorectal disease were randomly assigned to laparoscopic(LPS,n = 330) or open(n = 332) colorectal resection.All patients were analyzed on an intention-to-treat basis.Long-term follow-up was carried out every 6 mo by office visits.In 526 cancer patients five-year overall and disease-free survival were evaluated.Median oncologic follow-up was 96 mo.RESULTS:Eight(4.2%) LPS group patients needed conversion to open surgery.Overall long-term morbidity rate was 7.6%(25/330) in the LPS vs 11.1%(37/332) in the open group(P = 0.17).In cancer patients,fiveyear overall survival was 68.6% in the LPS group and 64.0% in the Open group(P = 0.27).Excluding stage Ⅳ patients,five-year local and distant recurrence rates were 32.5% in the LPS group and 36.8% in the Open group(P = 0.36).Further,no difference in recurrence rate was found when patients were stratified according to cancer stage.CONCLUSION:LPS colorectal resection was associated with a slightly lower incidence of long-term complications than open surgery.No difference between groups was found in overall and disease-free survival rates.