原发性肝癌复发转移早期的检测方法及其评价

原发性肝癌（primary hepatocellular carcinoma，HCC）预后差，术后复发率高，临床上早期发现肝癌患者外周血微小转移灶的意义变得更为重大。综述了在寻找肝癌患者外周血癌细胞方面，由细胞学到免疫组织化学再到分子生物学的发展历程，特别是用RT-PCR检测外周血白蛋白mRNA、甲胎蛋白mRNA和黑色素瘤抗原mRNA对发现肝癌细胞早期微小转移有着重要的意义。     

手术切除治疗巨大原发性肝癌的预后因素分析

目的 研究巨大原发性肝癌患者手术切除治疗后的预后影响因素,寻找改善巨大原发性肝癌患者预后的方法。方法 回顾性分析69例手术切除治疗的巨大原发性肝癌患者的临床资料,采用Cox回归模型对16个可能与患者预后有关的因素进行统计学分析。结果 58例患者获得随访,随访患者的l、3、5年生存率分别为58.2％、31.4％和12.3％。单因素分析的结果显示,有无肝内转移、有无血管侵犯、肝硬化程度和是否行根治性切除与巨大原发性肝癌手术切除治疗后患者的预后有关（均P＜0.05）。Cox多因素回归分析的结果显示,肝硬化程度、有无肝内转移和是否行根治性切除是影响巨大原发性肝癌患者手术切除治疗后预后的独立因素（均P＜0.05）。结论 积极行手术切除是治疗巨大原发性肝癌的主要措施,其预后取决于是否伴有肝内转移、肝硬化程度和是否行根治性切除。     

原发性肝癌术后复发转移的防治

原发性肝癌手术切除后的复发转移一直是影响肝癌远期疗效的重要因素。辨别复发转移的类型、了解危险因素和选择合适方法对其进行预防及治疗是提高肝癌患者预后的关键。本文就原发性肝癌术后复发转移的预防、治疗等相关方面的进展做一综述。     

胃癌腹膜微转移检测及其与胃癌预后关系的研究进展

胃癌的腹膜转移和复发是影响胃癌患者预后的重要因素,早期诊断腹膜微转移对提高患者的生存及预后有重要意义。应用灵敏度高的检测方法,选择特异性高的标志物能提高胃癌腹膜微转移的检测率,在肿瘤的诊治以及提高胃癌患者的生存率提供帮助。     

胃癌腹膜微转移检测及其与胃癌预后关系的研究进展

胃癌的腹膜转移和复发是影响胃癌患者预后的重要因素,早期诊断腹膜微转移对提高患者的生存及预后有重要意义.应用灵敏度高的检测方法,选择特异性高的标志物能提高胃癌腹膜微转移的检测率,在肿瘤的诊治以及提高胃癌患者的生存率提供帮助.     

前哨淋巴结检测在非小细胞肺癌纵隔淋巴结清扫方式中的应用现状

非小细胞肺癌( NSC LC)手术淋巴结清扫的方式与患者的预后密切相关,精确评估区域淋巴结的转移及淋巴结清扫术的选择是患者预后的重要影响因素.尽早发现局部淋巴结微转移灶对肿瘤的临床分期以及据此制定合理的治疗方案有极重要的意义.前哨淋巴结(SLN)活检术在肿瘤隐匿性转移检测及分期方面的潜在价值引起了越来越多研究者的注意.     

原发性肝癌骨转移的相关预后因素分析及放疗效果

目的观察原发性肝癌骨转移的放疗效果，探讨相关预后因素。方法对105例原发性肝癌骨转移病例进行回顾性分析，所有病例的骨转移灶均行常规放疗，中位肿瘤剂量40．0Gy。对性别、肝功能状况、原发灶大小和数目、原发灶控制情况、有无手术切除、骨转移灶数目、骨转移时AFP水平、r-GT水平及骨转移时是否伴骨旁软组织和其他脏器转移等多项因素进行分析。运用Kaplan-Meier法进行生存分析，单因素分析采用Logrank法，多因素分析采用Cox回归模型。结果原发性肝癌骨转移患者1、2、3年生存率分别为21．9％、5．6％、4．2％，中位生存期6个月。肝内原发灶控制情况、有无手术、骨转移时AFP和r-GT水平、骨转移时是否伴骨旁软组织和其他脏器转移为独立预后因子（P值均〈0．05）。其余因素与生存率无明显相关。结论原发性肝癌骨转移患者经外照射后症状明显缓解，但远期疗效仍然很差。肝内原发灶控制情况、肝内原发灶有无手术切除、骨转移时AFP和r-GT的水平、骨转移灶旁软组织转移和其他脏器转移与预后有关。     

肝细胞肝癌肺转移的预后因素分析

目的探讨肝细胞肝癌(下称肝癌)肺转移患者的预后因素。方法对105例肝癌肺转移患者进行回顾性分析。患者年龄、性别、肝功能、血清AFP、γ-GT水平、肝内肿瘤情况及其治疗、肺转移灶情况及其治疗、肺外其它部位转移进行Cox回归模型单因素及多因素分析,寻找肝癌肺转移患者的预后影响因素;并对死亡原因进行统计分析;采用K ap lan-M e ier进行生存率分析,进行Log-rank组间生存率差异显著性的比较。结果肝内肿瘤大小、Ch ild-pugh分级、肝内肿瘤手术切除、γ-GT、肺转移同时伴有胸水以及肺转移灶的治疗对肝癌肺转移患者生存有明显影响。20.0%(16/80)因肺转移导致死亡,且全部为双肺多发性转移。66.2%(53/80)因肝内肿瘤进展导致肝衰竭死亡。诊断肝癌至死亡时间的均值为(684±68)天,中位值487天;发生肺转移后生存时间的均值为(264±28)天,中位值为179天。结论肝细胞肝癌肺转移患者绝大部分死于肝内肿瘤未控,积极控制肝内肿瘤有重要意义;肺多发性转移,应积极行肺动脉化疗。     

肝癌射频治疗后影像学特征研究进展

肝细胞肝癌是最常见的恶性肿瘤之一, 早期诊断、及时治疗以及定期随访是延长肝癌患者生存时间的关键。肝癌早期症状隐匿, 大多数肝硬化肝癌患者由于残肝功能不足及肝源短缺, 不能耐受手术切除及肝移植。目前以射频消融(radiofrequencyablation, RFA)为代表的微创伤介入治疗逐渐在肝癌治疗中占据重要角色。RFA利用热效应原理局部毁损瘤灶, 对周围正常组织损伤小, 安全性高, 是当今乃至今后小肝癌非手术治疗的主要方法。然而RFA治疗后肿瘤残留、复发是限制RFA临床应用最主要的因素, 影像学检查早期识别肿瘤局部残留是评估肿瘤患者预后及指导后期治疗的关键。本文总结RFA后治疗灶各种影像学特征, 旨在为临床提供恰当可信、准确的影像学依据。      

肝癌切除术时机的选择对原发性肝癌自发性破裂出血患者术后复发、腹腔转移及预后的影响

目的 探讨肝癌切除术时机的选择对原发性肝癌自发性破裂出血患者术后复发、腹腔转移及预后的影响.方法 回顾性分析68例原发性肝癌自发性破裂出血患者的病历资料.根据肝癌切除手术时机的选择不同将患者分为急诊手术组(n=28)和二期手术组(n=40).比较两组患者的围手术期指标,术后肝癌复发或腹腔转移情况及预后情况;并对可能影响患者术后复发或腹腔转移的因素进行分析.结果 急诊手术组的术中出血量、术中输血量均明显高于二期手术组,而总住院时间明显短于二期手术组,差异均有统计学意义(P﹤0.01);两组患者的手术时间比较,差异无统计学意义(P﹥0.05).两组患者的总生存率比较,差异无统计学意义(P﹥0.05);但急诊手术组患者的1年生存率明显高于二期手术组(78.5％vs 40.0％),差异有统计学意义(P﹤0.01).两组患者的术后复发率、腹腔转移率比较,差异均无统计学意义(P﹥0.05).COX回归分析结果显示,AFP水平(RR=2.05)、肿瘤直径(RR=2.46)是影响原发性肝癌自发性破裂出血患者术后复发或腹腔转移的独立危险因素(P﹤0.05).结论 行急诊手术治疗患者的短期预后优于行二期手术治疗的患者,二期肝切除手术治疗不会增加患者的术后复发率及腹腔转移率.AFP水平和肿瘤直径是原发性肝癌自发性破裂出血患者术后复发或腹腔转移的独立危险因素.     

恶性肿瘤细胞血循环微转移检测进展

恶性肿瘤是严重威胁人类健康的重要疾病之一,其致死的主要原因是肿瘤局部或区域的复发和远处转移。具有转移潜能的肿瘤细胞在术前或术时已脱离原发灶,以极少的数量转移到淋巴结、骨髓、血液或远处器官中,常规的检测手段却不能发现,称为肿瘤的微转移（micrometastasis）。肿瘤细胞血循环微转移是肿瘤远处器官转移的重要起始步骤。及时诊断肿瘤血循环微转移有助于治疗方案的选择及预后的判断。现就恶性肿瘤血循环微转移检测方法及目前研究进展作一综述。     

大肠癌微转移检测的研究进展

随着人们生活方式的改变大肠癌的发病率逐年上升,尽管外科技术和辅助治疗手段不断改进,但是患者总体预后仍较差,微转移是导致大肠癌术后复发、转移的主要原因,及时发现微转移对准确判断病情、制定合理治疗方案、提高患者生存期具有特殊的意义。随着医学检测手段的不断成熟和完善,大肠癌微转移的检测已经成为当今研究的热点。现主要对大肠癌微转移的检测方法、检测途径和标志物选择等方面的研究现状及进展进行介绍。     

pN0期食管鳞癌血液微转移检测的临床意义

目的探讨pN0期食管鳞癌的血液微转移临床意义及其对预后的影响。方法提取血液标本总RNA,将mRNA反转录成cDNA,然后用实时荧光定量RT—PCR技术检测血液标本MMP-7 mRNA和hTERT mRNA表达,计算样本的△△Ct值,对40例N0期食管癌患者分别进行术后3、6、12个月跟踪随访复查。结果血液微转移与年龄、性别、癌肿长度等因素无相关关系,但与组织分化等级和pTNM分期间存在相关关系。随访结果显示单纯观察肿瘤不同侵犯深度与肿瘤术后转移（复发）率无相关性;随访术后6个月及12个月,血液微转移与否与肿瘤转移（复发）率有相关性（P〈0．05）,其中血液微转移阳性患者术后12个月肿瘤转移（复发）概率是阴性患者的6．44倍（OR=6．440,95％CI为1．547～26．822）。结论食管鳞癌患者血液微转移检测对早期诊断及预后判断具有重要意义。     

原发性肝癌者外周血AFP mRNA的表达及其动态和意义

目的探讨AFP mRNA在原发性肝癌患者外周血的表达及其动态变化和临床意义.方法用巢式逆转录聚合酶链反应检测93例肝癌患者外周血AFP mRNA,并观察其中36例患者血AFP mRNA表达在治疗前后的动态变化.结果血AFP mRNA阳性率为52.7%(49/93),阳性率与肝癌临床分期、门静脉癌栓、肝外转移、癌灶大小、HBV感染和肝硬化程度密切相关,并和癌组织中AFP mRNA的表达水平密切相关(P＜0.05).随访结果显示,外周血AFP mRNA呈阳性的病例发生肝内外转移率显著高于阴性病例,癌灶缓解期明显短于阴性病例(P均＜0.05).联合全身化疗和免疫治疗可显著降低肝癌患者外周血AFP mRNA的阳性率.结论外周血AFP mRNA阳性表达是预示肝癌发生肝内外转移的重要标志.联合全身化学免疫治疗可显著降低血AFP mRNA阳性率,对预防肝癌细胞的血行播散、降低肝内外转移率和提高患者预后可能有积极作用.     

Tumor growth patterns and biological characteristics of early gastric carcinoma

Gastric cancer is a major malignant disease. The development of new diagnostic techniques and mass screening have led to increased detection rates of patients with early-stage gastric cancer in Japan. However, after curative resection of early gastric cancer, there are various types of recurrences, and residual occult disease and distant micrometastasis precede death. The growth and metastatic potential of cancer cells are closely related to the postoperative outcome, and patients at risk for cancer-related death after surgery have to be closely monitored to prevent tumor recurrence. The biological behavior of cancer cells should be determined in patients with early gastric cancer and with a less favorable prognosis to detect potential early recurrences in the liver. Two types of growth patterns have been found in early gastric cancer: the superficially spreading (Super) type and the penetrating (Pen) type, and the clinicopathological and biological characteristics of each type have been extensively determined. A subtype of the Pen-type gastric cancer, which is progressing expansively with complete destruction of the muscularis mucosae (Pen A type) has a less favorable prognosis due to early recurrences in the liver. These clinical cancer types are closely related to chromosomal instability in DNA aneuploidy and p53 overexpression, and vascular endothelial growth factor activation induced tumor angiogenesis, vascular invasion and hematogenous metastasis. Thus, patients with Pen-A-type cancer showing expansive tumor growth had a poorer postoperative outcome and a hematogenous-related recurrence of the cancer. Antiangiogenic approaches in a postoperative setting may prove to be effective in preventing tumor recurrence and improving the prognosis for these patients.     

Clinical evidence of breast cancer micrometastasis in the era of sentinel node biopsy

Sentinel node biopsy for early-stage breast cancer has been established as an excellent surgical and staging procedure developed to enhance the detection of minimal lymph node involvement such as micrometastases. Multisection and the proper use of immunohistochemical staining have led to the increased detection of micrometastases, and this has given rise to new questions about the treatment to be employed concerning micrometastasis. That is whether complete axillary lymph node dissection (ALND) and adjuvant systemic therapy are really required for patients with micrometastasis because of the low prevalence of nonsentinel lymph node metastasis. Some currently published case studies report that selected patients with micrometastases without further ALND would not suffer from a high incidence of regional recurrence. However, the long-term prognostic risk of systemic recurrence and local failure associated with residual axillary disease in the sentinel lymph node-positive patient electing for no further axillary surgery has not been defined. Numerous studies have investigated the impact of occult metastases, which may be regarded as micrometastases or a small tumor deposit. Although data from randomized controlled trials are lacking, these studies suggest that the prognosis of breast cancer patients with micrometastases should not be considered the same as that in truly node-negative patients. Patients with micrometastases should have some adjuvant systemic therapy. Ongoing randomized trials will provide prospective answers to the question of the optimal treatment for micrometastasis.     

Nobel genes improve accuracy in detection of peritoneal micro-metastasis of gastric cancer to decide indication for chemotherapy

Peritoneal metastasis is the most frequent form of recurrence for advanced gastric cancer. We previously performed a global analysis of the gene expression of gastric cancer cell lines established from peritoneal metastasis with cDNA microarray. One of the up-regulated genes is L-3 phosphoserine phosphatase (L3-PP). We have examined its potential as a novel marker for the detection of peritoneal micrometastasis of gastric cancer. L3-PP mRNA in peritoneal wash in 93 gastric cancer patients was quantified for comparison of carcinoembryonic antigen (CEA) mRNA by means of real-time RT-PCR to predict peritoneal recurrence. The quantity of L3-PP and CEA correlated with wall penetration. Eleven out of 18 cases with peritoneal dissemination were L3-PP+ (61% sensitivity). For three out of 18 cases of peritoneal dissemination, only L3-PP could detect micrometastasis of gastric cancer. Consequently, free cancer cells that cannot be detected by CEA mRNA could be detected using L3-PP mRNA. Although CEA alone was not sufficient, L3-PP and CEA in combination can attain a higher accuracy of detection.