尿液中尿膀胱癌抗原和钙网蛋白联合检测对原发性膀胱癌的诊断价值

目的评价尿液中尿膀胱癌抗原（UBC）和钙网蛋白（CRT）联合检测对原发性膀胱癌的诊断价值。方法 76例膀胱癌患者、50例泌尿系统良性疾病患者均在膀胱镜检查前留取尿液,用ELISA法进行UBC、CRT定量检测,同时进行尿液中脱落细胞学检测。结果 UBC和CRT诊断膀胱癌的敏感性分别为89.47%和82.89%,高于脱落细胞学的51.32%（P〈0.05）;3种诊断方法对膀胱癌的诊断特异性分别为92.00%、78.00%和94.00%。联合检测UBC和CRT诊断膀胱癌的敏感性和特异性高达94.74%、94.00%。结论尿液中UBC和CRT是早期诊断膀胱癌较好的肿瘤标志物,而两者联合检测能进一步提高诊断效率。     

检测尿液中CA-50含量诊断膀胱癌的研究

目的　探讨检测尿液中CA -5 0含量诊断膀胱癌的价值。方法　搜集膀胱癌患者和健康体检者各 32例的尿液标本 ,采用IR MA法测定其中CA -5 0的含量。结果　 32例膀胱癌患者尿液中CA -5 0含量为 6 5 8± 5 4 2U/ml,32例正常对照组为 8 8± 5 1U/ml ,两者有非常显著性差异 (P <0 0 0 1)。Ⅲ级组CA -5 0含量较Ⅰ级组为高 (P <0 0 1)。以大于正常对照组尿液CA -5 0水平上限19 0U/ml为阳性临界值 ,检测尿CA -5 0水平诊断膀胱癌的灵敏度为 84 4(2 7/32 ) ,特异性为 96 9% (31/32 )。结论　尿液中CA -5 0含量检测方法简便 ,无创伤性 ,且具有较高的灵敏度和特异性 ,可作为膀胱癌的辅助诊断措施。     

Background Variables for the Patients with Invasive Bladder Cancer Suitable for Bladder-preserving Therapy

OBJECTIVE: The present study was undertaken to identify the patients suitable for bladder preservation by analysis of our data. METHODS: The subjects of this study were all 72 patients with T2-3N0M0 bladder cancer who underwent bladder-preserving therapy in our institute. The therapy involved intra-arterial chemotherapy with MTX and CDDP and concomitant radiotherapy. RESULTS: Of the evaluable 70 cases, complete response (CR) was confirmed in 57 cases (81.4%). Among 56 bladder preserved cases, 47 (83.9%) preserved their functioning bladder, and 9 underwent salvage radical cystectomy at the following period. The median follow-up was 45.3 months. The 5-year cause-specific survival rate was 81% and the 5-year overall survival rate was 66%. On the basis of the results of univariate analysis, variables contributing to CR were selected. In T2, tumor size of 3 cm was scored 1, whereas single tumor was scored 0 and multiple were scored 1. In T3, tumor size of 3 cm was scored 1, whereas G2 was scored 0 and G3 scored 1. The CR rates were 93.8, 92.6, and 62.9% for total scores of 0, 1, and 2, respectively (P = 0.003; score 0 or 1 versus 2). The overall survival rate was significantly higher in the former group (P = 0.003). CONCLUSION: Bladder-preserving therapy can be acceptable for cases of single T2N0M0 tumor with a size of 相似文献   

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Background: To investigate the impact of the lymph node ratio (LNR) on the prognosis of patients with locallyadvanced rectal cancer undergoing pre-operative chemoradiation. Methods: Clinicopathologic and follow up dataof 128 patients with stage III rectal cancer who underwent curative resection from 1996 to 2007 were reviewed.The patients were divided into two groups according to the lymph node ratio: LNR ≤0.2 (n=28), and >0.2 (n=100).Kaplan-Meier and the Cox proportional hazard regression models were used to evaluate the prognostic effectsaccording to LNR. Results: Median numbers of lymph nodes examined and lymph nodes involved by tumourwere 10.3 (range 2-28) and 5.8 (range 1-25), respectively, and the median LNR was 0.5 (range, 0-1.6). The 5-yearsurvival rate significantly differed by LNR (≤0.2, 69%; >0.2, 19%; Log-rank p value < 0.001). LNR was alsoa significant prognostic factor of survival adjusted for age, sex, post-operative chemotherapy, total number ofexamined lymph nodes, metastasis and local recurrence (≤0.2, HR=1; >0.2, HR=4.8, 95%CI=2.1-11.1) and asignificant predictor of local recurrence and distant metastasis during follow-up independently of total number ofexamined lymph node. Conclusions: Total number of examined lymph nodes and LNR were significant prognosticfactors for survival in patients with stage III rectal cancer undergoing pre-operative chemoradiotherapy.     

Lymph Node Ratio is an Independent Prognostic Factor in Node Positive Rectal Cancer Patients Treated with Preoperative Chemoradiotherapy Followed by Curative Resection

Background: The lymph node ratio (LNR) has been shown to be an important prognostic factor for colorectal cancer. However, studies focusing on the prognostic impact of LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection have been limited. The aim of this study was to investigate LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection. Materials and Methods: A total of 131 consecutive rectal cancer patients who underwentneoadjuvant CRT and total mesorectal excision were included in this study. Patients were divided into two groups according to the LNR (≤0.2 [n=86], >0.2 [n=45]) to evaluate the prognostic effect on overall survival (OS) and disease-free survival (DFS). Results: The median number of retrieved and metastatic lymph node (LN) was 14 (range 1-48) and 2 (range 1-10), respectively. The median LNR was 0.154 (range 0.04-1.0). In multivariate analysis, LNR was shown to be an independent prognostic factor for both overall survival (hazard ratio[HR]=3.778; 95% confidence interval [CI] 1.741-8.198; p=0.001) and disease-free survival (HR=3.637; 95%CI 1.838-7.195; p<0.001). Increased LNR was significantly associated with worse OS and DFS in patients with <12 harvested LNs, and as well as in those ≥12 harvested LNs (p<0.05). In addition, LNR had a prognostic impact on both OS and DFS in patients with N1 staging (p<0.001). Conclusions: LNR is an independent prognostic factor in ypN-positive rectal cancer patients, both in patients with <12 harvested LNs, and as well as in those≥12 harvested LNs. LNR provides better prognostic value than pN staging. Therefore, it should be used as an additional prognostic indicator in ypN-positive rectal cancer patients.     

Short-course Versus Long-course Preoperative Radiotherapy plus Delayed Surgery in the Treatment of Rectal Cancer: a Meta-analysis

Background: Short-course preoperative radiation (SCRT) with delayed surgery was found to increasepathologic complete response (pCR) rates in several trials. However, there was no clear answer on whetherSCRT or long-course chemo-radiotherapy (LCRT) is more effective. Therefore we conducted this meta-analysisto evaluate the safety and efficacy of SCRT versus LCRT, both with delayed surgery, for treatment of rectalcancer. Materials and Methods: The literature was searched from PubMed, EMBASE, Web of Science, CochraneLibrary and clinicaltrials.gov up to November, 2014. Quality of the randomized controlled trials (RCTs) wasevaluated according to the Cochrane’s risk of bias tool of RCT. The Grading of Recommendations Assessment,Development and Evaluation (GRADE) system was used to rate the level of evidence. Review Manager 5.3 wasemployed for statistical analysis. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.Results: Three RCTs, with a total of 357 rectal cancer patients, were included in this systematic review. Metaanalysisresults demonstrated there were no significantly differences in sphincter preservation rate, localrecurrence rate, grade 3~4 acute toxicity, R0 resection rate and downstaging rate. Compared with SCRT, LCRTwas associated with significant increase in the pCR rate [RR=0.49, 95%CI (0.31, 0.78), P=0.003]. Conclusions:In terms of sphincter preservation rate, local recurrence rate, grade 3~4 acute toxicity, R0 resection rate anddownstaging rate, SCRT with delayed surgery is as effective as LCRT with delayed surgery for management ofrectal cancer. LCRT significantly increased pCR rate compared with SCRT. Due to risk of bias and imprecision,further multi-center large sample RCTs were needed to confirm this conclusion.     

局部晚期直肠癌术前与术后同步放化疗的疗效比较

[目的]比较术前同步放化疗与术后同步放化疗对局部晚期中低位直肠癌的临床疗效和不良反应。[方法]收集100例局部晚期中低位直肠癌患者,50例行术前同步放化疗,同期50例先行根治术再行术后同步放化疗,比较两组的保肛率、局部复发率和生存率以及不良反应。[结果]术前同步放化疗的保肛率明显高于术后同步放化疗组,而局部复发率明显低于术后同步放化疗组（P〈0.05）,3、5年生存率两组间没有差别（P〉0.05）。[结论]局部晚期中低位直肠癌术前同步放化疗可以提高保肛率,降低局部复发率,值得临床推广。     

直肠癌及腹膜后肿瘤术中输尿管支架置入预防泌尿系并发症

目的：探讨在高手术难度直肠癌及腹膜后肿瘤术中联合膀胱镜下输尿管支架置入预防泌尿系并发症的临床价值。方法9例高手术难度直肠癌及腹膜后肿瘤患者手术前均在膀胱镜下行单侧或双侧输尿管支架置入,复发性直肠癌、新辅助放化疗后直肠癌、后腹膜肿瘤均行R0或R1切除,晚期直肠癌伴梗阻行R2切除。术后3个月门诊膀胱镜下取出支架。结果术中均未发生输尿管切断、损伤、误扎,膀胱损伤,术后均未发生尿瘘、输尿管狭窄等并发症。结论高手术难度直肠癌及腹膜后肿瘤术中先行膀胱镜下输尿管支架置入简单易行,且对于预防泌尿系并发症有重要意义。     

The Value of Preoperative CA 125 Levels in Prediction of Myometrial Invasion in Patients with Early-stage Endometrioidtype Endometrial Cancer

Aim: To evaluate the relationship between pre-operative CA-125 levels and myometrial invasion in patients with early-stage endometrioid-type endometrial cancer. Materials and Methods: Two-hundred and sixty patients were diagnosed with endometrial cancer between January 2007 and December 2012. Of these, 136 patients with stage 1 endometrioid histologic-type and documented pre-operative serum CA-125 levels were included in the study. Age, preoperative CA-125 level, histologic grade, surgical grade, and presence of deep myometrial invasion were recorded. Additionally, 16, 20, and 35 IU/ml cutoff values were used and compared to evaluate the relationship between pre-operative CA-125 levels and myometrial invasion. Results: The average serum CA-125 level was 35.4±36.7 in patients with deep myometrial invasion, and 21.5±35.8 in cases without deep myometrial invasion. The relationship between the presence of deep myometrial invasion and CA-125 cut-off values (16, 20, 35 IU/ml) was statistically significant, although the correlation was weak (p<0.05). When the relationship between 16, 20 and 35 IU/ml CA-125 cut-off values and the presence of deep myometrial invasion was studied, specifity and sensitivity values were identified as: 0.60-0.68 for 16 IU/ml; 0.73-0.48 for 20 IU/ml; and 0.89-0.33 for 35 IU/ml. The sensitivity of 16 IU/ml cut-off value was higher when compared to other values. Conclusions: This study demonstrates that preoperative serum CA-125 values maybe used as a predictive test in patients with early stage endometrioid-type endometrium cancer, and as a prognostic factor alone. Further studies should be conducted to identify different CA-125 cut-off values in patients with low risk endometrial cancer.     

Site-Specific Evaluation of Prognostic Factors on Survival in Iranian Colorectal Cancer Patients: A Competing Risks Survival Analysis

Background: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in differentparts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatmentapplication objectives. However, evaluation of these factors overall does not provide thorough understanding ofthe cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically,via a competing risks survival analysis with colon and rectum as competing causes of death. Methods: A total of1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard tosurvival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizingSTATA statistical software. Results: The results of univariate analysis showed that gender, body mass index(BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage weresignificantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind offirst treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumorgrade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and thekind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year andoverall adjusted survival of patients with rectal cancer was better than those of colon cancer. Conclusion: Basedon our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hiddenassociations which may not be revealed under general modeling.     

A Case-Control Study on the Etiology of Urinary Bladder Cancer in Istanbul,Turkey

Background: Urinary bladder cancer is the third leading cancer in male in Turkey. The incidence rates of bladdercancer are 13.0 and 2.1/ 100,000 for males and females, respectively, in Turkey. Smoking and occupation are themain causes of urinary bladder cancer. Our goal was to investigate the etiologic factors of urinary bladder cancer inour region to improve our preventive services. Methods: We conducted a hospital-based case-control study of patientswith bladder cancer and of controls drawn randomly from the acute non–urinary patients of three hospitals inIstanbul. Controls were matched for age, sex, and residence. Results: We interviewed 290 cases and 580 controls.Smoking and occupation were found to be related factors in urinary bladder cancer. Conclusion: Preventive measuresshould be planned regarding smoking and occupational factors for urinary bladder cancer in Turkey.     

可切除胃癌患者脉管侵犯的危险因素分析

目的分析可切除胃癌患者的临床病理特征,探讨其发生脉管转移的相关危险因素及对患者预后的影响。方法回顾性分析接受手术切除的1 077例Ⅰ~Ⅲ期胃癌患者资料,根据是否发生脉管转移分为LVI阳性组(672例)与LVI阴性组(405例)。Logistic单因素和多因素分析患者临床病理特征与LVI的关系。利用生存分析研究Ⅰ期胃癌患者脉管侵犯与生存率之间的关系。结果单因素分析结果显示,肿瘤大小、分化类型、浸润深度、淋巴结转移、TNM分期、Lauren分型、神经侵犯以及CEA、CA125、CA199的升高是发生脉管侵犯的危险因素(P<0.05)。多因素分析结果显示,肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高是发生脉管侵犯的独立风险因素。有脉管侵犯的Ⅰ期胃癌患者5年生存率明显低于无脉管侵犯的患者,两者差异有统计学意义(P<0.01)。结论肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高的胃癌患者更容易发生脉管侵犯。对于有可能发生脉管侵犯的Ⅰ期胃癌患者,应采取更积极的治疗手段。     

可切除胃癌患者脉管侵犯的危险因素分析

目的分析可切除胃癌患者的临床病理特征,探讨其发生脉管转移的相关危险因素及对患者预后的影响。方法回顾性分析接受手术切除的1 077例Ⅰ~Ⅲ期胃癌患者资料,根据是否发生脉管转移分为LVI阳性组(672例)与LVI阴性组(405例)。Logistic单因素和多因素分析患者临床病理特征与LVI的关系。利用生存分析研究Ⅰ期胃癌患者脉管侵犯与生存率之间的关系。结果单因素分析结果显示,肿瘤大小、分化类型、浸润深度、淋巴结转移、TNM分期、Lauren分型、神经侵犯以及CEA、CA125、CA199的升高是发生脉管侵犯的危险因素(P<0.05)。多因素分析结果显示,肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高是发生脉管侵犯的独立风险因素。有脉管侵犯的Ⅰ期胃癌患者5年生存率明显低于无脉管侵犯的患者,两者差异有统计学意义(P<0.01)。结论肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高的胃癌患者更容易发生脉管侵犯。对于有可能发生脉管侵犯的Ⅰ期胃癌患者,应采取更积极的治疗手段。     

Effect of Lymphangiogenesis and Lymphovascular Invasion on the Survival Pattern of Breast Cancer Patients

Background: Invasion of breast cancer cells into blood and lymphatic vessels is one of the most important steps for metastasis. In this study the prognostic relevance of lymphangiogenesis and lymphovascular invasion (LVI) in breast cancer patients was evaluated in terms of survival. Materials and Methods: This retrospective study concerned 518 breast cancer patients who were treated at Department of Surgical Oncology, Saroj Gupta Cancer Centre and Research Institute, Kolkata-700063, West Bengal, India, a reputed cancer centre and research institute of eastern India between January 2006 and December 2007. Results: The median overall survival and disease free survival of the patients were 60 months and 54 months respectively. As per Log-rank test, pooroverall as well as disease free survival pattern was observed for LVI positive patients as compared with LVI negative patients (p<0.01). Also poor overall as well as disease free survival pattern was observed for perineural invasion (PNI) positive patients as compared to PNI negative patients (p<0.01). Conclusions: From this study it is evident that LVI and PNI are strongly associated with outcome in terms of disease free as well as overall survival in breast cancer patients. Thus LVI and PNI constitute potential targets for treatment of breast cancer patients. We advocate incorporating their status into breast cancer staging systems.     

VMAT应用于局部晚期直肠癌术前同步放化疗的剂量学研究

[目的]比较局部晚期直肠癌术前静态调强放疗(IMRT)与动态容积调强放疗(VMAT)计划的剂量学差异.[方法]应用Pinnacle 9.0治疗计划系统分别对10例术前同步放化疗的直肠癌患者行IMRT和VMAT放疗计划设计,比较两种放疗技术的靶区剂量分布特点以及小肠、膀胱、双侧股骨头等危及器官的受照射剂量及体积.[结果]10例患者的靶区中位体积为2321.25cm3(2021.19cm3～2741.65cm3).IMRT和VMAT计划均能满足计划设计要求.VMAT与IMRT计划靶区的Dmax、Dmin、Dmean、V95％、V100％和V105％均无统计学差异,适形指数(CI)和均匀指数(HI)亦均无统计学差异(P=0.522,P=0.452).VMAT计划对小肠的保护较好,VMAT计划中小肠受量的Dmax、Dmean、V40及V50较IMRT计划均有明显下降(P=0.014,0.044,0.018和0.043).两组计划中膀胱及双侧股骨头受量的指标Dmax、Dmean、V50均未见统计学差异.VMAT计划的平均加速器跳数(MU)为507.220,IMRT计划为528.060(P=0.003).IMRT计划平均治疗时间390s,VMAT计划为157s (P＜0.001).[结论]VMAT计划具有降低总MU,缩短治疗时间及减少小肠受照射剂量的优势,但仍需要多中心、大样本的临床研究进一步证实.     

Ultrasonography and Computed Tomography for Management of Adnexal Masses in Iranian Patients with Suspected Ovarian Cancer: Results of a Prospective Study

Background: To determine and compare the accuracy of sonographic and computerized tomography (CT)scan assessments in distinguishing between benign and malignant adnexal masses in an under-studied populationof Iranian patients. Methods: Transabdominal sonography (TAS) and CT reports of 75 women with adnexalmasses (34 malignant, and 41 benign) who were consecutive operated patients at a tertiary gynecology cancercenter (Tehran, Iran) were examined. The sonography examinations were operated by a radiologist experiencedin the gynecologic oncology field. Biomarkers were determined in blood samples. For CT and TAS, to classifymasses as malignant or benign, receiver operating curves (ROC) were assessed and the areas under the curveswere compared. Results: For TAS the sensitivity, specificity, positive predictive value and negative predictivevalue were 91%, 68%, 71% and 90%, respectively. For CT scans the results were 85%, 56 %, 62% and 83%,respectively. The AUC of sonography assessment to diagnose malignancy was significantly higher than that ofCT scan (0.8 vs.0.71; p<0.05). Conclusion: TAS is a sensitive method for preoperative detection and staging ofsuspected ovarian cancer. Biomarkers and CT scan imaging add no additional findings for pre-operativecharacterization of ovarian masses.     

Optimisation of Radiation Therapy in Bladder Preservation Therapy for Patients With Clinical Stage T2N0M0 Bladder Cancer

AimsA novel bladder preservation therapy, the OMC (Osaka Medical College) regimen, which combines radiation therapy with balloon-occluded arterial infusion of anticancer agents, is a treatment option for patients with muscle-invasive bladder cancer (MIBC). We retrospectively analysed the effects of changes in radiation dose and irradiation field on treatment efficacy and adverse events.The purpose of this study is to use the results of this study to help determine a course of radiation therapy for bladder preservation therapy of cT2N0M0 MIBC.Materials and methodsWe examined 352 patients with clinical stage T2N0M0 (cT2N0M0) MIBC classified into the following groups based on the irradiation method: group A, the whole pelvis (50 Gy/25 fractions) + local bladder (10 Gy/5 fractions); group B, the small pelvis (50 Gy/25 fractions) + local bladder (10 Gy/5 fractions); group C, the whole pelvis (40 Gy/20 fractions) + local bladder (10 Gy/5 fractions).ResultsThe complete response rate, 3-year overall survival and progression-free survival rates in group A were 92.9%, 94.9% and 82.1%, respectively; in group B were 87.2%, 86.7% and 76.7%, respectively; and in group C were 95.2%, 92.6% and 71.1%, respectively. No significant differences between the groups were noted. The incidence of ≥grade 3 urinary tract and gastrointestinal toxicities were not significantly different among the groups (group A: 7.8%, 1.7%; B, 11.1%, 0%; C, 7.1%, 1.8%, respectively). The 3-year progression-free rates of the common iliac lymph node (CILN) region in patients who received whole-pelvis and small-pelvis irradiation were 99.0 and 89.0% (P < 0.01), respectively, with the latter group having significantly high lymph node recurrence in the CILN region.ConclusionsOur findings showed that the optimal radiation therapy for patients with cT2N0M0 MIBC undergoing the OMC regimen is whole-pelvis irradiation including the CILN region, with a total dose of 50 Gy/25 fractions.