卵巢未成熟畸胎瘤53例临床分析

目的：通过分析卵巢未成熟畸胎瘤的临床特点及生物学行为,找出最佳治疗方案。方法：收集我院自１９８０年１月至１９９９年１０月住院治疗的卵巢未成熟畸胎瘤５３例,用生命表法计算生存率及平均缓解时间,并就术式、是否合并妊娠、复发瘤是否良性变等因素对预后的影响进行分析。结果：术后化疗开始时间是影响预后的主要因素（Ｐ＜０．０５）,合并妊娠或生育年龄女性发生的肿瘤预后较差（Ｐ＜０．０５）。复发瘤良性变的发生有助于患者获得长期缓解（Ｐ＜０．０５）。结论：卵巢未成熟畸胎瘤复发率高,复发瘤具有恶性程度逆转的特性,因此,治疗上应强调术后及时化疗。术式的选择可由年龄及临床期别而定;年轻及希望保留生育功能的１期患者可考虑保守性手术。     

卵巢未成熟畸胎瘤的治疗与预后因素的分析

目的：分析卵巢未成熟畸胎瘤的临床特征、组织成分及生物学行为，找出最佳治疗方案。方法：我院1980年1月——1999年10月住院诊治卵巢未成熟畸胎瘤53例，用生命表法计算生存率及平均缓解时间，并对瘤内组织成分、成熟畸胎瘤恶变、复发瘤良性变及化疗对预后的影响进行回顾性分析。结果：术后7天内化疗者，平均缓解时间最长（P＜0.05)；含有神经上皮成分的未成熟畸胎瘤预后较好（P＜0.05)；成熟畸胎瘤恶变中位发病年龄较未成熟畸胎瘤晚10年且预后差（P＜0.05)；复发瘤良性变的发生有助于患者获得长期缓解（P＜0.05)。结论：卵巢未成熟畸胎瘤术后即时（7天内）化疗是影响疗效的重要因素，瘤内含有神经上皮成分预后较好；成熟畸胎瘤具恶性变、未成熟畸胎瘤的复发瘤具有良性变的特性。因此对于卵巢未成熟畸胎瘤非常强调术后即时化疗，并应采取一切积极措施，保证患者生存，争取良性变的到来。     

喉癌病人外周血T淋巴细胞亚群的研究

目的研究喉癌病人外周血Ｔ淋巴细胞亚群的分布状况及其意义。方法测定喉癌病人的外周血Ｔ淋巴细胞亚群的分布，并进行了连续观察研究。结果喉癌Ⅰ－Ⅲ期较Ⅳ期外周血Ｔ淋巴细胞亚群ＣＤ３、ＣＤ４、ＣＤ８和ＣＤ４／ＣＤ８均有显著性差异（Ｐ＜０．０５）。声门上型与声门型外周血Ｔ淋巴细胞亚群无显著性差异（Ｐ＜０．０５）。鳞状细胞癌Ⅰ－Ⅱ级较Ⅲ－Ⅳ级外周血Ｔ淋巴细胞亚群有显著性差异（Ｐ＜０．０５）。病人术后半个月外周血ＣＤ８较术前显著下降（Ｐ＜０．０５）、而ＣＤ３、ＣＤ４、ＣＤ４／ＣＤ８均无显著性差异（Ｐ＜０．０５）；术后三个月、术后半年、术后二年较术前外周血Ｔ淋巴细胞亚群ＣＤ８、ＣＤ４／ＣＤ８有显著性差异（Ｐ＜０．０５），ＣＤ３、ＣＤ４无显著性差异（Ｐ＞０．０５）。本组术后复发、转移或带癌生存的病人不同时期外周血Ｔ淋巴细胞亚群无显著性差异（Ｐ＞０．０５）。术后一年时，无癌生存者与复发、转移或带癌生存者，外周血Ｔ淋巴细胞亚群均有显著性差异（Ｐ＜０．０５）。结论连续测定喉癌病人外周血Ｔ淋巴细胞亚群，对了解病人的免疫状态，监视复发和预后有较大的临床意义。     

宫颈低分化癌术后复发及转移规律分析

为了探讨宫颈低分化癌术后复发转移的规律,回顾性分析了以手术治疗为主的宫颈低分化癌（Ⅰ～Ⅱ期）１５８例的术后复发转移及其影响因素。结果发现,宫颈低分化癌术后２ａ复发率为３０．８％,中位复发时间为１１个月,盆腔复发率为４０．０％,远处转移率为３８．０％。治疗方法明显地影响术后复发转移。对于Ⅱ期或宫颈深肌层浸润的病例,手术结合化疗或放疗者的复发率较单纯手术组或手术＋化疗＋放疗三联疗法组低（Ｐ＜０．０５）;淋巴结阳性者术后加放疗可降低复发率（Ｐ＜０．０５）;手术加化疗可能对控制远处转移有益（Ｐ＜０．０５）。提示宫颈低分化癌术后的复发转移与临床期别、宫颈病灶浸润深度、淋巴结阳性、治疗方法及机体免疫力有关;术后适当的化疗或放疗有助于降低远处转移率及局部复发率。     

增殖细胞核抗原在卵巢癌中表达与淋巴结转移,预后的关系

目的探讨在卵巢上皮癌中增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ,ＰＣＮＡ）的表达及其与淋巴结转移、预后和二探术结果的关系。方法用单克隆抗ＰＣ１０抗体免疫组化染色石蜡包埋的卵巢癌组织。结果全部７４例原发肿瘤和其中３１例腹腔转移肿瘤标本均显示ＰＣＮＡ阳性。在３１例转移灶中,ＰＣＮＡ表达（７．４９）较同一患者的原发灶（６．８９）要明显增高。当两侧卵巢均累及时,ＰＣＮＡ表达亦较单侧卵巢癌高（Ｐ＜０．０４）。ＰＣＮＡ表达与淋巴结转移、临床分期、组织分级、亚型无关。２８例Ⅲ期患者行二探术,阴性二探术者原发灶平均免疫反应分数（７．５９）,较阳性二探术者（６．１０）显著增高（Ｐ＝０．０３）。经单因素分析,总的生存率与ＰＣＮＡ表达呈负相关,但经Ｃｏｘ模型多因素分析显示,独立的预后因素为首次减瘤术后残留肿瘤大小（Ｐ＜０．０１）和临床期别（Ｐ＜０．０５）,再次是ＰＣＮＡ的表达（Ｐ＝０．０９）。结论本研究显示ＰＣＮＡ表达水平具有一定指示预后的价值,但与淋巴结转移无关。     

Ⅰ期卵巢上皮癌的治疗研究——辅助放射治疗评价

为探讨放射治疗在Ⅰ期卵巢上皮癌中的作用，对１９７０年初至１９８９年底在中国医学科学院肿瘤医院住院治疗的９１例Ⅰ期卵巢上皮癌的临床资料进行回顾性分析。９１例患者中接受手术＋化疗者６０例，接受手术＋化疗＋放射治疗者３１例。两组间中位年龄、临床期别、病理分级、组织学类型、残存肿瘤情况、手术方式、化疗方案及化疗疗程数均有可比性。两组５年生存率分别为７２．４％和７８．３％（Ｐ＞０．０５），复发率分别为６０．６％和３２．２％（Ｐ＜０．０５），中位复发时间分别为１８．６个月和３４个月（Ｐ＜０．０５）。说明术后化疗后补充放射治疗能显著降低复发率，延长复发时间。     

卵巢成熟畸胎瘤鳞癌变预后与鳞癌抗原等肿瘤标记物的关系

目的：探讨卵巢成熟畸胎瘤鳞癌变组织中鳞状细胞癌抗原（ SccAg）表达及与其预后的关系。方法6例卵巢成熟畸胎瘤恶变病例，采用免疫组化方法，检测血清中肿瘤标记物水平变化，分析其与预后的关系。结果6例病例中，有3例为鳞癌变，其他3例为混合型恶变。3例鳞癌变组织中SccAg水平术后有反弹趋势，其预后差，复发率较高。结论对卵巢成熟畸胎瘤鳞癌变的患者，其术后肿瘤标记物SccAg的变化趋势对患者的预后判断有一定的临床意义。     

Ia、Ib期卵巢浸润性上皮癌术后辅加化疗的探讨

目的：为探索Ｉａ、Ｉｂ期上皮性卵巢癌术后辅助化疗是否能提高疗效。方法；对天津市医院自１９５４～１９９２年间收治的Ｉａ、Ｉｂ期上皮性卵巢浸润癌住院患者４４例进行回顾性分析。结果：包括低分化肿瘤在内的Ｉａ、Ｉｂ期铲巢癌术后单纯随方组与辅化组比较，２年复发率、５年级１０年生存率均无明显差异（Ｐ〉０．０５），并且术后化疗 能延长肿瘤复发时间（Ｐ〉０．０５）。结论：Ｉａ、Ｉｂ期卵巢癌术后无需化，可以单纯随访     

喉癌患者围手术期血清SIL－2R浓度的测定及其与预后的相关性研究

本文测定了３２例喉癌患者围手术期血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）的浓度。结果表明，喉癌组较对照组明显什高（Ｐ＜０．０１），在喉癌中，声门上型及混合型较声门型为高，临床ⅢⅣ刊期病变较ⅠⅡ期病变显著增高（Ｐ＜０．０５）。手术后１日较术前明显增高，至１０日则降至术前水平。部分病人术后１０日血清ｓＩＬ－２Ｒ持续增高，与术后１年内复发有明显相关性。     

绝经前乳癌患者手术时间和预后

乳腺是一个性器官。乳癌的发生，发展和预后和卵巢激素的关系十分密切。绝经前乳腺癌手术时机的选择影响其预后。在月经周期中的黄体早期实施手术和在非黄体早期手术者，术后局部复发率无差异；３、５年远处转移和生存率相似；１０年远处转移率黄体早期组低于非黄体早期组（Ｐ＜Ｄ．０５）；１０年生存率黄体早期组高于非黄体早期组（Ｐ＜０．０５）。提示：黄体早期是绝经前乳腺癌的优选手术时机。     

Immature teratomas: identification of patients at risk for malignant recurrence

We investigated the significance of immature elements in an otherwise benign teratoma in 28 patients with immature teratomas diagnosed and treated at the Childrens Hospital of Los Angeles from 1941 to 1986. Different characteristics, including age, sex, primary tumor site, type of surgery (complete resection vs. partial resection or biopsy), and preoperative levels of alpha-fetoprotein (AFP) were analyzed to evaluate their association with risk of subsequent local malignant recurrence. After a median follow-up of 6 years, 21 patients are alive with no recurrence of the tumor (72% event-free survival). One patient died from infection after surgery and six patients had local malignant tumor recurrence within 1 year from diagnosis. Of the 28 patients, 12 had AFP levels measured at diagnosis. Eight patients had normal levels with no further evidence of tumor recurrence, and four had elevated levels with three tumor recurrences. Our experience demonstrates that only at the time of diagnosis do AFP levels correlate with a subsequent malignant behavior of these tumors (P = .004). Those patients with immature teratomas and elevated AFP levels at diagnosis should receive adjuvant chemotherapy after the initial surgical resection.     

卵巢恶性混合型生殖细胞肿瘤诊断治疗分析（附18例）

目的：探讨卵巢恶性混合型生殖细胞肿瘤的临床特点、治疗及预后。方法：回顾我院1980年-2008年间18例卵巢混合性生殖细胞肿瘤病例资料,对诊断、治疗特点及预后进行回顾性研究。结果：发病年龄6-38岁,中位年龄20岁。腹痛、腹部包块、发热是常见症状。肿物多较大,平均直径15.7cm,病理包括2-3种生殖细胞成分混合,16例（88.9%）含有2种成分,2例（11.1%）含有3种成分。其中,卵黄囊瘤成分最多见,占83.3%,最常见的组合成份是未成熟畸胎瘤混合卵黄囊瘤（50%）。Ⅰ期9例（占50%）,Ⅱ期2例（占11.1%）,Ⅲ期7例（占38.9%）。Ⅰ-Ⅱ期病人5年生存率81.8%,Ⅲ期病人5年生存率42.9%,差异有显著性意义（P〈0.01）。保留生育功能手术12例,5年生存率75%。肿瘤细胞减灭术6例,5年生存率50%,两者差异无显著性意义。术后病人均进行化疗。在80年代及90年代初主要化疗方案是VAC方案（VCR＋KSM＋CTX）或PVC（PDD＋VCR＋CTX）方案,死亡率较高,5年生存率44.4%。1995年后主要是PVB/PVC＋PVB联合化疗方案,2例病人死亡,5年生存率66.7%。90年代末至今应用BEP方案（BLM＋VP-16＋PDD）,无一例死亡,5年生存率100%。结论：卵巢混合型恶性生殖细胞肿瘤患者腹痛、腹部包块是常见症状,病理类型多包括2-3种生殖细胞成分混合,卵黄囊瘤成分最多见,可以行保留生育功能手术,术后辅以规范的化疗是重要环节,化疗方案目前主要为BEP方案,有较高的5年生存率。     

门静脉泵灌注化疗预防肝癌术后复发的作用

目的 探讨门静脉泵灌注化疗对肝癌根治术后复发的预防作用.方法 193例肝癌患者行根治术后随机分为门静脉置泵组和对照组.门静脉置泵组行灌注化疗1年.两组分别追踪观察其术后复发情况.结果 门静脉置泵组术后1、2、3年复发率分别为10.9%、38.1%、51.7%,明显低于对照组的19.6%、47.8%、76.1%(P<0....     

Teratoma with malignant transformation in germ cell tumors in men

Pathology reports of over 580 male patients with germ cell tumors treated between 1972 and 1982 were screened for teratomas in which malignant transformation was apparent. The diagnosis was established in 17 cases. The median age was 28 years (range, 14-52). For patients with disease limited to the testis, the median survival has not been reached, with all five patients surviving disease-free at 22+ to 120+ months. Among the 12 patients with metastatic disease, the median survival was 30.5 months (range, 12-69). All 12 patients were treated with cisplatin-containing regimens. Six had complete responses either to chemotherapy alone or to chemotherapy plus resection of residual disease. Four of the six complete responders relapsed, and three died of progressive disease. One patient with sarcomatous differentiation was treated with a doxorubicin-based regimen and had a partial remission, which lasted 8 months. Teratoma with malignant transformation, when found in metastatic sites, appeared to be a poor prognostic pathologic variant in male patients with germ cell tumors.     

The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study

BackgroundSurgery followed by platinum-based chemotherapy is the standard of care for MOGCTs, except for stage IA dysgerminoma and stage IA grade 1 immature teratoma where surveillance only is recommended. The role of adjuvant chemotherapy and surgical staging is debated.Patients and methodsData from 144 patients with stage I MOGTs were collected among MITO centers (Multicenter Italian Trials in Ovarian Cancer) and analyzed.ResultsFifty-five (38.2%) patients were affected by dysgerminomas, 49 (34%) by immature teratomas, 26 (18.1%) by yolk sac tumors and 14 (9.7%) by mixed tumors. Seventy-three (50.7%) patients receive surgery plus chemotherapy, while 71 (49.3%) patients underwent surgery alone. The latter group included 32 dysgerminomas (14 IA–13 Ix, 3 IB, and 2 IC), 34 immature teratomas (20 1A–13 IA grade 1, 6 Ix, 1 IB, and 7 IC), 4 mixed tumors and 1 yolk sac tumor. Forty-four patients did not received chemotherapy, even if it would have been indicated by recommended approach. 94 (65.3%) patients received peritoneal surgical staging. Twenty-three (15.9%) developed a recurrence. Incomplete surgical staging was associated with recurrence (P < 0.05; OR 2.37) at Cox regression analysis. Seven patients died. Four patients were affected by yolk sac tumors, two by mixed tumors and one by immature teratoma. Five patients died for disease, one for acute leukemia and one for suicide. Prognostic parameter analyses showed that yolk sac component is a predictor for survival (P < 0.05). Five-years OS rates were 96.8% and 88.7% in the surgically staged and the incomplete staged group, respectively, while 93.8% and 94.1% in the standard treatment and in the surveillance group, respectively.ConclusionsThis study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.     

The treatment of cranial germ cell tumours

Germ cell tumours of the central nervous system (CNS) include many subtypes whose response to treatment varies, even though the symptoms and radiological appearances are similar. Five-year survival rates are 96% for germinomas, 100% for mature teratomas, 67% for immature teratomas and 69% for immature teratomas mixed with germinomas; for beta-HCG secreting germinomas the rate is only 38%. Patients with choriocarcinoma, embryonal carcinoma, or yolk sac tumour have the lowest survival rates; patients with germinoma or mature teratoma have longer survival rates.Although a wider resection is associated with a higher rate of survival for patients with non-germinomatous germ cell (NGGC) tumours, to date an aggressive surgical approach has been advocated only for pineal region tumours, but not for hypothalamic/neurohypophyseal tumours. Beside the delayed injury induced by radiotherapy, the late injury induced by chemotherapy is becoming increasingly evident. Cisplatin is considered an indispensable drug, but it may cause renal damage, ototoxicity, peripheral neuropathy and sterility, while etoposide is associated with an excess frequency of second neoplasms.Taking into account all of the published literature, the following therapeutic options are suggested: in pure germinoma tumours (GT) radiotherapy alone will usually ensure adequate control of the disease, and the long-term sequelae may be limited by reducing the dose delivered, as was proposed for germ cell testicular tumours, to 30 Gy to limited fields plus 25-30 Gy to the spinal axis if there is disseminated disease. In cases of recurrence, which should be uncommon, patients may be rescued with both radiotherapy and chemotherapy.In NGGC tumours, the prognosis is more unfavourable and there is often dissemination to the spine at diagnosis; however, the tumour's high chemosensitivity suggests neoadjuvant treatment chemotherapy with cisplatin and etoposide for three cycles followed by consolidation radiotherapy with 40 Gy to the limited fields plus 30 Gy to the spinal axis if disseminated.In our opinion, a higher dose of radiotherapy in cases in which chemotherapy does not achieve a radiological complete remission is not advisable, because very often the residual radiological abnormality does not represent biologically active tumour but differentiated forms such as mature teratoma.The challenge for 2000 is to both cure these patients, and avoid the late and permanent sequelae of radiation and/or chemotherapy that may subsequently impair quality of life.     

DSA下多支超选择性动脉灌注化疗联合手术治疗中晚期乳腺癌的临床疗效分析

目的:探讨中晚期乳腺癌多支超选择性动脉化疗联合手术治疗的临床应用价值。方法:60例经临床穿刺活检病理明确诊断为乳腺癌的患者,随机分为2组,A组为介入化疗组(30例),采用Seldinger’s方法术前在DSA造影下多支供血动脉分别超选择性插管,靶血管区域化疗栓塞。B组为对照组(30例),采用术前常规外周静脉全身注药新辅助化疗,2组化疗方案均用吡柔比星联合紫杉醇。比较两组的近期、远期疗效,生存率,复发率,疗程、并发症及化疗不良反应。结果:A组完全缓解(CR)6例(20.0%),部分缓解(PR)23例(76.7%),稳定(SD)1例(3.3%),CR+PR 29例(96.7%),平均疗程时间(29.8±3.2)d,A组复发5例16.7%),中位生存期39个月。B组CR 1例(3.3%),PR 22例(73.3%),SD 7例(23.3%),CR+PR23例(76.7%),平均疗程时间(39.9±4.5)d,复发16例(53.3%),中位生存期25个月。A组完全缓解率、部分缓解率及有效率均高于对照B组(P<0.05)。平均疗程低于对照组,复发率降低且生存时间延长。结论:中晚期乳腺癌术前多支供血动脉超选择性插管,靶血管区域化疗栓塞可明显提高疗效,降低临床分期,降低化疗不良反应及并发症,增加手术切除机会,减少术中出血和缩短手术时间,降低复发率。     

肺癌术后行肺动脉灌注化疗的探讨

目的：比较肺动脉灌注化疗与外周静脉化疗用于中、晚期肺癌肺叶切除术后的远期疗效。方法：90年例患者随机分为2组。PAI组于肺叶切除后行选择性肺动脉灌注化疗；Ⅵ组则于手术后行外周静脉化疗。结果：PAI组共化疗215疗程，平均4．8疗程；VI组化疗195疗程，平均4．3疗程。PAI组1、3、5年生存率分别为88．9％、77．8％和47．4％，VI组则为82．2％，53．3％和20．5％，两组间3、5年生存率比较有显著差异（P＜0．05）。PAI组根治手术病例3年局部复发率为12．8％，VI组为35．0％（P＜0．05）。PAI组1、3、5RH TLD TF LFTQTJT V YX O 17．8％、20．0％和26．3％，VI组为15．6％，35．6％和51．3％，两组间3、5年血行转移复发率有显著性差异（P＜0．05）。结论：选择性肺动脉灌注化疗用于肺叶切除后的肺癌患者，能够杀灭和抑制局部微转移灶，减少局部复发和远期血行转移的发生率，提高长期生存率。