TNM因素对非小细胞肺癌治疗效果的影响

目的探讨肺邬原发肿瘤的大小、淋巴结不同区域的转移及有无远处转移对非小细胞肺癌（NSCLC）综合治疗效果的影响。方法回顾性分析手术治疗的987例NSCLC患者的临床资料,将其中以手术＋化、放疗的574例患者与单纯手术冶疗的413例患者进行对比分析。结果全组患者的1、3、5、10年生存率分别为87．7％、57．5％、54．6％和54．5％。其中综合治疗组的1年生存率高于单纯手术组沪〈（0.01）。在丁4患者中,手术＋放疗组的5年生存率高于单纯手术组（RO．05）。在NO患者中,手术＋化疗组、手术＋放疗组与单纯手术组比较,1年生存率差异有统计学意义（均P〈005）;在N1患者中,手术＋化疗组、手术＋放化疗组与单纯手术组比较,1年生存率差异有统计学意义沪〈O．01）;在N2患者中,手术＋化疗组与单纯手术组比较,1年和3年生存率差异均有统计学意义（均P〈0．05）。结论对于NSCLC患者,以手术为主的综合治疗疗效优于单纯手术。对T4患者应加强术后局部放疗,对NO和N1患者应辅以适度化、放疗,对N2患者则应强调辅以足够的化疗。     

633例中晚期食管癌患者的疗效分析

将６３３例中晚期食管癌患者随机分为三组进行治疗，Ａ组单纯手术，Ｂ组术前放疗＋手术，Ｃ组术前放疗、休息２周后手术、术后辅以化疗。结果显示，Ａ组肿瘤切除率低于Ｂ、Ｃ组（Ｐ〈０．０５）；术后死亡率、并发症三组无明显差异（Ｐ〉０．０５）；２年生存率三组相近（Ｐ〉０．０５），３年生存率Ａ组低于Ｂ、Ｃ组（Ｐ〈０．０５），５年生存率Ａ、Ｂ组相近（Ｐ〉０．０５），但均低于Ｃ组（Ｐ〈０．０５）。提示对中晚期食管癌宜     

165例Ⅲ期小细胞肺癌的外科治疗评价

对胸外科１９７９年～１９９１年底经手术切除的１６５例Ⅲ期小细胞肺癌（ＳＣＩＣ）的治疗效果进行分析，并将其中的８７例综合治疗病例与７８例单纯手术病例进行对比讨论。同时，就综合治疗组中术前化学治疗（化疗）和（或）放射治疗（放疗）对预后的影响做了观察。全组５年生存率占１６．６％。ＴＮＭ分期５年生存率Ⅲａ期达２０．４％，Ⅲｂ期为０。综合治疗５年生存率占２２．８％，单纯手术５年生存率占７．９％。结果显示：Ⅲａ期ＳＣＬＣ综合治疗优于单纯手术治疗；综合治疗组中Ｎ＿２术前化疗和（或）放疗病例较术后化疗和（或）放疗病例预后变差；手术适应证应限于Ⅲａ期病例。     

颈段食管癌的个性化综合治疗

34例颈段食管癌患者确诊后经专家组会诊，进行量表评分并确定个性化综合治疗方案。手术＋放疗14例，手术＋放疗＋化疗10例，手术＋化疗6例，放疗＋化疗4例。个性化综合治疗组3、5a生存率分别为50％、29％，单纯放疗组分别为22％、25％。两组比较，P＜0．05。认为对颈段食管癌实行个性化综合治疗方案，可提高生存率和生存质量。     

Ⅲ期食管癌综合治疗69例分析

将已确诊Ⅲ期食管癌鳞癌患者患者69例随机分为综合治疗组和单纯手术组。综合治疗组35例采用术前放疗化疗＋手术治疗＋术后化疗。单纯手术组34例采用食管癌根治术＋淋巴结三野清扫术。发现综合治疗组根治性手术切除率、1a生存率、无病生存率高于单纯手术组（P〈0．05）,单纯手术组开胸探查率高于综合治疗组（P〈0．05）。认为Ⅲ期食管癌综合治疗可以提高根治性手术切除率,改善近期预后及无病生存率,术后化疗对于预防肿瘤复发有一定作用。     

40岁以下肺癌病人放疗与化疗疗效分析

目的探讨40岁以下失去手术机会的肺癌病人放疗与化疗的疗效及影响预后因素。方法103例40岁以下病人单纯化疗45例，化疗与放疗综合治疗54例，单纯放疗4例。结果103例中CR23．3％（24／103），总有效率75．73％。1、2、5年生存率分别为52．37％、29．87％、7．8％，中位生存期15个月。结论放疗与化疗综合治疗疗效优于单一方法治疗；血清CEA、误诊及机体免疫功能为影响愈后的重要因素。     

Ⅲ期肺癌不同治疗模式的探讨

目的探讨Ⅲ期肺癌在不同治疗模式下的远期疗效,以提高患者生存率,改善预后。方法回顾性分析北京市结核病胸部肿瘤研究所自1995-2004年10年间1921例不同病理类型的Ⅲ期肺癌患者在不同治疗模式下的远期疗效并进行比较分析。结果在不同治疗模式下,以手术为主（辅以化、放疗）的综合治疗组606例、单纯手术组317例和非手术组998例,其1、3、5年生存率比较分别为66．0％、62．7％、51．2％;32．3％、21．4％、8-2％和19．3％、13．2％、4．2％。以手术为主的综合治疗组1、3、5年生存率高于单纯手术组和非手术组,其中综合治疗组和单纯手术组与非手术组比较1、3、5年生存率差异均有统计学意义（均P〈0．01）。结论根治性肿瘤切除,同时辅以化、放疗的综合治疗是Ⅲ期肺癌有效的冶疗模式。     

手术加化疗对Ⅰ期肺腺癌长期生存的影响

目的研究术后化疗对Ⅰ期肺腺癌长期生存的影响。方法收集1995年1月～2005年1月手术切除Ⅰ期（Ⅰa＋Ⅰb）肺腺癌427例,比较术后化疗组与单纯手术组的治疗效果。结果Ia期1、3、5、10年生存率,术后化疗组为100．00％、92．34％、86．17％、74.82％。单纯手术组为9663％、88．11％、79．52％、65．85％。Ⅰb期1、3、5、10年生存率,术后化疗组为96馏4％、77．99％、69．56％、64．36％。单纯手术组为85．65％、67．11％、59．56％、53．06％。Ⅰa、Ⅰb期术后化疗组与单纯手术组1年生存率比较差异均有统计学意义（P〈0．05,P〈0.01）。结论Ⅰa和Ⅰb术后化疗均比单纯手术预后好;Ⅰ期肺腺癌要取得较好的治疗效果,手术加术后化疗模式不可缺少。     

颅内血管外皮细胞瘤手术辅助放疗和化疗的效果及病理学分析

目的探讨手术切除颅内血管外皮细胞瘤后辅助放疗和化疗的效果及病理学改变。方法回顾性分析首都医科大学宣武医院经病理学检查证实的17例颅内血管外皮细胞瘤患者的临床资料,分析手术切除肿瘤辅以放疗和化疗的治疗效果。其中男13例,女4例;年龄为28～54岁,平均49岁。肿瘤全切除的15例,术后实施全脑放疗,放射剂量为50～60Gy。肿瘤次全切除的2例,采用伽玛刀治疗,放射剂量为30Gy。术后放疗前、术后2周和8周,采用尼莫司汀化疗3次,150mg/次。结果颅前窝底（6例）及矢状窦前1/3处（3例）肿瘤于手术显微镜下全部予以切除,术后头痛、呕吐、视力下降、复视的症状消失。8例小脑幕肿瘤患者中,6例手术显微镜下全切除肿瘤,2例手术显微镜下次全切除肿瘤。术后头痛症状消失,3例视野缺损症状好转,5例无明显改善。所有患者术后未出现新的神经功能缺损,无死亡病例。病理学检查示：肿瘤内有丰富的血管网,状似＂鹿角＂,这些血管扩张明显,近似血窦,肿瘤细胞围绕着血管排列,有分化和未分化两种细胞。未分化肿瘤细胞内有大量的胞质,核呈圆形或卵圆形,可见核分裂。9例患者的肿瘤有囊变,未见钙化征象。免疫组化提示血管外皮细胞瘤对Vimentine及CD34染色呈阳性反应。术后对所有患者MRI随访6～40个月,未见肿瘤复发。结论颅内血管外皮细胞瘤是一种血管丰富的恶性肿瘤,手术彻底切除肿瘤及术后辅以放疗和化疗,可防治其复发和转移。     

原发性胃淋巴瘤25例临床分析

我们分析了25例原发性胃淋巴瘤，其中占胃恶性肿瘤的1．55％，占淋巴瘤总数的12．6％。原发性胃淋巴瘤X线诊断的阳性率为30．4％。内镜肉眼诊断的阳性率为20％，通过内镜活检的阳性率为72％。25例中18例进行了手术治疗，其中2例先剖腹探查，后放疗化疗，待肿瘤缩小至原来－半时再行第二次手术根治，1例术后胃标本病理检查中原淋巴瘤细胞消失。原发性胃淋巴瘤的组织学诊断应与假性淋巴瘤、低分化腺瘤相鉴别。我们统计原发性胃淋巴瘤的5年存活率为54．28％，如及早手术或术后辅以放疗或（和）化疗，5年的生存率可达72％。     

肺癌累及食管的外科治疗(附18例报告)

目的 探讨肺癌累及食管的外科治疗的可行性。方法 对18例肺癌累及食管的患者施行手术治疗，14例手术切除肺肿瘤及扩大切除部分食管，其中7例仅切除局部受累的食管肌层，5例行受累段食管切除、胃食管吻合术，2例切除大部受累肌层，部分肿瘤残留；4例病人单纯探查。患者术前、后辅助化或(和)放疗。结果 该组无手术死亡。14例切除组患者1年生存率可达78．6％。9例正在随访中，最长者为34个月，单纯探查组无1例生存过1年。结论 肺癌单纯累及食管者，经术前辅助化疗后，手术切除肺及受累食管是可行的，大部分患者的近期效果理想，远期效果仍在观察。     

Clinical and pathological features of head and neck follicular dendritic cell sarcoma

Abstract

Objectives

Follicular dendritic cell sarcoma (FDCS) in the head and neck is uncommon. The etiology, pathogenesis, optimal treatment, and prognosis are not well understood. In this review, we investigated these features to deepen the understanding of the disease.

Methods

We reviewed FDCS in the head and neck in the English language literature through Medline. We analyzed the clinical characteristics, pathologic features, immunophenotypic profile, and treatments of FDCS.

Results

Of 137 reported cases of FDCS in the head and neck region, 127 included data on age and gender. Among those, 64 were females and 63 were males. The mean age was 46 years (9–79 years). In the 106 cases with complete follow-up data, fourteen patients (13.2%) had local recurrence. Fourteen patients (13.2%) had distant metastasis. The metastatic site involved the lung, liver, adrenal, rib, vertebral body, and iliac bone. The overall 5-year survival rate was 80.0%. Compared to nodal FDCS and extranodal FDCS, the overall 5-year survival rates were 71.1 and 85.3%, respectively, with no significance (P = 0.42), 0.8% waived treatment, 46.6% received surgery alone, 30.5% received surgery combined with postoperative radiotherapy, 8.4% received surgery combined with postoperative radiotherapy and chemotherapy, 7.6% received surgery combined with postoperative chemotherapy, 3.1% received chemotherapy alone, 2.2% received chemotherapy combined with radiotherapy, 0.8% received radiotherapy alone.

Conclusions

FDCS in the head and neck is rare. There was no difference in the survival between nodal and extranodal FDCS. The optimal treatment was undetermined.     

局部晚期非小细胞肺癌化疗与放化联合治疗观察

目的比较放化联合治疗与单纯化疗对局部晚期非小细胞肺癌（NSCLC）的临床疗效及安全性。方法回顾性分析68例不能手术的NSCLC患者,纯化疗组30例（A组）,放化联合组38例（B组）,两组均予长春瑞滨联合顺铂方案化疗两周期,疾病无进展者,A组继给予多西他赛联合顺铂方案化疗两周期,B组给予常规放疗60Gy后再予多西他赛联合顺铂方案化疗两周期,对比两组疗效及安全性。结果A组治疗有效率、中位生存期及1、3年生存率、分别为33.3%、8.9月、36.7%和0。B组分别为68.4%、12.6月、68.4%和5.3%,B组较A组明显提高,差异有显著性（P〈0.05）。主要毒副反应为骨髓抑制及肝功能异常。A组白细胞减少、血小板减少及肝功能异常发生率分别为63.3%,16.7%和66.7%,B组分别为78.9%、18.4%和68.4%,两组相比差异均无显著性（P〉0.05）。结论对局部晚期NSCLC放化联合治疗优于单纯化疗,毒副反应能耐受。     

Primary small intestinal malignant tumors: survival analysis of 48 postoperative patients

BACKGROUND: Primary small intestinal malignant tumor is relatively uncommon compared to gastric and colorectal cancer. It is difficult to make an early diagnosis due to the atypical primary symptoms and lack of effective diagnostic methods. GOALS: To analyze the relationship between the prognoses, histologic type, and therapeutic strategy in postoperative patients with small intestinal tumor. STUDY: The parameters that affect survival were evaluated using multivariate Cox analysis in 48 cases of small intestinal tumor (confirmed by operation and pathology) for the past 10 years. RESULTS: The overall survival (OS) of all 48 cases after surgery was 28 months. The 5-year postoperative survival rate for all of the 48 cases was 27.1%. The median OS for all the 20 stage II/III patients who received adjuvant chemotherapy was 28 months, whereas the median OS for the 15 patients who did not receive the therapy was 37 months (P=0.276). The median time to progression for 8 patients with adenocarcinoma who received 5-fluorouracil or platinum-based palliative chemotherapy was 7 months, whereas for the patients who did not receive the therapy it was 3 months (P=0.06). The result of multivariate analyses showed that only the clinical stage was significantly correlated with OS (P<0.001). CONCLUSIONS: The prognosis for small intestinal malignancies is associated with clinical stage, and palliative chemotherapy with a 5-fluorouracil or platinum-based regimen offers a potential benefit to patients with adenocarcinoma. Postoperative adjuvant chemotherapy seems to hold no therapeutic or survival benefit for patients with primary small bowel malignancies.     

Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease. METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients accepted brachytherapy or extra-radiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis. RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholan-giocarcinoma, 4 cases of pancreatic carcinoma), and 13 patients accepted brachytherapy (7 cases of cholangio-carcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively, longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%, 80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group. CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.     

Treatment and prognosis of limited disease primary small cell carcinoma of esophagus

Primary small cell carcinoma of esophagus (SCCE) is a relatively rare and highly aggressive tumor characterized by early dissemination and poor prognosis. The optimal treatment has not yet been established, and the role of surgery has remained controversial. Most of the limited diseases were treated conventionally by surgery, but the five‐year survival rate was still very low. This retrospective study was designed to investigate the clinical characteristics, treatment, and prognostic factors of limited disease SCCE. Clinical data of 40 SCCE patients with clinically limited disease who received transthoracic esophagectomy with lymphadenectomy at the Cancer Hospital of Shantou University Medical College from November 1990 to December 2009 were reviewed to summarize the clinical characteristics and treatment impacted on the survival. Twenty‐five cases of the 40 patients were treated with surgery alone, eight cases were treated with surgery + postoperative chemotherapy, four cases were treated with surgery + postoperative radiotherapy, and the other three were treated with surgery + postoperative radiochemotherapy. The Kaplan–Meier and log‐rank methods were used to estimate and compare survival rates. Cox's hazard regression model was used to identify the prognostic factors with the entry factors of gender, age (≤60 years versus >60 years), length of the primary lesion (≤5 cm versus >5 cm), location of the primary lesion, macroscopic tumor type, pT, pN, pTNM stage, operation (radical/palliative), and chemotherapy (yes/no). The mean follow‐up duration of this series was 24.7 months (1–121 months). Thirty‐four patients died of the disease during the follow‐up, five were still alive, and one was lost of follow‐up. The median survival time of the 40 patients was 13.0 months (95% confidence interval 4.7–21.3), and the 6‐, 12‐, 24‐, 36‐, and 60‐month overall survival rates (OS) were 77.5%, 56.4%, 28.9%, 23.7%, 10.5%, respectively. In univariate analysis, age (≤60 years versus >60 years) (P= 0.049), operation (radical/palliative) (P= 0.008), and chemotherapy (yes/no) (P= 0.013) significantly influenced the OS of the SCCE patients. In multivariate analysis, operation (P= 0.015) and chemotherapy (P= 0.031) were independent prognostic factors. The patients who received radical surgery and postoperative chemotherapy had relatively better survival. Surgical resection combined with chemotherapy should be recommended to patients with limited disease SCCE.     

Neoadjuvant and adjuvant radio- and radio-chemotherapy of rectal carcinomas

The objectives in treating rectal cancer are to achieve locoregional tumor control and to prolong overall survival. With surgery alone the reported local failure rates in recent decades have been unacceptably high, and this is associated with substantial morbidity and mortality. Perioperative radiotherapy with or without concomitant chemotherapy has been used extensively to reduce the high frequency of local recurrence. Adjuvant radiotherapy reduces the local recurrence rate dramatically if the dose is high enough and is administered preoperatively. Although a higher dose has been used in most postoperative radiotherapy trials, the reduction has not proven particularly pronounced. If the reduction were as great as that with preoperative radiotherapy, it would also have a positive effect on survival, which as yet has not been achieved with postoperative radiotherapy. However, postoperative irradiation combined with chemotherapy yields a survival benefit of the same magnitude as preoperative irradiation. Modern radiation techniques allow preoperative radiotherapy to be delivered without interfering substantially in the postoperative healing process; it does not increase mortality or morbidity and entails a low rate of late toxicity if the radiation technique is optimal. A major question today is whether radiotherapy is necessary if surgery is optimal. Control trials report an average local recurrence rate of 29% with standard surgery. With optimal surgery the figure reported from institutional series is about 10%. Other questions to be answered include whether to use superfractionation or standard fractionation in radiotherapy, and how chemotherapy should be given, concomitantly to radiotherapy or in the classical method of postoperative intravenous treatment. Accepted: 26 November 1999     

老年女性乳腺癌166例临床分析

目的 探讨老年女性乳腺癌的手术效果.方法对1989年8月至2004年8月收治的166例老年女性乳腺癌患者的临床资料进行回顾性分析.结果166例中,改良根治术98例（59.0%）,根治术21例（12.7%）,全乳房切除术29例（17.5%）,肿瘤局部切除术18例（10.8%）.术后化疗126例,放疗12例,内分泌治疗73例.术后并发症发生率为10.8%,无手术死亡.术后3年和5年生存率分别为82.2%和65.2%.结论老年人乳腺癌采用手术及综合治疗可以取得满意的临床疗效,不同病情的患者应用不同的术式,老年并非是手术禁忌证;同时要内外科配合,重视并处理好并存症和术后并发症.     

48例非小细胞肺癌再程放疗临床探究

目的探究非小细胞肺癌再程放疗的临床效果。方法收集我院非小细胞肺癌复发48例,再次放疗距初次放疗时间为19.1±8.6周。分为观察组与对照组,观察组患者进行辅助化疗1～6周期后给予再程放疗,对照组只进行辅助化疗,观察患者的存活率。结果观察组的患者治疗三个月后复查胸部CT,CR2例;PR17例;SD为3例;PD为2例,有效率为70.8%,远高于对照组。48例中1年生存率63%,中位生存时间为10.5个月。接受再程放疗的患者均有较高的存活率。结论再程放疗能较安全地应用于非小细胞肺癌,疗效较好,不良反应较轻,值得进一步推广应用。     

Primary early-stage intestinal and colonic non-Hodgkin＇s lymphoma： Clinical features, management, and outcome of 37 patients

AIM: To analyze the clinical features, management, and outcome of treatment of patients with primary intestinal and colonic non-Hodgkin's lymphoma (PICL). METHODS: A retrospective study was performed in 37 patients with early-stage PICL who were treated in our hospital from 1958 to 1998. Their clinical features, management, and outcome were assessed. Prognostic factors for survival were analyzed by univariate analysis using the Kaplan-Meier product-limit method and log-rank test. RESULTS: Twenty-five patients presented with Ann Arbor stage I PICL and 12 with Ann Arbor stage II PICL. Thirty-five patients underwent surgery (including 31 with complete resection), 22 received postoperative chemotherapy or radiotherapy or both. Two patients with rectal tumors underwent biopsy and chemotherapy with or without radiotherapy. The 5- and 10-year overall survival (OS) rates were 51.9% and 44.5%. The corresponding disease-free survival (DFS) rates were 42.4% and 37.7%. In univariate analysis, multiple-modality treatment was associated with a better DFS rate compared to single treatment (P=0.001). While age, tumor size, tumor site, stage, histology, or extent of surgery were not associated with OS and DFS, use of adjuvant chemotherapy significantly improved DFS (P=0.031) for the 31 patients who underwent complete resection. Additional radiotherapy combined with chemotherapy led to a longer survival than chemotherapy alone in six patients with gross residual disease after surgery or biopsy. CONCLUSION: Combined surgery and chemotherapy is recommended for treatment of patients with PICL. Additional radiotherapy is needed to improve the outcome of patients who have gross residual disease after surgery.