口腔鳞状细胞癌中PD-L1的表达与P16、HPV感染以及淋巴结转移关系分析

目的观察口腔鳞状细胞癌中程序性死亡分子-L1配体(PD-L1)的表达与乳头瘤病毒-16 (P16)、人乳头瘤病毒(HPV)感染以及淋巴结转移关系,初步探讨PD-L1在口腔鳞状细胞癌病情发展中的作用。方法以本院2017年6月至2018年6月期间收集到的口腔鳞状细胞癌组织蜡块为研究标本,行采用免疫组化染色法检测组织标本PD-L1、P16及HPV表达情况。观察PD-L1、P16、HPV的表达情况,并采用Spearman等级相关性分析法分析PD-L1与P16、HPV感染以及淋巴结转移关系的相关性。结果 51例口腔鳞状细胞癌组织中,PD-L1呈阳性表达44例(86.27%),PD-L1呈阴性表达7例(13.72%),P16呈阳性表达22例(43.14%),P16呈阴性表达29例(56.86%)。口腔鳞状细胞癌组织中的PD-L1表达与P16表达呈负相关(rs=-0.819,P=0.000),与淋巴结转移分期之间呈负相关(rs=-0.736,P=0.000),与HPV感染呈正相关(rs=0.653,P=0.000)。结论 PD-L1在口腔鳞状细胞癌组织中呈高度表达,且与口腔鳞状细胞癌病情发展标志物P16、HPV密切相关,同时在淋巴结转移中也具有促进作用,因此,深入研究PD-L1在口腔鳞状细胞癌病情发展的作用,有助于口腔鳞状细胞癌免疫疗法的完善。     

口咽鳞状细胞癌患者预后影响因素分析

目的探讨口咽鳞状细胞癌患者的预后现状和影响因素。方法采用自制问卷收集2005年12月—2009年12月作者所在医院收治的69例口咽鳞状细胞癌患者的临床资料,根据口咽鳞状细胞癌患者的预后情况将其分为A组和B组。采用SPSS 19.0统计软件进行描述性统计和二分类Logistic回归分析口咽鳞状细胞癌预后现状和影响因素。结果所有患者中,死亡患者42例,预后不良患者比例为60.87%;人乳头瘤病毒感染(OR=12.167)、淋巴结转移(OR=24.184)、情绪紧张(OR=8.576)、治疗并发症(OR=11.470)和基础疾病种数多(OR=12.198)是口咽鳞状细胞癌患者预后不良的危险因素;肿瘤组织分化程度高(OR=0.118)是口咽鳞状细胞癌患者预后良好的保护因素。结论口咽鳞状细胞癌患者预后较差,预后结局受多方面因素影响,治疗中应采取针对性的预防干预措施来提高疗效,改善患者的预后。     

晚期口咽癌23例挽救性手术治疗分析

目的:探讨晚期口咽癌根治或扩大切除并一期修复的临床效果.方法:回顾性分析23例晚期口咽癌的临床资料,包括临床病理、手术方式、修复方法、功能评价、并发症和预后等方面.结果:23例舌根癌7例,软腭癌5例,咽侧壁癌9例,扁桃体癌2例.颈淋巴结转移率为61％(14/23).5例软腭癌只行局部扩大切除外,18例行原发灶切除和颈淋巴清扫术(13例施行一侧下颌骨部分切除或截骨切除,5例软腭癌扩大切除后以邻近硬腭瓣修复);18例中2例拉拢缝合未行修复,13例采用胸大肌皮瓣修复,2例采用前额皮瓣修复,1例采用舌瓣修复.22例安全度过围手术期,1例术后第5日因咽侧创口大出血窒息死亡.采用舌瓣修复的1例咽侧创口大部分裂开,形成咽颌下瘘,经反复换药2个月后闭合;1例胸大肌皮瓣和1例前额皮瓣部分坏死,但未产生咽颌下瘘.术后语言、吞咽功能基本恢复.19例随访3个月至5年,1例术后6个月复发死亡,3例术后1～2年复发死亡,2例术后3～5年复发死亡.结论:手术是晚期口咽癌治疗的有效手段之一,采用适当的修复方法是手术成功的重要因素,带蒂胸大肌皮瓣是修复口咽大型缺损的理想选择.     

口泰与康复新液联用防治急性放射性口咽粘膜反应的护理

目的评价口泰与康复新液联用在头颈部肿瘤放疗中防治急性口咽粘膜放射反应的临床效果。方法将162例接受放射治疗的头颈部肿瘤患者随机分为观察组和对照组，每组均为81例。观察组采取口泰漱口液含漱，2h后再用康复新液含漱后慢咽，半小时避免进食进水；对照组则单用口泰漱口液含漱。结果放射剂量（DT）为30Gy时，两组粘膜反应发生率比较，差异无显著性意义（p〉0．05）；DT为50、70Gy时，观察组急性口咽粘膜反应发生率显著低于对照组（均p〈0．05），观察组急性口咽粘膜反应恢复时间及总疗程完成时间显著短于对照组（p〈0．05）。结论口泰与康复新液联用可降低头颈部肿瘤患者急性口咽粘膜放射反应发生率，缩短粘膜反应恢复时间及总疗程完成时间，减轻患者痛苦，提高生存质量。     

口咽癌术后多重耐药菌感染的原因分析及护理

目的 探讨口咽癌术后多重耐药菌感染的各种原因及护理措施.方法 对2007年3月至2009年6月收治的口咽癌手术患者57例于手术结束后进行采样,检出致病菌21例,对其多重耐药菌感染的原因进行细致分析,并及时有效地进行相应的护理.结果 21例均痊愈,其中20例住院23 d以内,1例住院48 d.结论 加强围手术期营养,严格执行无菌操作技术,加强口腔护理及气管切口管理对预防伤口感染至关重要.     

口咽癌术后多重耐药菌感染的原因分析及护理

目的 探讨口咽癌术后多重耐药菌感染的各种原因及护理措施.方法 对2007年3月至2009年6月收治的口咽癌手术患者57例于手术结束后进行采样,检出致病菌21例,对其多重耐药菌感染的原因进行细致分析,并及时有效地进行相应的护理.结果 21例均痊愈,其中20例住院23 d以内,1例住院48 d.结论 加强围手术期营养,严格执行无菌操作技术,加强口腔护理及气管切口管理对预防伤口感染至关重要.     

1例口咽癌术后病人颈部感染诱发颈动脉破裂的预见性护理与抢救

正口咽癌是头颈颌面部较常见肿瘤,肿瘤所处位置靠近颈部,术前放化疗造成的组织纤维化致使手术切口经久不愈合、术后反复感染以及顽固性口内外瘘管形成容易导致颈部动脉的暴露破裂,危及病人的生命[1-4]。对于这一类病人的护理,预见性地做好抢救准备与病情观察,有效应对出血时的抢救配合,是挽救病人生命的重要举措。我院2013年1月—2013年4月收治1例口咽癌伴颈淋巴结转移病人,行肿物切除术+颈淋巴结清扫术+气管切开术,术后出现颈部伤口愈合不良伴感染并累及颈     

MSI、PD-L1在NSCLC患者中的表达及其与预后的相关性

目的 探讨微卫星不稳定性(MSI)、程序性死亡配体-1(PD-L1)在非小细胞肺癌(NSCLC)患者中的表达水平及其预后相关性.方法 收集2010年6月至2014年12月在本院收集的86例NSCLC患者手术切除癌组织及对应距病灶5 cm以上癌旁正常组织.利用PCR技术检测172例样品中BAT-25、BAT-26、D2S...     

1例口咽癌复发患者术后颈总动脉大出血的急救与护理

总结1例口咽癌复发患者术后颈总动脉大出血床边成功急救的护理体会。此例患者为临床中的危急重患者,我们对患者的病情进行了全面的评估,密切观察病情变化,严防意外的发生,并做好充分的人员和急救物品的准备。患者颈总动脉出血发生后,实施紧急有效的止血和抗休克处理,医护配合良好,床边抢救成功。术后经过精心治疗和护理,患者未发生偏瘫和失语等严重并发症,顺利出院。     

CyclinD1在肝细胞癌中的表达及与肝细胞癌患者预后的关系

目的 探讨Cyclin1l在肝细胞癌中的表达及与肝细胞癌患者预后的关系.方法 取133例肝细胞癌患者的癌组织(HCCs)及癌旁组织(PTLTs)病理切片,用免疫组化染色技术分析CyclinD1的表达,统计分析CyclinD1表达强度与肝细胞癌患者临床病理因素之间的关系,并以Kaplan-Meier生存曲线及Log-rank法检测不同CycleD1表达组的生存差异.最后以单因素及多因素Cox回归模型分析影响肝细胞癌患者预后的独立危险因素.结果 免疫组化染色结果发现5l例肝癌患者的癌组织中CyclinD1表达阳性,表达率为38.3%(51/133),而在癌旁组织中仅有4例CyclinD1表达阳性,表达率为3%(4/133),肝癌组织中Cy-clinD1表达率显著高于癌旁组织(P=0.01).Mann.Whitney U检验发现肝癌组织中CyclinD1的高表达与AFP水平(P=0.006)之间呈正相关,且有统计学意义.而CyclinD1表达与性别(P=0.394)、年龄(P=0.232)、肿瘤大小(P=0.842)、肿瘤数目(P=0.479)、包膜(P=0.085)、脉管侵犯(P=0.331)、淋巴结转移(P=0.168)和Edmondson-Steiner病理分级(P=0.521)不相关;Kaplan-Meier生存曲线发现CyelinD1表达强度与患者生存相关,即表达强者预后差(P=0.001);单因素及多因素Cox回归分析发现肿瘤数目、脉管侵犯、CyclinD1表达是影响HCC患者预后的独立危险因素(P值分别为0.003,0.010和0.017).结论 CyclinD1在肝细胞癌中表达升高,其表达与肝细胞癌患者预后呈负相关,并且是肝细胞肝癌预后的独立危险因素.     

Macrophages expressing TREM-1 are involved in the progression of HPV16-related oropharyngeal squamous cell carcinoma

IntroductionMany types of research have been performed to improve the diagnosis, therapy, and prognosis of oropharyngeal carcinomas (OP-SCCs). Since they arise in lymphoid-rich areas and intense lymphocytic infiltration has been related to a better prognosis, a TREM-1 putative function in tumour progression and survival has been hypothesized.Materials and methodsTwenty-seven human papillomavirus (HPV) 16⁺ OP-SCC specimens have been analyzed to relate TREM-1 expression with histiocytic and lymphocytic markers, HPV presence and patients’ outcome.ResultsNo differences have been shown between intratumoral and stromal CD4⁺ cells, while intratumoral CD8⁺ lymphocytes are higher with respect to the tumour stroma (p = .0005). CD68⁺ cells are more than CD35⁺ and TREM-1⁺; their presence is related to CD35^± and TREM-1^± histiocytes (p = .005 and .026, respectively). Intratumoral CD4⁺ lymphocytes are higher in p16⁺ cases (11/27) than in p16⁻ (p = .042); moreover, p16 positivity correlates to a better survival (p = .034). CD4⁺, CD8⁺ and CD35⁺ cells have no impact on survival, while CD68 expression heavily influences progression and bad outcome (p = .037). TREM-1 positivity also leads to worst overall survival (p = .001): peritumoral expression and death-cause relationship are always significant, particularly when the cause is OP-SCC (p = .000).ConclusionWhile p16 shows to better stratify HPV16⁺ patients’ outcome, TREM-1⁺ macrophages suggest their key importance in HPV-related OP-SCCs progression.

KEY MESSAGES

• TREM-1 positivity correlates to the worst overall survival of HPV16-positive OPSCCs-affected patients.
• p16-positive HPV16 related OPSCCs patients have a better prognosis with respect to p16-negative ones.

     

食管鳞癌患者血清血红素氧合酶-1和鳞状细胞癌抗原水平与临床病理特征及预后的关系

目的观察不同临床病理特征食管鳞癌患者血清血红素氧合酶-1(heme oxygenase-1,HO-1)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)水平变化,探讨HO-1、SCCA与食管鳞癌患者预后的关系。方法食管鳞癌患者93例为食管鳞癌组,同期体检健康者72例为对照组,采用ELISA法检测2组血清HO-1、SCCA水平。比较食管鳞癌组与对照组及不同临床病理特征食管鳞癌患者血清HO-1、SCCA水平。食管鳞癌患者根据病情程度采用内镜治疗、食管癌根治术治疗及放化疗综合治疗,并依据HO-1、SCCA水平分为高水平HO-1(HO-1≥2.43μg/L)组47例和低水平HO-1(HO-1<2.43μg/L)组46例,高水平SCCA(SCCA≥2.76μg/L)组49例和低水平SCCA(SCCA<2.76μg/L)组44例。随访5年,比较食管鳞癌患者高、低水平HO-1组,高、低水平SCCA组5年总生存率,多因素Cox回归分析食管鳞癌患者死亡的危险因素。结果食管鳞癌组血清HO-1[(2.43±0.55)μg/L]、SCCA[(2.76±0.61)μg/L]水平高于对照组[(0.23±0.09)、(0.42±0.13)μg/L](P<0.05)。肿瘤分期Ⅲ期、病理分级低分化者血清HO-1[(2.75±0.64)、(2.57±0.57)μg/L]、SCCA[(3.22±0.71)、(2.93±0.64)μg/L]水平高于肿瘤分期Ⅰ~Ⅱ期[(2.32±0.43)、(2.60±0.52)μg/L]、病理分级高中分化者[(2.30±0.51)、(2.61±0.58)μg/L](P<0.05);不同年龄、性别、肿瘤大小、肿瘤位置及淋巴结有无转移者血清HO-1、SCCA水平比较差异均无统计学意义(P>0.05)。随访至2020年2月,均未失访,高水平HO-1组5年总生存率(10.6%)低于低水平HO-1组(30.4%)(P<0.05),高水平SCCA组5年总生存率(8.2%)低于低水平SCCA组(34.1%)(P<0.05)。肿瘤分期Ⅲ期(OR=3.054,95%CI=1.021~6.141,P=0.004)、病理分级低分化(OR=3.011,95%CI:1.003~5.051,P=0.023)、高血清HO-1水平(OR=2.407,95%CI:1.123~4.989,P=0.022)、高血清SCCA水平(OR=2.025,95%CI:1.003~8.077,P=0.019)是食管鳞癌患者死亡的危险因素。结论食管鳞癌患者血清HO-1及SCCA水平升高,其增高程度与肿瘤分期、病理分级有关,是食管鳞癌患者死亡的危险因素。     

Diagnostic and prognostic value of circRNAs expression in head and neck squamous cell carcinoma: A meta‐analysis

BackgroundCircular RNAs (circRNAs) have been found to have potential biological applications against tumors in humans. This study aimed to evaluate the diagnostic, prognostic, and clinicopathological value of circRNAs in head and neck squamous cell carcinoma (HNSCC).MethodsThe PubMed, Web of Science, EMBASE, and the Cochrane Library were comprehensively searched for the relevant studies before October 20, 2021. Statistical analysis was performed based on STATA 15.0, Meta‐DiSc 1.4, and RevMan 5.3 software.ResultsA total of 55 reports regarding 56 kinds of circRNA were studied in this meta‐analysis, including 23, 38, and 26 articles on diagnosis, prognosis, and clinicopathological features, respectively. The pooled sensitivity, specificity, and area under the curve (AUC) of the summary receiver‐operating characteristic curve (SROC) were 0.78, 0.84, and 0.87, respectively. Besides, the upregulation of oncogenic circRNAs was significantly associated with poorer overall survival (OS) (HR=2.25, p < 0.05) and disease‐free interval (DFS) (HR=1.92, p < 0.05). In contrast, the elevated expression of tumor suppressor circRNAs was associated with a favorable prognosis (HR=0.50, p < 0.05). In addition, the high expression of oncogenic circRNAs was associated with the tumor size (OR=3.59, p < 0.05), degree of differentiation (OR=1.89, p < 0.05), TNM stage (OR=2.35, p < 0.05), lymph node metastasis (OR=1.85, p < 0.05), and distant metastasis (OR=3.42, p < 0.05). Moreover, the expression of tumor suppressor circRNAs was associated with improved clinicopathological features (lymph node metastasis: OR=0.25, p < 0.05).ConclusionsCircRNAs could serve as potential predictive indicators and be useful for the diagnosis, prognosis, and identification of clinicopathological features in HNSCC.     

The expression profile and clinical application value of hsa_circ_0016148 in head and neck squamous cell carcinoma

BackgroundDysregulated circular RNAs (circRNAs) are involved in human cancers and may be used as biomarkers with the potential of clinical application. However, little is known regarding the mechanism of circRNAs and their clinical application value in head and neck squamous cell carcinoma (HNSCC).MethodsIn the current study, we established the profile of circRNAs in HNSCC using microarray and then measured the expression of hsa_circ_0016148 in 137 paired HNSCC tissues by qRT‐PCR technique, analyzed the relationship between hsa_circ_0016148 and clinicopathological data, and investigated its diagnostic and prognostic value. The hsa_circ_0016148‐miRNA‐mRNA interaction network was predicted and constructed by Cytoscape.ResultsOur study showed a circRNA expression profile and confirmed downregulated hsa_circ_0016148 in HNSCC tissues (p = 2.64E‐35). The hsa_circ_0016148 expression is remarkably correlated with lymph node metastasis (p = 0.001) and clinical stage (p = 0.029). Then, the area under the receiver characteristic curve (AUC) was 0.912 with 92% of sensitivity and 86.9% specificity, respectively. Besides, our study demonstrated that lower‐expressed hsa_circ_0016148 could independently predict poorer overall survival of HNSCC patients (hazard ratio [HR] = 0.456; 95% confidence interval [CI] = 0.265–0.784; p = 0.005). The hsa_circ_0016148‐miRNA‐mRNA interaction network was constructed, which included a total of nine targeted miRNAs.ConclusionTaken together, our results revealed that hsa_circ_0016148 might play a critical role in HNSCC tumorigenesis and may serve as an indicator with the potential of diagnosis and prognosis for HNSCC.     

miRNAs in human papilloma virus associated oral and oropharyngeal squamous cell carcinomas

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer in the world with 600,000 new cases diagnosed annually. Tobacco and alcohol use have been associated as the principal etiological factors of this pathogenesis. The incidence of smoking-associated HNSCC has declined, while human papilloma virus (HPV)-associated HNSCC is on the rise. There are currently no clinically validated biomarkers to detect this cancer at an early stage (cancers independent of HPV status). It is well-established that the aberrant expression of miRNAs can lead to tumorigenesis. miRNA expression differences have also been demonstrated in HPV-positive and HPV-negative HNSCC tumor tissues as well as in body fluids. Therefore, miRNAs have the potential to provide an unprecedented insight into the pathogenesis of HNSCC and serve as potential biomarkers. This review addresses HNSCC disease burden and the regulation of miRNA by HPV viral oncoproteins, potential miRNA biomarkers and future perspectives. miRNA provides an unique opportunity to fulfill the current clinical challenge in HNSCC patient management by enabling early detection followed by targeted interventions, leading to a significant reduction in mortality and morbidity.     

人乳头状瘤病毒阳性口咽部鳞状细胞癌治疗研究进展

临床一般认为口咽部鳞状细胞癌发病与烟草、酒精等传统危险因素相关,但20％～30％患者并无吸烟或酗酒等危险因素,人乳头状瘤病毒可能是其发生口咽部鳞状细胞癌的原因.人乳头状瘤病毒引起癌变,可能因2个病毒癌基因和非结构蛋白(E6和E7)通过对P53和视网膜母细胞瘤蛋白发挥抑制作用而引起.人乳头状瘤病毒阳性口咽部鳞状细胞癌患者较人乳头状瘤病毒阴性者预后好.目前口咽部鳞状细胞癌的标准治疗方案并不取决于人乳头状瘤病毒阴性或阳性.最近临床研究的焦点是对人乳头状瘤病毒阳性口咽部鳞状细胞癌患者降低治疗强度的意义.本文对人乳头状瘤病毒阳性口咽部鳞状细胞癌的治疗现状作一综述.     

人乳头状瘤病毒相关头颈颌面部鳞癌的研究进展

头颈部鳞状细胞癌（head and neck squamous cell carcinoma，HNSCC）发病率占头颈部恶性肿瘤的90%，死亡率为40%~50%，来源于口腔、口咽、鼻咽、下咽及喉。通常认为烟草、酒精的过度使用与HNSCC有关，但越来越多的研究表明，人乳头状瘤病毒（human papillomavirus，HPV）感染与HNSCC的发生发展高度相关，尤其是口咽鳞状细胞癌（oropharyngeal squamous cell carcinoma，OPSCC）。本文对HPV相关HNSCC的分子生物学表现、致病机制、治疗进展、预防策略作一综述，为临床及个体化治疗提供新的思路。