消化道恶性肿瘤组织中端粒酶的检测及其意义

目的 探讨端粒酶活性在恶性肿瘤诊断中的意义。方法 采用TRAP－ELISA方法,对41例消化系统恶性肿瘤及10例良性疾病组织中的端粒酶活性进行检测并相互比较。结果 恶性肿瘤细胞中端粒酶活性的检测阳性率为75．6％（31／41）,端粒酶活性与组织类型、分化程度无明显相关性;良性疾病组织中端粒酶活性的检测阳性率为20．0％（2／10）。结论 大多数消化系统恶性肿瘤组织中有端粒酶活性,端粒酶活性的检测可能成为恶性肿瘤1个诊断指标。     

The Risk of Malignancy Index (RMI) in Diagnosis of Ovarian Malignancy

Objective : To evaluate the ability of two risk of malignancy indices (RMI) based on serum levels of CA 125,ultrasonographic score, and menopausal status to discriminate between benign and borderline or malignantovarian tumor. Materials and Methods: A retrospective study was conducted in 209 women with pelvic massesadmitted for laparotomy at Srinagarind Hospital, between January 2002 and December 2007. The sensitivity,specificity and positive predictive (PPV) and negative predictive (NPV) values of two RMI were calculated.Results: Using a cut-off level of 200 to indicate malignancy, the RMI 1 gave sensitivity of 70.6%, specificity of83.9%, PPV of 75%, and NPV of 80.6%. The RMI 2 gave sensitivity of 80%, specificity of 78.2%, PPV of71.6%, and NPV of 85.1%. The RMI 2 was significantly better in predicting malignancy than RMI 1. Conclusion:The RMI is able to discriminate between benign and borderline or malignant ovarian tumor.     

十年前后染发剂致血液系统不同恶性肿瘤的报告及文献复习

背景与目的： 染发剂的致癌性及致突变性日益受到关注,结合一例十年前后使用染发剂致不同血液系统恶性肿瘤的病例报告及文献复习,进一步阐述染发剂与血液系统恶性肿瘤的关系。材料与方法： 血液系统恶性肿瘤的病例报告及国内外文献。 结果： 国内外关于永久型染发剂的致突变性报道不一致,可能是各国使用的染发剂的有效成分的纯度不同所致。关于半永久型染发剂目前普遍认为HCB1未经纯化时具有致突变性和致癌性,纯化后致突变性大大减弱,但致癌性不变,提示HCB1的致突变性是由于产品不纯所致。HCB2具有致突变性但致癌性不能肯定。结论： 使用染发剂可以使部分血液系统恶性肿瘤的发病率增加。     

The Role of Angiogenesis in Neuroblastoma

Neuroblastoma (NB), a common pediatric neoplasm arising from neural crest cells, is characterized by a diversity of clinical behavior ranging from spontaneous remission to rapid tumor progression and death. Biologic and genetic factors have been identified which, to a certain extent, can predict prognosis and guide risk-based therapy. Recent research has focused on the role of angiogenesis in NB tumor biology and in determining clinical phenotype. Preclinical studies have explored the efficacy of antiangiogenic therapies as a novel treatment modality for children with NB. This review discusses the current understanding of angiogenesis in NB, the clinical implications, and future directions for antiangiogenic therapeutic strategies in NB.     

肿瘤家族史与卵巢恶性肿瘤发病的关系

目的 :探讨恶性肿瘤家族史与卵巢恶性肿瘤发病的关系。方法 :对 5 31例卵巢肿瘤患者的临床资料进行回顾性分析。结果 :良性卵巢肿瘤 4 35例 ,有恶性肿瘤家族史者 19例 ,占 4 37% ;恶性卵巢肿瘤 96例 ,有恶性肿瘤家族史者 11例 ,占 11 5 %。结论 :卵巢恶性肿瘤患者有恶性肿瘤家族史者发病率明显高于良性肿瘤患者     

Frailty in Hematologic Malignancy

Purpose of Review

Older adults with hematologic malignancy are a growing demographic. Estimating risk of chemotherapy toxicity based on age alone is an unreliable estimate of quality of life, functional capacity, or risk of treatment complications.

Recent Findings

Dedicated geriatric assessment tools can aid the clinician in identifying geriatric syndromes such as frailty, resulting in improved prognostication to decrease morbidity and mortality. Frailty is not synonymous with individual performance status and is dynamic.

Summary

Establishing the patient goals, values, and preferences is central to the consideration of malignant hematology decision process. Careful considerations of available data on the patient’s prognosis based on estimated life expectancy, geriatric assessment data, and age-specific cancer mortality, with and without treatment, can reconcile the risks and benefits. Assessments of frailty can aid the clinical feasibility and burden of the treatment to the patient and family in the context of each patient’s unique needs.

     

Hemostatic alterations in cancer patients

Summary Nearly all patients with cancer manifest laboratory evidence of hypercoagulability and some develop clinical thromboembolic disease (TED). Routine laboratory studies of blood coagulation have been performed in several large, prospective trials of the use of anticoagulant drugs in cancer treatment. The results of these studies, as well as data from several smaller studies of more sensitive tests of hypercoagulability [e.g. fibrinopeptide A (FPA); thrombin-antithrombin (TAT) complexes; prothrombin fragment F1+2)], indicate that the levels of some clotting proteins parallel disease activity. However, no studies of sound methodologic design have yet been performed to indicate that any of these tests of blood coagulation can serve as adequate predictors of TED in patients with cancer.In addition to the important role played by tumor-related procoagulants, several other mechanisms may be involved in the pathogenesis of thromboembolic events in patients with cancer, including stasis and endothelial damage. Considerable variability in the relative importance of these mechanisms in the pathogenesis of TED may exist among patients with different types of cancer.The risk for TED associated with surgical procedures in cancer patients is substantial and prophylactic antithrombotic therapy should be considered for most of these patients. Chemotherapy and hormonal therapy of cancer probably increases the likelihood of TED, particularly in those subjects with indwelling venous catheters. This risk has been particularly well-studied in patients with breast cancer treated with tamoxifen plus cytotoxic drugs. The pathogenic mechanisms may be complex but vascular injury is likely as a proximate cause of venous access catheter thrombosis and can be prevented with low dose coumadin therapy. The utility of low dose coumadin anticoagulation in reducing the risk for TED during breast cancer treatment is unknown but is currently being tested in a large, multiinstitutional study. Since chronic coumadin anticoagulation of cancer patients, and single pulse dose heparin prior to intravenous chemotherapy, both prevent thrombin generation, these agents may be of use in reducing the risk of chemotherapy-associated thrombosis. Prophylactic anticoagulation should be considered for high risk patients.     

恶性肿瘤与胰岛素抵抗

恶性肿瘤患者存在胰岛素抵抗(insulin resistance,IR),同时IR又是引起恶性肿瘤发生的诱因之一。监测恶性肿瘤患者中IR水平,有助于提高对肿瘤疗效及预后的判断,并有助于预防肿瘤。     

Thrombosis and Hemostatic Abnormalities in Hematological Malignancies

There is a paucity of data that pertain to thrombosis in patients with hematological malignancies. Recent studies showed that patients with lymphoma, multiple myeloma, and acute leukemia have an increased thrombotic risk, particularly at the time of diagnosis and during chemotherapy. We searched the PubMed database for articles on thromboembolic complications in patients with hematological malignancies published between 1996 and 2013. The incidence of thrombotic events is variable, and is influenced by the type and the stage of hematological malignancy, the antitumor therapy, and the use of central venous devices. The pathogenesis of thromboembolic disease in hematological malignancies is multifactorial. Tumor cell-derived procoagulant, fibrinolytic, or proteolytic factors, and inflammatory cytokines affect clotting activation, and chemotherapy and immunomodulatory drugs increase the thrombotic risk in patients with lymphoma, acute leukemia, and multiple myeloma. Infections might also contribute to the pathogenesis of the thromboembolic complications: endotoxins from gram-negative bacteria induce the release of tissue factor, tumor necrosis factor and interleukin-1b, and gram-positive organisms can release bacterial mucopolysaccharides that directly activate factor XII. In the setting of plasma cell dyscrasias, hyperviscosity, decreased fibrinolysis, procoagulant autoantibody production, inflammatory cytokines, acquired activated protein C resistance, and the prothrombotic effects of antimyeloma agents might be the cause of thromboembolic complications. Anticoagulant therapy is very complicated because of high risk of hemorrhage. Therefore, an accurate estimate of a patient's thrombotic risk is essential to allow physicians to target thromboprophylaxis in high-risk patients.     

The Role of Surgery in the Palliation of Malignancy

Surgery has always had an important role to play in the palliation of advanced malignancy and the advent of new techniques and procedures means that this role will continue to evolve. The field is not built on a strong evidence base, however, and the lack of consensus regarding definitions of palliative surgery and few validated outcome measures mean good prospective trials are difficult to carry out. In this review we propose a definition of palliative surgery from the literature and review the current role of surgical palliation in advanced malignancy. We discuss the central role of good decision-making and the influence of multidisciplinary working on this process. The barriers to carrying out research, both in surgery and in advanced cancer patient populations, are examined and the economic impacts considered.     

Angiogenesis in melanoma

The process of angiogenesis is crucial for progression and metastasis of the majority of solid tumors including melanomas. The current review summarizes existing knowledge of the mechanisms of angiogenesis in melanoma, as well as current anti-angiogenic therapeutic strategies and their targets. We focus primarily on the role of key growth factors that are secreted by melanoma cells and known to trigger angiogenic responses, and their receptors as expressed on both endothelial and melanoma cells. Many of these growth factors function in synergy with receptors for extracellular matrix, integrins, and matrix metalloproteinases (MMPs). All of these systems of molecules are activated during major stages of angiogenesis such as endothelial migration, proliferation, and reorganization of surrounding extracellular matrix. The blockade of these molecules and their downstream pathways leads to inhibition of melanoma vascularization. Thus, these classes of molecules are essential for melanoma angiogenesis and, therefore, might serve as promising targets for therapeutic intervention. Many recently developed compounds targeting key pathways in angiogenesis are in their final stages of clinical trials.