Her-2和胃癌诊疗进展

胃癌的治疗效果不佳,提倡个体化治疗,生物标记物是筛选个体化治疗的重要手段。人类表皮生长因子受体2(human epidermal growth factor receptor 2,Her-2)在胃癌组织中高表达,与胃癌的预后相关,可指导晚期胃癌的分子靶向治疗。Her-2状态还可能和晚期胃癌患者化疗敏感性相关,并可指导胃癌术后辅助治疗获益人群的筛选。     

多发性骨髓瘤的危险因素以及个体化治疗进展

多发性骨髓瘤是一种浆细胞来源的恶性血液肿瘤,具有较强的异质性.不同患者具有多样性的临床特征以及生物学特点,预后也有很大差异.对于其危险因素分析以及各种新型药物和移植的应用成为目前的研究热点.本文就目前多发性骨髓瘤的危险因素研究以及相应的个体化治疗进展进行综述.     

进展期胃癌术中腹腔温热化疗的疗效研究

目的：探讨术中腹腔温热化疗对进展期胃癌患者的疗效。方法：将同期收治的进展期胃癌患者随机分成腹腔温热化疗组（以下称治疗组）和对照组，治疗组在术中行腹腔温热化疗，对照组术后常规静脉途径化疗。对术后患者随诊，分析两组患者术后生存率、腹腔复发率。结果：治疗组1、3、5年生存率分别为89％、82％、45％；对照组1、3、5年生存率分别为77％、58％、36％。两组差异有显著性（P＜0．01）。治疗组腹腔复发率为6％；对照组腹腔复发率24％。具有显著性差异（P＜0．05）。两组毒副作用无关差异。结论：术中温热化疗可提高进展期胃癌患者生存率，预防腹腔复发，有广阔临床应用前景。     

一例胃低分化腺癌合并同时性多发性结直肠腺癌的MDT诊治

多学科综合治疗协作组（multi－disciplinary team,MDT）诊治模式符合精准医学和个体化治疗的准则,目前逐渐成为一种主流模式。这一模式能够弥补不同学科对疾病认识上的不足,提高医疗质量,并且能使患者利益最大化。本文总结本院诊治的1例罕见胃低分化腺癌合并同时性多发性结直肠腺癌患者的资料,通过治疗过程中多次MDT讨论,制定适合该患者的最佳诊断和治疗方案,体现出MDT诊治的优势,最终使患者获益。     

初发多发性骨髓瘤的治疗进展

多发性骨髓瘤（MM）是一种恶性浆细胞肿瘤。MM患者大多数年龄超过65岁,目前认为65岁以下初发MM患者的标准治疗为大剂量美法仑化疗支持的自体干细胞移植（ASCT）,而65岁以上老年MM患者的标准治疗至今仍认为是口服美法仑和泼尼松（MP）方案。但是一些新药的发明,如沙利度胺、雷利度胺和蛋白酶体抑制剂硼替佐米,能针对骨髓瘤细胞和骨髓微环境进行靶向治疗,联合使用在很大程度上能提高以往化疗方案的临床疗效。     

多发性骨髓瘤诊治进展

多发性骨髓瘤（Multiple Myeloma,MM）又称浆细胞骨髓瘤,是发生在骨髓的多灶性浆细胞恶性肿瘤。MM占所有恶性肿瘤的1％,血液系统恶性肿瘤的10％,在欧美国家已成为仅次于非霍奇金淋巴瘤的第二大常见血液系统恶性肿瘤。中老年人多发,至今尚不能完全治愈。但随着新的检测手段和新药的不断开发应用,多发性骨髓瘤的诊治及预后已发生了很大的改观,现综述如下。     

多发性骨髓瘤的治疗进展

目的 多发性骨髓瘤(mutciple myelome,MM)是血液系统恶性肿瘤,近年来,MM的治疗已经取得了显著的进展.一些新药沙利度胺、硼替佐米、雷利度胺的应用扩大了MM患者的治疗选择并改善了预后.大量的Ⅲ期临床实验已经表明了新药联合治疗移植和非移植患者的有效性,基于这些研究结果,标准的诱导方案已经受到挑战、甚至被取代.对于适合移植的患者,一些新的诱导缓解方案的有效性优于长春新碱+多柔比星+地塞米松(VAD)方案.同样,对于不适合移植的患者,联合这些新药的一线治疗也被证明优于传统的马法兰+泼尼松(MP)方案.现基于新药的联合治疗策略就MM的治疗进展进行综述.     

多发性骨髓瘤治疗现状及进展

 多发性骨髓瘤目前仍然是一种不可治愈的疾病,其主要治疗手段为化疗。一些新型靶向药物与传统化疗方案以及造血干细胞移植等治疗手段的联合极大地提高了治疗的完全缓解率,延长了患者的生存期。近年来,根据不同的危险因素和细胞遗传学、分子蛋白组学提供的信息进行分层,选择个体化治疗方案已经成为骨髓瘤治疗的趋势所在。     

同时性多发性肺良性肿瘤

本文报告５例同时性多发性肺良性肿瘤。女３例，男２例。年龄４８－６５岁，其中６０岁以上４例。主要临床症状为：胸痛３例，咳嗽、痰中带血２例，发热１例。结合文献对其临床特征、诊断和治疗进行了讨论。主要治疗手段是手术切除。手术要遵守保守性切除肿瘤、保护肺功能的原则。     

胃癌淋巴结转移的进展分析

规范联合淋巴结清扫范围和数目是取得胃癌治疗较佳疗效的保障,淋巴结转移数目联合阴性淋巴结数目能够提高胃癌患者预后评估准确性。最新研究表明:1）淋巴结转移的数目是目前最佳的评估胃癌预后的淋巴结转移分期方式;2）规范的淋巴结清扫应该遵从清扫范围达到D2而清扫淋巴结数目不低于15枚;3）阴性淋巴结数目是一个新的评估胃癌患者预后的重要指标。本文针对淋巴结转移在胃癌治疗效果和预后评估中的新进展和观点作一适于临床胃癌诊治的概述。      

多原发肺癌诊治新进展

近年来,多原发肺癌（MPLC）的发病率逐渐上升,但目前尚无诊断MPLC的金标准,尤其当多发病灶病理类型相同时,与肺内转移癌的鉴别仍较困难。因此需综合考虑组织学类型、影像学特征、临床表现及分子遗传学特点。新诊断技术的出现为MPLC的正确诊断作了重要补充。MPLC应将多发病灶单独分期,治疗以手术为首选,预后较好。本文通过总结最新的文献进展,结合本院对MPLC的诊治体会作如下综述。     

Clinical picture, diagnosis and treatment of multiple primary synchronous cancer of the large intestine

Clinical course and procedures for diagnosis of primary multiple synchronous cancer of the colon are discussed on the basis of the data on 52 patients treated at the Institute's Clinic in 1962-1986. In 30.5%, these tumors were accompanied by single or multiple polyps of the colon. A significant role of endoscopy in the diagnosis was demonstrated. As a result of complex examination of the organ, a correct preoperative diagnosis of multifocal cancer was made in 48.1% of patients. Tumor multiplicity was established intraoperatively in 14 cases, at autopsy--in 2 (3.8%) and in the course of gross and histologic examination of the resected material--in 11 patients. Laparoscopy proved effective in 81.8%. Surgery is the major procedure for treatment of these tumors. Radical operation was carried out in 36 cases. The postoperative lethality rate was 13.9%. In the radical surgery group, 3-year survival was 61.7%.     

Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery

Background

In the preoperative evaluation for gastric cancer, high-resolution endoscopic technologies allow us to detect small accessory lesions. However, it is not known if the gastric remnant after partial gastrectomy for synchronous multiple gastric cancers has a greater risk for metachronous cancer. The purpose of this study was to determine the incidence of metachronous cancer in this patient subset compared with that after solitary cancer surgery.

Methods

Data on a consecutive series of 1,281 patients gastrectomized for early gastric cancer from 1991 to 2007 were analyzed retrospectively. The 715 gastric remnants after distal gastrectomy were periodically surveyed by endoscopic examination in Shikoku Cancer Center. Among those surveyed cases, 642 patients were pathologically diagnosed with solitary lesion (SO group) and 73 patients with synchronous multiple lesions (MU group) at the time of the initial surgery.

Results

In the follow-up period, 15 patients in the SO group and 3 patients in the MU group were diagnosed as having metachronous cancer in the gastric remnant. The cumulative 4-year incidence rate was 1.9 % in the SO group and 5.5 % in the MU group. The difference did not reach the significant level by the log-rank test.

Conclusions

The incidence of metachronous cancer is higher after multiple cancer surgery; however, the difference is not statistically significant.     

胃癌治疗进展

胃癌目前仍是第二大癌症死因,总生存率为15%～20%.手术仍然是可切除胃癌的根治性治疗手段,近来的meta分析表明辅助放化疗可使患者临床受益,但辅助化疗作为常规治疗还缺乏结论性的证据.新辅助化疗对局部晚期胃癌降低分期是可行的,进一步研究正在进行中.对于晚期胃癌,姑息化疗可使中位生存期提高到7.5～12个月.含CPT-11、紫杉类的化疗方案能进一步提高化疗有效率,化疗联合新靶向治疗药物将为胃癌的治疗开辟另一途径.     

Clinicopathological analysis of synchronous multiple gastric carcinoma

Clinicopathological analysis was performed on 839 cases surgically resected for gastric carcinoma. The incidence of multiple gastric carcinoma was 4.8% (40 cases, 97 lesions). Multiple carcinoma was more frequently observed in early than in advanced carcinoma (P less than 0.01). The rate of intestinal type lesions was significantly (P less than 0.01) higher in multiple than in single gastric carcinoma, and all of the intestinal type carcinoma correlated with intestinal metaplasia, which is assumed to be closely related to pyloric and atrophic fundic gland area. Eight cases (20.0%) of multiple carcinoma were both in the upper one-third and lower one-third of the stomach. Twenty-nine (51.9%) of the accessory lesions were not detected pre-operatively; 12 (21.1%) of them were detected only by postoperative histology. Twelve (48.0%) of 25 early cancerous foci located in the anterior wall and greater curvature were overlooked before operation. These results indicate that the whole stomach must be carefully examined to detect accessory carcinoma before gastric surgery, especially for intestinal type carcinoma, with greater attention paid to the anterior wall and greater curvature, and that complete removal of the pyloric and atrophic fundic gland area would be required for distal gastrectomy.     

晚期胃癌内科治疗的研究进展

目的:总结晚期胃癌内科治疗发展历程及研究现状,探讨其治疗发展方向及最新动态。方法:应用Medline、PubMed及CNKI期刊全文数据库探索系统,以"晚期胃癌化疗、靶向治疗和二线"等为关键词,检索2000-2010年的相关文献,共检索到英文文献245条。纳入标准:1)胃癌治疗发展;2)晚期胃癌一线治疗;3)晚期胃癌二线治疗;4)长期生存获益;5)晚期胃癌靶向治疗。根据纳入标准,符合分析的文献35篇。结果:胃癌内科治疗发展缓慢,随机试验的Meta分析表明,一线联合化疗可以获益,但仍无统一的标准方案。对于适当的胃癌患者可以考虑给予二线治疗。随着靶向药物治疗胃癌研究的深入,尤其是抗血管生成及抗HER-2药物的加入,晚期胃癌的治疗前景逐渐广阔。结论:大多数晚期胃癌患者有机会接受一线治疗,当前的联合方案有更好的耐受性,治疗效果亦有所改善。分子靶向药物临床试验成效可喜,但最终靶向治疗联合化疗的治疗地位仍需大型多中心随机临床试验来验证。     

胃癌的诊断与治疗进展

近年来有关胃癌的基础和临床科研均取得一定的成果,作者就此对胃癌的诊断和治疗进展做一综述.     

胃癌新辅助治疗的研究进展

胃癌是全球常见的恶性肿瘤之一,我国是胃癌高发地区,大多数患者在确诊时已处于进展期,此时胃癌根治性切除率低,且单纯的手术治疗即使进行根治性切除,预后仍较差。目前,为提高胃癌根治性切除率,改善胃癌预后,胃癌的治疗手段不再局限于单纯的手术治疗,进展期胃癌术前的新治疗模式已经出现,如新辅助化疗、新辅助放化疗、新辅助化疗联合靶向治疗等,这些治疗模式统称为新辅助治疗。新辅助治疗已逐渐成为进展期胃癌治疗的新方向,新辅助治疗可以使肿瘤降期并提高R_0切除率,降低局部复发率,从而改善预后,且越来越多的临床研究证明了新辅助治疗提高根治性切除率和改善预后的可行性。现对胃癌新辅助治疗的进展情况作一综述。