甲状腺微小乳头状癌预后指标的研究

近年来,甲状腺乳头状癌( papillary thyroid carcino-ma,PTC)发病趋势呈全球化激增,其中甲状腺微小乳头状癌( papillary thyroid microcarcinoma ,PTMC)所占比重逐渐上升[1]. 甲状腺乳头状微小癌( papillary thyroid microcarcinoma ,PTMC)是指直径≤1.0 cm、无论有无淋巴结转移或远处转移的PTC. 一般认为PT-MC的恶性程度较低,总体预后良好. 但另一方面却有极少数PTMC的临床表现的乳头状癌,显示出侵袭性的临床病理特点,如伴有颈部淋巴结的转移(可巨大)及复发等,造成临床治疗方案的不统一及争议[2].     

1 401 例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析*

目的:探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）患者的临床病理特征及中央区淋巴结转移的危险因素。方法:回顾性分析2014年1 月至2014年12月天津医科大学肿瘤医院甲状腺颈部肿瘤科收治的1 401 例具有完整病例资料的甲状腺微小乳头状癌患者临床病理特征,应用χ2检验和多因素Logistic回归模型分析中央区淋巴结转移的危险因素。结果:临床病理特征方面,PTMC 男女性别比约1:3.4,其中央区淋巴结转移率为30.5% 。单因素分析显示发病年龄（χ2= 14.587,P < 0.01）、性别（χ2= 21.636,P < 0.01）、原发灶数目（χ2= 35.505,P < 0.01）、肿瘤最大直径（χ2= 58.868,P < 0.01）、肿瘤位置（χ2= 8.385,P < 0.05）及被膜外/ 腺外侵犯（χ2= 26.481,P < 0.01）均与中央区淋巴结转移有显著性差异。肿瘤处于甲状腺下极时,中央区淋巴结转移率最高（48.1%）。 多因素Logistic回归分析显示男性、年龄< 45岁、肿瘤直径> 6 mm、被膜外/ 腺外侵犯及双侧多发癌灶为PTMC 患者中央区淋巴结转移的独立危险因素。结论:具备男性、年龄< 45岁、肿瘤直径> 6 mm、腺外侵犯及双侧甲状腺受累等特征的PTMC 患者较易发生中央区淋巴结转移,建议行预防性中央区淋巴结清扫。      

甲状腺微小乳头状癌热消融技术研究进展及现状分析

甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）广义上指最大直径＜10 mm的乳头状癌。随着检查技术及水平的提高,甲状腺癌的检出率逐渐增加,并且PTMC在甲状腺乳头状癌（papillary thyroid carcinoma,PTC）中的构成比越来越高。目前针对PTMC,尤其是低危PTMC的治疗决策争论不断,但是精准化、微创化、个体化的治疗方式是目前的发展趋势。     

甲状腺微小乳头状癌：选择手术还是非手术主动监测？

甲状腺癌发病率逐年增加，新增病例中绝大多数为甲状腺乳头状癌，其中约一半为甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）。外科治疗是甲状腺乳头状癌主要治疗手段。甲状腺乳头状癌因其可治疗性和相对较好的生存率而被称为“良癌”或者“惰性癌”。特别是甲状腺微小乳头状癌，绝大多并不危及患者生命，因此，在过去的十年中出现了一种替代的管理方法，即“主动监测（active surveillance, AS）”，也有研究者称之为“延迟或延迟手术”，在监视过程中发现肿瘤进展就需要积极手术。外科手术和AS有各自优缺点，特别是AS的实施，本文就PTMC实施AS作简要介绍，以供临床工作者参考。     

对低危甲状腺微小乳头状癌主动监测的研究动态和新认识

随着超声诊断技术的广泛应用,甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)检出率上升,但是大多数低危PTMC的临床意义有限.为避免过度治疗,日本学者率先提出对低危PTMC可以通过主动监测而非直接手术的方式进行管理.这一理念提出至今已近30年,期间多国研究数据的积累使PT...     

228例甲状腺微小乳头状癌临床特征及颈部淋巴结转移危险因素分析

背景与目的：甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）的发病率不断增加,总体预后较好,但在临床诊治过程中存在争议。通过分析患者资料,总结PTMC的临床特征及危险因素,以指导临床精准治疗。方法：回顾性分析蚌埠医学院第一附属医院2015年1月—2017年12月间行手术治疗的PTMC患者的临床病理学资料。结果：在228例患者中,109例发生中央区淋巴结和（或）颈侧区淋巴结转移（47.81%）,单因素分析结果显示,患者性别、年龄、肿瘤最大径及原发灶数目与颈部淋巴结转移相关（P均＜0.05）;二元logistic多因素分析结果显示,男性患者、年龄＜45岁、肿瘤最大径>4 mm及多中心病灶是PTMC颈部淋巴结转移的独立危险因素（P均＜0.05）。结论：PTMC虽然肿瘤较小但不等同于淋巴结转移风险小,特别对于男性患者、年龄＜45岁、肿瘤最大径>4 mm及多中心病灶患者应积极进行外科手术干预。     

彩色多普勒超声诊断甲状腺微小癌的临床价值

甲状腺微小癌(thyroid microcarcinoma,TMC)病灶小,发病隐匿,常因其他甲状腺疾病行手术治疗或出现颈部淋巴结转移而明确诊断。我们总结32例TMC临床资料,旨在探讨彩超对TMC的诊断价值。1临床资料1.1一般资料我院1988年1月~2005年1月共收治手术切除的TMC患者32例,男7例,女25例。年龄23~62岁,平均年龄41岁,中位年龄40岁。乳头状癌29例,髓样癌2例,滤泡状癌1例。1.2诊断方法采用美国产AspenTM彩色超声诊断仪,L7线阵探头,频率5~10MHz。患者取仰卧位,充分暴露颈部,首先用二维超声对甲状腺进行全面检查,确定结节的数目、位置,并仔细观察其大…     

甲状腺微小癌的诊断与治疗进展

甲状腺癌是头颈部较为常见的恶性肿瘤之一,占全身肿瘤的0．2％（男性）～1．0％（女性）。1928年Graham首次报道了关于静息甲状腺癌的临床概念后,关于甲状腺癌的研究日渐增多。甲状腺微小癌（ thyroid micro carcinoma,TMC）的概念也逐渐被各国学者熟知。甲状腺微小癌是指甲状腺癌肿直径小于或等于10 mm的甲状腺癌［1］。以往,TMC患者大多因其他甲状腺疾病进行手术治疗,在术后常规病理检查中被偶然发现,甚至有些患者在因其他疾病死亡后的尸检中发现。世界各地尸检中TMC的发现率为1．5％～35．6％。以前部分学者认为,甲状腺微小癌因其癌灶直径较小,与直径较大的甲状腺癌相比,其侵袭性较低,故对其的治疗应采用临床观察等相对保守的方法［2］。近年来,随着超声技术的进步、细针穿刺病理学技术的发展以及人们对甲状腺疾病重视程度的增加, TMC的检出率明显上升。但是,对于TMC的治疗方法尚无统一标准,因此这一问题成为近些年的研究热点。与其他恶性肿瘤相似,甲状腺微小癌的病因仍不是很明确,目前普遍认为其发病可能与放射线接触史、体内碘水平异常、遗传因素以及基因突变等因素有关。甲状腺癌有不同的病理类型及生物学特点,甲状腺微小癌亦是如此,其病理分型包括乳头状腺癌、滤泡状腺癌、髓样癌及未分化癌。甲状腺微小癌的特点是起病缓慢、隐匿,可长期处于无进展的亚临床状态,也可与其他甲状腺疾病共存,易误诊、漏诊。但是,也有部分TMC表现出恶性肿瘤的特点,癌细胞分化不成熟、浸润破坏器官的结构和功能,并且可以发生转移。 TMC主要的转移途径为淋巴结转移,第一站多为颈部Ⅵ区淋巴结,即中央组,一旦发生转移,患者多出现颈部淋巴结肿大等临床症状,此时多需要进行手术治疗。 Andreas等［3］关于甲状腺微小髓样癌生物相关性的研究中得出甲状腺微小髓样癌有较高的淋巴结转移风险。甲状腺微小癌整体发病率不断攀升的大背景下,乳头状微小癌比例的上升尤为突出。未来,我们将会面临更多的微小癌患者,所以,对于TMC的诊断及治疗应予重视。利用更加先进的技术手段,如基因诊断细化其危险分层,制定更加合理的（积极或保守）个体化治疗方案。     

BRAFV600E基因突变与甲状腺微小乳头状癌淋巴结转移的相关性研究

目的:探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）发生淋巴结转移是否与BRAFV600E基因突变相关。方法:回顾性分析行手术治疗的55例甲状腺微小乳头状癌有淋巴结转移（A组）和70例甲状腺微小乳头状癌无淋巴结转移（B组）的患者，用免疫组化对其肿瘤组织及转移性的淋巴结进行BRAFV600E基因突变蛋白检测并通过统计学分析甲状腺微小乳头状癌淋巴结转移与BRAFV600E基因突变的相关性。结果:A组总的BRAFV600E基因突变率（69.1%）、右侧PTMC（78.3%）、双侧PTMC的突变率(83.3%)要分别高于B组(37.1%、26.7%、42.9%)（P值均＜0.05），但强阳性率（23.6%）和左侧PTMC的突变率（50.0%）与B组（11.4%、46.2%）相比无统计学差异（P值均＞0.05）。A组组内淋巴结转移灶BRAFV600E基因突变率无论PTMC在左侧（72.2%）、右侧（92.0%）或双侧（91.7%）的阳性率和强阳性率（30.9%）上与原发灶（50.0%、78.3%、83.3%、23.6%）均无差异（P＞0.05），但总的突变率，前者（85.5%）要高于后者（69.1%）（P＜0.05）。结论:BRAFV600E突变是导致PTMC早期发生淋巴结转移的重要因素之一，术前或术后通过各种方法测得的BRAFV600E突变阳性预示着淋巴结转移的高风险。     

Personalized Cancer Treatment for Ovarian Cancer

Recently there have been numerous advances in understanding the genetic basis of cancer which have resultedin more appropriate treatments. In this paper we describe the experience of the Burzynski Clinic, involved intreatment of numerous patients based on personalized approach using novel combinations for difficult-to-treatmalignancies, with gynecological cancers. This retrospective study was conducted by extracting data fromBurzynski Clinic’s medical records and comprehensive review. Among the advanced refractory ovarian cancerscases (N=33), an objective response (OR) was found in 42.4%. We anticipate that with improved technology andnovel therapeutics this rate will increase and adverse events will be reduced.     

肿瘤干细胞与肿瘤转移

肿瘤干细胞和其微环境住肿瘤形成、浸润性生长和转移灶形成等各步骤均具有关键性作用。阐明其相互作用的分子机制，可为肿瘤转移的诊断、治疗和预后，提供可靠的分子标志和靶点：文章主要就以上进行综述。     

Esophageal Cancer Associated with Gastric Cancer

Among a total of 1,137 patients with esophageal cancer, therewere 44 cases of esophageal cancer associated with gastric cancer,an incidence of 3.9%. The majority of the patients were between60 and 70 yr old. Forty-two patients were male and two werefemale. Eleven of these patients had a third cancer. Six had multiplecancers in the esophagus and/or stomach. Eighteen patients hadearly gastric cancer. Thirty-two of the cancers were synchronousand 12 were metachronous. Of these 44 patients, 21 had familyhistories of cancer, 37 were smokers, and 36 were drinkers.Twenty-five patients received surgery for all of their cancers,and two patients received resection of only esophageal cancer.Of these 27 patients. five patients lived more than 5 yr. Themost frequent cause of death in our series was esophageal cancer(52.9%). Surgical treatment of all of the cancers is desirable. Whenthis is impossible, the surgery must be emphasized for the esophagealcancer in most cases.     

Europe Against Cancer: Cancer Week UK

Since the beginning of the Europe Against Cancer (EAC) programme in 1989, much support and emphasis has been given to informing both health professionals and the public about cancer. This has come from the government and the many cancer-related charities and organizations. A week focused on cancer throughout the European Union (EU) has been encouraged each October. This paper describes the gradual development of these weeks to provide a more planned, co-ordinated and evaluated strategy. Collaboration with European partners is also addressed, emphasizing the positive benefits of such activities. Finally, the issue of monitoring and evaluation is addressed in some detail.     

National Cancer Institute Prostate Cancer Genetics Workshop

Compelling evidence supports a genetic component to prostate cancer susceptibility and aggressiveness. Recent genome-wide association studies have identified more than 30 single-nucleotide polymorphisms associated with prostate cancer susceptibility. It remains unclear, however, whether such genetic variants are associated with disease aggressiveness--one of the most important questions in prostate cancer research today. To help clarify this and substantially expand research in the genetic determinants of prostate cancer aggressiveness, the first National Cancer Institute Prostate Cancer Genetics Workshop assembled researchers to develop plans for a large new research consortium and patient cohort. The workshop reviewed the prior work in this area and addressed the practical issues in planning future studies. With new DNA sequencing technology, the potential application of sequencing information to patient care is emerging. The workshop, therefore, included state-of-the-art presentations by experts on new genotyping technologies, including sequencing and associated bioinformatics issues, which are just beginning to be applied to cancer genetics.     

干细胞、癌症与癌症干细胞

干细胞被认为是一种未分化的细胞,具有永远增殖和自我更新能力.大量研究证明,癌症中存在对化疗更具抵抗性的癌症干细胞.识别癌症干细胞和普通癌症细胞之间的差异,可以发展更有效的癌症分类、诊断和治疗方法.     

American Cancer Society Colorectal Cancer Survivorship Care Guidelines

Answer questions and earn CME/CNE Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two‐thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short‐term and long‐term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long‐term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk‐based health care for CRC survivors who have completed active therapy. CA Cancer J Clin 2015;65:427–455 . © 2015 American Cancer Society.