食管鳞癌中Survivin和Nm23-h1表达及其联合检测的临床意义

目的：探讨Survivin与Nm23-h1基因在食管鳞状细胞癌、癌旁组织、正常组织中的表达情况及其联合检测与淋巴结转移的关系。方法：采用免疫组化sP法观察78例食管鳞癌手术切除标本,30例食管鳞癌切除标本断端（距肿瘤〉5cm）和食管鳞癌切除标本断端（距肿瘤〈2cm）30例的石蜡标本切片中Survivin和Nm23-h1的表达情况,分析其与临床病理特征的关系。结果：Survivin在食管鳞癌组织,癌旁组织,正常组织的阳性表达率分别为70．51％,20．0％,6．67％,有显著性差异（P=0．001）。Nm23-h1在食管鳞癌组织,癌旁组织,正常组织的阳性表达率分别为60．26％,80．00％,96．67％,有显著性差异。（P=0．001）。Survivin表达与肿瘤分化程度、TNM分期、淋巴结转移相关（P〈0．05）。Nm23-h1表达与患者的TNM分期、淋巴结转移相关（P〈0．05）。Survivin阳性率与淋巴结转移呈正相关（P=0．008）,nm23-h1阳性率与淋巴结转移呈负相关（P=0．001）。Survivin与nm23-h1呈低度负相关（P=0．001）,在促进肿瘤的进展和转移过程中起联合作用。结论：Survivin蛋白的抑制凋亡作用和nm23蛋白的抑制转移作用可能在食管鳞癌的发生、发展过程中起重要作用,联合检测是判断食管鳞癌患者淋巴结转移倾向及预后的重要指标。     

食管鳞癌中bcl-2与nm23-h1基因表达情况与纵隔淋巴结转移的相关研究

目的：研究与探讨bcl-2基因与nm23-h1基因在食管鳞状细胞癌中的表达情况及其与纵隔淋巴结转移的关系。方法：采用免疫组化SP法观察了85例食管鳞癌手术切除标本切片中bcl-2和nm23-h1的表达。结果：63．53％（54／85）肿瘤呈bcl-2阳性表达，bcl-2表达与肿瘤淋巴结转移及TNM分期有关（P均〈0．05）。40％（34／85）肿瘤呈nm23阴性表达，nm23-h1阴性表达与肿瘤侵润深度、淋巴结转移、TNM分期有关（P分别为0．032、0．001、0．001）。单因素分析显示：bcl—2基因与nm23-h1基因表达为影响淋巴结转移的主要因素（OR值分别为6．985、0．014，P〈O．001）。而其他临床病理学参数与淋巴结转移之间未见明显相关（P均〉0．05）。bcl-2基因与nm23-h1基因表达之间呈负相关（0=-0．3849，P〈0．05），在促进肿瘤的进展和转移过程中起联合作用。结论：bcl-2基因与nm23-h1基因联合测定是判断食管鳞癌患者淋巴结转移倾向及预后的一个重要手段。     

食管鳞癌nm23-H1蛋白表达及DNA倍体与淋巴结转移关系

目的研究食管鳞癌nm23-H1蛋白表达及DNA倍体状态与区域淋巴结转移的关系.方法应用流式细胞仪检测食管癌患者新鲜手术标本包括食管癌组织(癌)、食管癌旁粘膜(癌旁)、食管正常粘膜(切缘)及食管癌区域淋巴结(淋巴结)中nm23-H1蛋白表达水平及DNA倍体状态.结果无论有、无淋巴结转移,nm23-H1蛋白表达在癌与癌旁、癌与切缘之间差异有显著性(P＜0.05),癌与淋巴结之间差异无显著性(P＞0.05);DNA指数(DI)在癌组织与癌旁、切缘、淋巴结之间比较差异均有显著性(P＜0.05),癌旁、切缘、淋巴结之间DI差异无显著性(P＞0.05);nm23-H1蛋白表达在有、无淋巴结转移两组对应组织间比较差异均有显著性(P＜0.05);两组对应组织比较DI差异无显著性(P＞0.05);DI在不同病理分级间差异有显著性(P＜0.05),DI及nm23-H1蛋白表达在性别、肿瘤部位、病理类型、浸润深度间差异无显著性(P＞0.05).结论nm23-H1蛋白高表达对食管癌转移有一定的抑制作用,结合DNA倍体检测有助于了解食管鳞癌的生物学行为和预后判断.     

nm23H1和S100A4基因表达与食管鳞癌发生发展的关系

目的:探讨nm23H1、S100A4基因的表达与食管鳞癌发生发展的关系。方法:在60例食管鳞癌及20例正常食管黏膜组织中,SP法检测nm23H1、S100A4基因的表达,并结合肿瘤的病理生物学行为进行分析。结果:nm23H1基因的表达阳性率在食管鳞癌组织(51·7%,31/60)中明显低于癌旁正常组织(80·0%,16/20),其表达与肿瘤的浸润(P=0·015)、淋巴结转移(P=0·009)有关;S100A4基因的表达阳性率在食管鳞癌组织(43·3%,26/60)中明显高于癌旁正常组织(15·0%,3/20),其表达与肿瘤的分化(P=0·013)、浸润(P=0·019)、淋巴结转移(P=0·007)有关;在食管鳞癌组织中2种基因的表达呈负相关,r=-0·505,P<0·01。结论:nm23H1及S100A4基因可作为食管鳞癌早期诊断及评估预后的客观指标。     

LSD1和EZH2蛋白表达与食管鳞癌术后预后相关性分析

目的 表现遗传学是当前肿瘤生物学研究的热点,本研究探讨食管鳞状细胞癌癌组织中组蛋白赖氨酸特异性脱甲基酶1 (lysine specific demethylase 1,LSD1)和Zeste基因增强子(enhancer of zeste homolog 2,EZH2)的蛋白表达与术后预后的相关性.方法 收集2008-05-07-2009-8-20在安阳市肿瘤医院胸外科行食管癌根治术的食管鳞癌患者85例.选取食管鳞癌组织85例,淋巴结转移癌组织30例,癌旁组织30例.免疫组织化学法检测食管鳞癌组织、淋巴结转移癌组织、癌旁组织中LSD1和EZH2蛋白表达.采用x2检验分析LSD1和EZH2蛋白表达与临床病理特征的关系;Spearman法分析LSD1和EZH2两者的相关性;Kaplan-meier法和Logrank-test检验分析LSD1和EZH2蛋白表达与术后总生存期(overall survival,OS)和无进展生存期(progression free survival,PFS)的关系,Cox模型多因素预后分析.结果 LSD1在食管鳞癌组织和淋巴结转移癌组织中的高表达率分别为64.7％ (55/85)和70.0％(21/30);癌旁组织均为少量阳性表达(低表达),主要位于增殖较旺盛的鳞状上皮基底部;LSD1在食管鳞癌组织、淋巴结转移癌组织的表达均高于癌旁组织(P＜0.001,P=0.001),食管鳞癌组织与淋巴结转移癌组织中的表达差异无统计学意义,P=0.598.EZH2在食管鳞癌组织、淋巴结转移癌组织和癌旁组织中的高表达率分别为62.3％(53/85)、76.7％ (23/30)和20.0％ (6/30);EZH2在食管鳞癌组织、淋巴结转移癌组织的表达均高于癌旁组织(P＜0.001,P=0.001),食管鳞癌组织与淋巴结转移癌组织中的表达差异无统计学意义,P=0.155.Spearman相关分析显示,LSD1和EZH2蛋白表达存在正相关,r=0.239,P=0.028.LSD1蛋白表达水平与pT分期(P=0.007)和分化程度(P=0.021)相关.EZH2蛋白表达水平与pT分期(P=0.022)、pN分期(P=0.046)和分化程度(P=0.018)相关.单因素分析显示,LSD1高表达患者的mOS和mPFS均低于低表达患者,均P＜0.001.EZH2高表达患者的mOS和mPFS均低于低表达患者,均P＜0.001.亚组分析LSD1和EZH2同时高表达患者的中位总生存期(median overall survival,mOS)和中位无进展生存期(median progress free survival,mPFS)均低于非LSD1和EZH2同时高表达患者,均P＜0.001.多因素分析显示,LSD1表达为独立的PFS预后指标,P=0.005;EZH2表达为独立的OS和PFS预后因素(P=0.003,0.014).结论 LSD1和EZH2在食管鳞癌组织和淋巴结转移癌组织中表达上调,高表达的患者与术后不良预后有关.     

食管鳞状细胞癌中Survivin与Smac蛋白的表达及临床意义

目的:研究Survivin和Smac蛋白在食管鳞状细胞癌组织及其对应正常组织中的表达情况,以及与临床生物学指标的关系。方法:运用Western blot检测Survivin和Smac在42例食管鳞癌患者标本中的表达量,分析蛋白表达与患者临床资料的关系。结果:Survivin在食管鳞癌中的表达较正常组织高(t=25.733,P<0.05),Smac在癌旁正常组织的表达高于食管癌组织(t=7.510,P<0.05),且都有显著性差异。二者在肿瘤组织中的含量与肿瘤分化程度及淋巴结转移有关(P<0.05)。Survivin和Smac蛋白在肿瘤组织中表达呈负相关(r=-0.407,P=0.008)。结论:Survivin和Smac蛋白在食管鳞癌组织中表达异常,提示两者参与了食管鳞癌的发生发展和肿瘤转移。     

食管癌组织中Survivin和Bcl-2的表达与血管新生的关系

目的:探讨Survivin和Bcl-2基因的表达及其MVD测定在食管癌组织中的意义。方法:采用免疫组化方法检测61例食管鳞癌手术切除标本及癌旁组织的Survivin、Bcl-2和MVD。结果:食管鳞癌组织Survivin阳性表达率为60·7%(37/61),Bcl-2为65·6%(40/61),MVD值为(42·1±13·3)/HP。Survivin表达与淋巴结转移相关,P=0·0206;Bcl-2表达与肿瘤分化程度(P<0·01)和淋巴结转移(P=0·0316)相关。Survivin和Bcl-2的表达存在显著正相关,P<0·01。MVD与食管癌的淋巴转移和临床TNM分期密切相关,P<0·01。Survivin阳性组MVD高于阴性组,食管癌的Survivin表达与MVD密切相关,r=0·4052,P=0·0016。结论:Survivin和Bcl-2的表达以及MVD的测定可以作为判断食管癌恶性潜能的重要生物学指标。     

微管不稳定蛋白Stathmin在食管鳞癌组织中的表达及意义

目的 探讨Stathmin蛋白在食管鳞癌组织中的表达及意义.方法 收集新乡医学院2006年4月至9月期间食管鳞癌切除标本及其相应癌旁组织31例,以免疫组织化学法检测Stathmin蛋白在所取标本中的表达情况.结果 在31例食管鳞癌标本中,Stathmin蛋白表达阳性的标本为23例,阳性率为74.2%,阳性颗粒可见于细胞质;分别按年龄、性别、组织类型、分化程度、淋巴结转移、肿瘤浸润深度及TNM分期将31例食管癌标本分组,Stathmin蛋白表达差异有统计学意义的因素有分化程度、淋巴结转移、肿瘤浸润深度及TNM分期(P＜0.05).结论 食管鳞癌组织中Stathmin蛋白高表达,其表达与食管鳞癌的分化程度、淋巴结转移、肿瘤浸润深度及TNM分期显著相关,Stathmin蛋白可能为人食管癌的生物治疗提供一个新靶点.     

非小细胞肺癌Survivin和Skp2的表达及其临床意义

目的 检测Survivin和Skp2蛋白在非小细胞肺癌中的表达,探讨其相互关系及临床意义.方法 用实时定量PCR的方法检测30例非小细胞肺癌组织及其对应的癌旁组织中survivin mRNA的表达,应用免疫组织化学法检测50例非小细胞肺癌组织中Survivin和Skp2的表达,统计Survivin与病理特征及Skp2的关系.结果 76.7%(23/30)肿瘤组织survivin mRNA表达量明显高于对应的癌旁组织.Survivin蛋白在癌组织的阳性表达率(74.0%)显著高于癌旁组织(16.7%),χ2=25.9,P<0.001.Skp2在非小细胞肺癌组织中的阳性表达率(70.0%)也显著高于癌旁组织(20.0%),χ2=18.8,P<0.001).Survivin表达与非小细胞肺癌的病理类型、分化程度、肿瘤分期以及是否有淋巴结转移无统计学意义的相关性(P>0.05).Survivin表达与Skp2表达呈正相关(χ2=8.32,P<0.05).结论 Survivin在肺癌组织中高表达,其阳性表达率与肿瘤病理类型、肿瘤分期、细胞分化程度和淋巴结转移无明显相关性,与Skp2表达呈正相关.     

食管鳞癌组织Survivin mRNA和蛋白表达的临床意义

目的:研究食管鳞癌组织中SurvivinmRNA与蛋白表达的相互关系,探讨两者在食管鳞癌发生和发展中的作用.方法:采用原位杂交技术检测30例食管鳞癌及相应的癌旁组织中Survivin mRNA的表达,同时采用免疫组织化学SP法检测相应标本中Sur-vivin蛋白的表达.结果:在食管鳞癌和相应的癌旁组织中Survivin mRNA表达的阳性率分别为66.7%和10.0%,Survivin蛋白表达的阳性率分别为76.7%和16.0%.食管鳞癌组远高于癌旁组,差异有统计学意义,P<0.01.Survivin mRNA与蛋白在食管鳞癌组织中的阳性表达具有一致性(P>0.05),其阳性率高低与性别、年龄、肿瘤大小无关,而与组织学分级、淋巴结转移、TNM分期有关.结论:Sur-vivin基因的异常表达可能对食管鳞癌的发生和发展起重要作用.     

Experience in the treatment of synchronous and metachronous carcinoma of the oesophagus and the head and neck

BACKGROUND AND OBJECTIVES: Treatment of multiple primary squamous cell carcinomas of the head and neck and oesophagus is controversial. The poor prognosis of these 2 types of carcinoma taken individually and their anatomic proximity complicate the therapeutic strategy and limit the treatment choices for each location. METHODS: From 1986 to 1998, 43 patients received curative treatment for multiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of the oesophagus and head and neck. For synchronous cancers, the therapeutic strategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. RESULTS: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectomies were performed. The postoperative mortality rate was 9.3% (4/43). The rate of anastomotic leakage was 30% (13/43), and all such leaks were cervical. Pulmonary infection occurred in 19% of cases (8/43). A past history of cervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagectomy did not affect the functional results in the 31 patients whose larynx could be preserved. CONCLUSIONS: Oesophagectomy after head and neck cancer treatment is possible with a low mortality rate and acceptable morbidity.     

Clinicopathological study of carcinomas of the lip and the mucosa of the upper and lower lips

BACKGROUND: Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. METHODS: Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. RESULTS: Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. CONCLUSION: We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival.     

The relation between the aging of the steroid generating system and the geneses of cancers of the stomach, the breast and the uterine cervix

The purpose of the present study is to test the validity of the steroid carcinogenesis hypothesis in humans by investigating the problem whether or not a cancer-specific change of the hormonal milieu emerges at a specified stage of life where the growth rate of cancer risk is at its zenith. A case-control study of 14 urinary steroid excretions was conducted for each of 3 human neoplasias. The identification and the size (in parenthesis) of the population units used in this study were,given as follows: a) the male gastric cancer group (421); b) the male control group (104); c) the female breast cancer group (245); d) the cervical cancer group (345); e) the female control group (127). Two kinds of steroid parameters were employed for the statistical analysis of hormonal data: a) the logarithm of a steroid excretion figure (mu g/day), as expressed by log x; b) the logarithm of a relative weight of a given steroid to tetrahydrocortisol, as expressed by log x/THF. The case-control difference for each parameter was expressed in terms of a t-value of Student's t-test. The steroid deviation profile was prepared for each neoplasia and for each of the log x data set and the log x/THF data set. The results obtained are as follows: a) the 2 steroid parameters (log x and log x/THF) for each of 14 urinary steroids were both subject to change with the progress of host age. The rate of age-dependent change was different for each steroid parameter and for each population unit. b) The above differential age dependency of the steroid parameters gave rise to a continual transition of the steroid deviation profile in the course of aging. c) The hormonal traits of male gastric cancer, female breast cancer and cervical cancer were described each as a complex of androgen depression and glucocorticoid stimulation (male gastric cancer), a sequential emergence of premenopausal progestin depression and postmenopausal predominance of glucocorticoid over androgen (female breast cancer), and a complex of androgen-glucocorticoid depression over progestin (cervical cancer). d) The emergence of the above cancer-specific steroid disorders chronologically coincided with the quasiexponential growth phase of cancer risk (and slow growth phase of cancer risk in postmenopausal breast cancer). e) The usefulness of the log x/THF type deviation profile for the assessment of the hormonal milieu of the host was verified by both theoretical approach to the problem and its application to the real data of a case-control study. f) The age dependent decline of androgens was generally much faster in their progressions than that of glucocorticoids - a finding to suggest the possibility that the production of a cancer-specific steroid deviation profile might have taken the form of the stress shift of Hans Selye, since both phenomena share depletion of gonadal steroids relative to glucocorticoid in common. The etiological relevancy of the 3 cancer-specific steroid changes to the geneses of 3 cancers:was discussed in the light of the experimental pathology studies in our laboratory as well as in other laboratories.     

Effect of freezing the helix and the rim or edge of the human and pig ear

We have studied the effect of increasing freeze times on the normal pig's ear and on a variety of lesions of the human ear. The clinical and laboratory data suggest that cartilage necrosis secondary to cryosurgery is a dose-related phenomenon and is uncommon with the freeze times used in clinical practice. Cryosurgery is an effective and cosmetically acceptable treatment for superficial skin lesions of the ear.     

Degree of manifestation of therapeutic pathomorphosis and the nature of the change in the estrogen and progesterone receptors after the radiation and chemotherapy of breast cancer

Estradiol and progesterone receptor levels were measured in 130 patients with stage III breast tumors before treatment and following preoperative radiation or chemotherapy. The data were evaluated versus the morphologic features of posttreatment pathomorphosis of tumor. Standard fractionated radiation (total dose of 70 Gy) was followed by pronounced postradiation pathomorphosis and a decrease in the level and incidence of steroid receptors in 72.7-87.5%. The essentially unchanged receptor profile of tumor following large-fraction (total dose-20 Gy) irradiation as well as presence of estradiol and progesterone receptors in the originally receptor-negative neoplasms after chemotherapy were matched by a slight degree of pathomorphosis.     

Urbanization and the incidence of abnormalities of squamous and glandular epithelium of the cervix

BACKGROUND: The large data bases of the Dutch cervical screening program can be exploited to establish the relation between urbanization and the incidence of abnormalities of the squamous and glandular epithelium, including mild or greater changes of the squamous and glandular epithelium of the cervix. METHODS: Six cytology laboratories in the context of the Dutch cervical screening program screened over 190,000 cervical smears. Urbanization (place of residence) data were derived from postal codes. All smears were coded with the Dutch national coding system, the Dutch national classification system KOPAC, in which squamous abnormalities are coded S4-S9, and glandular cell changes are coded G4-G9. From the scores per 1000 screened women, the relative risk (RR) of living in a large city compared with living in rural areas was calculated. To investigate a trend in incidence in relation to urbanization, the Schaafsma method was used. RESULTS: Of the smears with positive cytology, mild squamous dysplasia (S4) had the highest incidence per 1000 screened women (4.32), and the lowest incidence was found for adenocarcinoma (in situ; G7/G9; RR, 0.07). The RR for urban women ranged from 1.73 for moderate squamous dysplasia (S5) to 7.55 for adenocarcinoma (in situ; G7/G9). For smears with positive cytology for both squamous and glandular abnormalities, the Schaafsma method indicated a significant positive trend. CONCLUSIONS: The incidence of squamous and glandular abnormalities are maximal in women who live in a large city, which, in The Netherlands, is where there also is a population at high risk for human papillomavirus and bacterial vaginosis.     

Patient-reported outcomes: Assessment and current perspectives of the guidelines of the Food and Drug Administration and the reflection paper of the European Medicines Agency

AimsPatient-reported outcomes (PROs) have recently gained greater credibility with regulatory bodies aiming to standardise their use and interpretation in RCTs, thereby supporting medicinal product submissions. For this reason, the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) have released guidelines. This review paper provides an overview of the current perspectives and views on these guidelines.MethodTo evaluate the FDA and EMEA PRO guidelines, 47 expert responses to the FDA guidance were qualitatively reviewed. Two reviewers independently extracted data from these letters and checked these responses to warrant consistency and agreement in the evaluation process. A PubMed literature review was systematically examined to obtain supporting evidence or related articles for both the guidance documents.ResultsGenerally, there is agreement between regulatory authorities and the research community on the contents of the FDA and EMEA PRO draft guidance. However, disagreements exist on significant philosophical topics (e.g. the FDA focuses more on conceptual models and symptoms than the EMEA) and design topics (e.g. the FDA is more restrictive on issues of recall bias, blinding of oncology trials and degrees of psychometric validation than researchers and the EMEA). This could influence the approval of PRO claims.ConclusionPRO guidance from the EMEA and FDA has been valuable, and has raised the profile and active debate of PROs in oncology. However, our review of the current opinion shows that there are controversial aspects of the guidance. Consequently, greater latitude should be given to how the guidance is interpreted and applied.     

Osteonecrosis of the jaw and the role of macrophages

Nitrogen-containing bisphosphonates have been associated with the development of osteonecrosis of the jaws (ONJ), but the lack of reliable epidemiological data and appropriate animal models has restricted our understanding of ONJ pathophysiology and limited its management. The best available information is from histopathologic findings, which implicate bone necrosis and infection, although it is not clear which is primary. However, there are data suggesting that macrophages could well be the central factor in allowing the infection to develop first, followed by local necrosis, which could also account for the development of ONJ in patients treated with denosumab, a human monoclonal antibody to the receptor activator of nuclear factor-κB ligand. This review examines the evidence that macrophages could play a prominent role in development of ONJ and the proposal that it may be more appropriate to view ONJ as a drug and not only a bisphosphonate-related complication.