环加氧酶-2在人结直肠肿瘤中的表达及其临床意义

目的 :探索环加氧酶 2 (cyclooxygenase 2 ,COX 2 )在人结直肠癌发生、发展过程中的地位。 方法 :应用免疫组化法检测 1 2 2例 (结直肠腺瘤 35例 ,结直肠癌 64例 ,结直肠癌伴同时性肝转移 2 3例 )组织标本中COX 2的表达 ,采用形态定量法分析 ,计算每张切片的平均COX 2染色强度。结果 :结直肠腺瘤组的COX 2平均染色强度为 70 4 .5± 1 31 .8,结直肠癌组为 1 1 97.2± 2 0 4 .3 ,结直肠癌伴肝转移组为 1 90 1 .2± 32 4 .8,三组之间有统计学差异(P <0 .0 1 )。按Dukes分期来分 ,B期 1 1 4 5 .3± 1 87.0 ,C期 1 2 37.0± 2 98.7,D期 1 90 1 .2± 32 4 .8,D期显著高于B、C期 (P <0 .0 1 )。结直肠肿瘤COX 2的表达与性别、年龄、肿瘤部位、肿瘤大小无关。结论 :COX 2在结直肠腺癌组织中的表达远高于腺瘤组织 (P <0 .0 1 ) ;伴同时性肝转移的结直肠腺癌组织显著高于无肝转移者 (P <0 .0 1 ) ;DukesD期者显著高于B、C期 (P <0 .0 1 )。因此 ,COX 2在结直肠癌发生、发展过程中起着重要的作用 ,非甾体类抗炎药或其他新型药物作为COX 2的抑制剂可应用到结直肠癌的化学预防中去     

大肠癌中nm23、CD44基因的表达及临床意义

目的　研究大肠癌中nm 2 3、CD44基因的表达及其在大肠癌局部进展中的作用。方法　用FCM (流式细胞术 )方法 ,测定 6 4例大肠癌患者nm 2 3和CD44基因蛋白。结果　蛋白表达量以荧光指数 (flurescentindex)表达 ,大肠癌nm2 3(FI =0 .84± 0 .0 9) ,正常粘膜 (FI =1.0± 0 .0 3) ,P <0 .0 0 1。大肠癌CD44(FI =1.43± 0 .14 ) ,正常粘膜 (FI =1.0± 0 .33) ,P <0 .0 0 1。大肠癌增殖指数 (PI =2 8.6 0± 8.0 7) ,正常粘膜 (PI =19.6 1± 6 .94) ,P <0 .0 2。Duke′s分期C D :nm 2 3(FI =0 .80± 0 .0 8)CD44(FI =1.46± 0 .13) ;Duke′s分期A B :nm2 3(FI =0 .89± 0 .10 )、CD44(FI =1.34± 0 .13) ,P均 <0 .0 5。浸润和溃疡型癌肿 :nm2 3(FI =0 .80± 0 .0 8) ,CD44(FI =1.48± 0 .12 ) ;隆起型 :nm 2 3(FI =0 .88± 0 .10 )、CD44(FI =1.35± 0 .13) ,P均 <0 .0 5。异倍体癌 :CD44(FI =1.45± 0 .15 ) ;二倍体癌 :CD44(FI =1.33± 0 .11) ,P <0 .0 5。结论　nm 2 3基因蛋白在大肠癌形成、浸润、转移中有负调控作用 ,CD44基因蛋白起正调控作用 ;nm2 3基因蛋白低表达和CD44基因蛋白高表达的大肠癌预后差。     

环氧合酶2与增殖细胞核抗原在家族性腺瘤性息肉病发生、发展中的作用

背景与目的：环氧合酶-2（cyclooxygenase-2,COX-2）在结直肠癌中有较高的表达。长期使用COX-2抑制剂可有效降低结直肠癌等消化道肿瘤的发病危险性。增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）是细胞异常增殖的重要标志物。本研究检测了COX-2及PCNA蛋白在正常结直肠肠黏膜、家族性腺瘤性息肉病（familial adenomatous polyposis,FAP）腺瘤和FAP癌组织中的表达,探讨COX-2在FAP肿瘤发生过程中的意义,以及与细胞增殖的关系。方法：对2004年11月至2007年7月在北京军区总医院经肠镜跟踪检查的11个FAP家系中,收集腺瘤组织36例,癌组织32例,以健康查体者结肠镜活检的正常结直肠黏膜组织34例作为对照。采用免疫组织化学染色．分别检测COX-2、PCNA的表达情况。结果：COX-2在正常结直肠黏膜、FAP腺瘤和癌组织阳性表达率分别为0％（0／34）、80．6％（29／36）、93．8％（30／32）,PCNA指数分别为17．79±7．49、34．47±10．57、71．75±9．22。与正常结直肠黏膜比较,FAP腺瘤和癌组织中COX．2、PCNA表达均升高（P〈0．01）。PCNA表达在FAP癌组织中显著高于FAP腺瘤（P〈0．01）。FAP腺瘤中PCNA表达在COX-2阳性者显著高于COX-2阴性者（P〈0．01）。结论：正常结直肠黏膜、FAP腺瘤、FAP癌组织中COX．2、PCNA表达呈逐步升高趋势,COX-2在FAP腺瘤的形成、结直肠癌发生和发展过程中起重要作用;COX-2、PCNA的检测对研究结直肠肿瘤癌前病变及干预治疗具有重要意义。     

COX-2和iNOS在实验性大鼠肺癌发生发展中的表达及其与微血管密度的关系

目的　探讨环氧化酶 2蛋白 (COX 2 )和诱导型一氧化氮合酶蛋白 (iNOS)在肺癌发生发展中的表达及其与肿瘤血管生成的关系。方法　Wistar大鼠 88只 ,“左肺叶支气管灌注致癌质碘油”法诱发肺鳞癌 ,分批处死 ,获取肺鳞癌发生发展各阶段标本 ,以 10只正常大鼠作为对照。用免疫组化法检测标本中COX 2、iNOS的表达和MVD值。结果　共获取 15 5例病变组织 ,其中 14例支气管粘膜增生 ,2 5例鳞状化生 ,33例不典型增生 ,12例原位癌 ,5 4例浸润癌 ,17例转移癌。不典型增生 (2 .1± 1.9)与鳞状化生 (0 .6± 0 .9)比较、原位癌 (3.7± 2 .4)与不典型增生比较、转移癌 (5 .9± 3.2 )与浸润癌 (3.8± 2 .7)比较 ,COX 2表达评分差异均有显著性 (P <0 .0 1,P <0 .0 5 ,P <0 .0 1)。支气管粘膜增生 (3.7± 2 .1)与正常粘膜 (0 .5± 0 .7)比较、转移癌 (9.1± 4.0 )与浸润癌 (5 .3± 3.7)比较 ,iNOS表达评分差异均有显著性 (P <0 .0 5 ,P <0 .0 1)。原位癌 (31.7±13.3)与不典型增生 (6.2± 4.0 )比较、浸润癌 (4 7.8± 15 .7)与原位癌比较、转移癌 (64 .4± 2 7.7)与浸润癌比较 ,MVD值差异均有显著性 (P <0 .0 1,P <0 .0 1,P <0 .0 1)。COX 2与iNOS表达呈正相关 (r =0 .60 16,P<0 .0 0 1)。MVD与COX 2、iNOS表达均有密切关     

还氧合酶-2蛋白表达与卵巢癌生物学行为的相关性

目的　研究还氧合酶 - 2 (cyclooxygenase 2 ,COX 2 )蛋白表达与卵巢浆液性肿瘤发生发展的关系。方法　应用免疫印迹 (Westernblot)法对 5 4例卵巢浆液性肿瘤组织和 10例正常卵巢组织进行COX 2蛋白检测。结果　COX 2蛋白在卵巢浆液性癌组织中表达率 (81.8% )和相对含量(2 0 .0 8± 3.5 3)明显高于良性卵巢浆液性肿瘤 (0 ,15 .0 4± 0 .12 )及正常卵巢组织 (0 ,15 .33± 0 .6 0 ;P <0 .0 5 ) ;COX 2蛋白在交界性卵巢浆液性肿瘤中表达率 (90 .0 % )和相对含量 (2 0 .6 1± 3.0 3)明显高于良性卵巢浆液性肿瘤及正常卵巢组织 (P <0 .0 5 )。卵巢浆液性癌组织与交界性卵巢浆液性肿瘤、良性卵巢浆液性肿瘤组织与正常卵巢组织比较 ,COX 2蛋白表达率和相对含量差异均无显著性 (P >0 .0 5 )。COX 2蛋白表达率和相对含量在不同的临床分期 (Ⅰ +Ⅱ与Ⅲ +Ⅳ )、组织学分级、有无腹水及有无淋巴结转移间比较 ,差异均无显著性 (P >0 .0 5 )。结论　COX 2蛋白与卵巢浆液性肿瘤发生发展密切相关。COX 2可作为卵巢浆液性癌早期诊断指标及治疗靶位点     

环氧化酶-2与p53在食管上皮癌变及鳞癌细胞中的表达

目的　探讨环氧化酶 (Cyclooxygenase,COX) 2基因表达在食管上皮癌变中的作用 ,为食管癌早期诊断及非类固醇类抗炎药 (Nonsteroidalanti inflammatorydrugs ,NSAIDs)在食管癌高发区进行化学预防提供理论依据。 方法　从食管癌高发区人群中采集食管上皮细胞标本 ;并收集该省食管癌高发区食管鳞癌及癌前病变新鲜标本 76例。采用间接免疫荧光标记技术 ,应用流式细胞仪对COX 2及 p5 3的表达进行定量检测。 结果　COX 2在食管脱落上皮细胞中的表达随异型性的增高而逐渐增加 ,在癌细胞组达最高 (FI=1.6 2± 0 .2 3) ;COX 2在高分化鳞癌组表达最高 (FI=2 .37± 0 .71) ,并随癌细胞分化程度的降低而显著减少。p5 3的表达在脱落上皮细胞中随细胞异型性的增高逐渐增多 ,在癌细胞组表达含量最高 (FI =2 .2 8± 0 .2 0 ) ;而在癌组织中的表达 ,则随分化程度的降低继续升高。对COX 2与p5 3表达的相关分析发现 ,从正常上皮至高分化鳞癌两者表达呈显著正相关 (r=0 .42 4,P =0 .0 0 2 ) ;而在不同分化程度癌中的表达 ,两者呈显著负相关 (r =- 0 .345 ,P =0 .0 31)。结论　COX 2及 p5 3表达在食管上皮早期癌变进程中异常增高 ,并有明显的协同作用。COX 2单独或与p5 3联合检测可以作为食管上皮早期癌变的分子标志。     

NOB1在结直肠癌中的表达及其临床意义

目的：研究NOB1编码蛋白在结直肠癌及正常结直肠黏膜（距癌组织边缘5cm以上）、结直肠良性息肉中的表达特征.探讨结直肠癌中NOB1表达的临床病理意义.方法：利用免疫组织化学SABC法检测87例结直肠癌组织、22例正常结直肠黏膜组织18例结直肠息肉组织中NOB1的表达.结果：NOB1在结直肠癌,结直肠良性息肉及正常结直肠黏膜中的阳性表达率分别为74.7％、44.4％、13.6％,三组进行比较,差异有统计学意义（P＜0.01）.细胞分化差的结直肠癌NOB1蛋白阳性率表达高（P＜0.05）与患者年龄,性别,肿瘤浸润深度及淋巴结转移无明显相关性.结论：NOB1蛋白在结直肠癌中表达升高,并与大肠癌临床病理学特征有关.     

结直肠癌肿瘤实质和肿瘤间质中MMP-2的表达

目的　探讨结直肠癌肿瘤实质及肿瘤间质中基质金属蛋白酶 -2 (MMP -2 )的表达及其病理学意义。方法　采用免疫组化LSAB法对 13 7例结直肠癌进行免疫组化检测 ,取 12例大肠腺瘤样息肉及 8例正常大肠粘膜组织作对照。结果　结直肠癌肿瘤实质细胞MMP -2的阳性表达率 ( 4 2 .3 % ,5 8例 )高于对照组 ( 15 .0 % ,3例 ) (P <0 .0 5 ) ;发生转移的结直肠癌肿瘤实质细胞其MMP -2阳性表达率明显高于无转移者 (P <0 .0 1) ;低 (未 )分化结直肠癌MMP -2阳性表达率高于高、中分化大肠癌 (P <0 .0 1及P <0 .0 5 )。肿瘤间质中MMP -2阳性表达率 ( 60 .6% ,83例 )明显高于肿瘤交界的正常肠粘膜间质 ( 10 .2 % ,14例 ) (P <0 .0 1)。结论　MMP -2表达与结直肠癌的分化程度及转移密切相关 ,与性别、年龄、肉眼类型、病变部位无明显相关性。     

环氧合酶-2对胃癌血管内皮生长因子及血管形成的影响

 目的　探讨环氧合酶 2 (COX 2 )对胃癌血管内皮生长因子 (VEGF)的表达及血管生成的影响。方法　应用免疫组织化学技术检测胃癌组织中COX 2 ,VEGF表达和微血管密度 (MVD)。结果　COX 2在62 .2 %胃癌组织中表达增高 ,COX 2表达与VEGF表达显著相关 (γS=0 .5 85 ,P <0 .0 1 ) ,且COX 2和VEGF均阳性的胃癌组织MVD(64.0± 2 5 .4)亦明显高于两者均阴性者 (3 0 .7± 1 1 .5 ) (P <0 .0 1 )。结论　胃癌组织中存在COX 2的高表达 ,COX 2通过增加VEGF表达而促进肿瘤血管形成     

大肠肿瘤COX-2的表达及与细胞增殖的关系

 目的　检测环氧化酶 (cyclooxygenase ,COX)及增殖细胞核抗原 (proliferatingcellnuclearanti gen ,PCNA)蛋白在大肠正常粘膜、腺瘤和癌组织中的表达 ,探讨COX 2在大肠肿瘤发生发展中的意义及其与细胞增殖的关系。方法　采用链霉素抗生物素蛋白 生物素 过氧化物酶免疫组化染色方法。结果　三组间的差异有显著性意义 (P <0 .0 1 ) ,大肠腺瘤PCNA表达在COX 2阳性者显著高于阴性者 (P <0 .0 5 ) ,但在大肠癌中 ,PCNA表达在COX 2阳性及阴性中无显著性差异 (P >0 .0 5 )。结论　COX 2的表达在大肠正常粘膜、腺瘤、腺癌中有逐渐上调趋势。在大肠腺瘤中 ,COX 2表达与细胞增殖有关     

Colon and rectal carcinoma

In the United States the incidence of carcinoma of the colon or rectum appears to be increasing. Although certain dietary habits appear to be associated with disease incidence, the putative carcinogens in the lumen of the bowel remain unidentified. The use of clinical screening based on a combination of proctosigmoidoscopy and tests for occult fecal blood allows detection of colorectal carcinomas at an early stage; however, it is unclear whether such screening is cost-effective in persons over 40 years of age or if treatment undertaken on the basis of screening results truly alters the natural history of the disease. Surgical resection is the mainstay of curative therapy, and its effectiveness will probably be enhanced by adjuvant x-ray therapy and chemotherapy.     

Chemotherapy and rectal cancer

Chemotherapy does not increase the survival time of patients treated for rectal cancer. Chemotherapy given concomitantly to radiotherapy and combined before or after radiation significantly reduces the risk of local recurrence. The sterilization of the tumour (complete pathological response) by chemotherapy is a favourable prognostic factor. New trials on optimisation of pathological complete response rates are based on using drugs effective on metastatic colorectal cancer, given prior to chemoradiotherapy and followed by a resection at least 8 weeks after the end of the radiotherapy. The level of evidence for postoperative chemotherapy is low due to lack of specific study. The indication of postoperative chemotherapy depends on the disease extent after preoperative treatment.     

Sphincter and rectal preservation approaches for early stage distal rectal cancers

In rectal cancer, the problem of sphincter preservation is of increasing interest. This paper is a review of recent data regarding sphincter preservation. Randomized trials give the best evidence of any improvement in sphincter preservation. Such trials have been performed for T3 and T2 rectal cancers. For T2-3 rectal tumors immediate surgery after preoperative radiotherapy or the addition of chemotherapy to radiotherapy did not improve the chance of sphincter preservation. Only dose escalation with endocavitary contact x-ray and delayed surgery was able to achieve a 30% increase in sphincter preservation. Ongoing clinical research is exploring the role of preoperative chemoradiotherapy in early T2 (T3) rectal cancers combined with local excision. This approach is of special interest in elderly patients. Sphincter preservation is a very complex issue in rectal cancer requiring great clinical experience to select properly the patients to perform the optimal treatment.     

Laparoscopic rectal resection versus open rectal resection with minilaparotomy for invasive rectal cancer

Background

The minilaparotomy approach is technically feasible for the resection of rectal cancer in selected patients with rapid postoperative recovery and small incision. The study aimed to compare the clinical and oncological outcomes of minilaparotomy and laparoscopic approaches in patients with rectal cancer.

Methods

The 122 included patients with rectal cancer were assigned to either minilaparotomy group (n=65) or laparoscopic group (n=57) which ran from January 2005 to January 2008. Clinical characteristics, perioperative outcomes, postoperative and long-term complications, pathological results and survival rates were compared between the groups.

Results

The demographic data of the two groups were similar. The time to normal diet (P=0.024) and the hospital stay (P=0.043) were less in the laparoscopic group than that in the minilaparotomy group. Compared with the minilaparotomy group, the mean operation time was significantly longer [low anterior resection (LAR), P=0.030; abdominoperineal resection (APR), P=0.048] and the direct costs higher for laparoscopic group (P<0.001). The morbidity and mortality were comparable between the two groups. Local recurrence was similar (5.3% laparoscopic, 1.5% minilaparotomy, P=0.520). The 5-year overall and disease-free survival rates were also similar (overall survival is 87.1% in laparoscopic group, and 82.5%in minilaparotomy group, P=0.425; disease-free survival is 74.2% in the laparoscopic group, and 71.4% in mini- laparotomy group, P=0.633).

Conclusions

The minilaparotomy approach was similarly safe and oncologically equivalent to laparoscopic approach for patients with rectal cancer. At the expense of a longer operative time and higher cost, laparoscopic surgery was associated with faster postoperative recovery.     

Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors

BackgroundTo explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5–10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid over-treatment.MethodsWe collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ² test and Fisher exact probability method.ResultsA total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS.ConclusionsThe morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.     

Interstitial irradiation of rectal carcinoma with rectal template

Using Iridium-192 wires through a rectal template after Syed, interstitial brachytherapy was conducted in a patient with inoperable adenocarcinoma of the rectum. 67-year-old man with constipation and change in the stool caliber underwent external radiotherapy (4,000 cGy/4 W) to the whole pelvis including the perineum, followed by interstitial implant using a template, at the Department of Radiology, Osaka University Hospital. Marked tumor regression, marked circumferential fibrosis and a remarkable decline of CEA titers (pre-RT: 35.8 ng/ml, post-RT: 6.2 ng/ml) were observed until 7 months post-RT. The domestic production of Iridium-192 wires has made possible the integrated use of brachytherapy in the perineal region in Japan.     

直肠腺癌和黏液腺癌腔内超声图像分析

目的探讨直肠腺癌和黏液腺癌的腔内超声图像的不同特点。方法回顾分析30例直肠进展期腺癌和28例直肠进展期黏液腺癌腔内超声特征,并与病理结果进行对比。结果进展期直肠腺癌28例腔内表面凹凸不平,肿瘤浸润肠壁回声19例无层次感,10例部分区域有模糊层次感,1例有清晰层次感。癌浸润最深处的边界17例有毛刺、呈角或呈结节样突起,5例呈波浪状起伏,8例光整平直。直肠黏液腺癌20例腔内表面平坦,肿瘤浸润肠壁回声6例有清晰层次感,13例部分区域有层次感,6例无层次感。癌浸润最深处的边界8例光滑平直,10例呈波浪状起伏,7例局部有少许毛刺、呈角或呈结节样突起。超声诊断癌浸润肠壁深度与病理诊断对比,直肠腺癌有25例诊断正确,2例诊断过浅,3例诊断过深;直肠黏液腺癌有10例诊断正确,14例诊断过浅,1例诊断过深。黏液腺癌浸润深度超声诊断符合率明显低于腺癌,且大部分为过浅诊断。结论直肠腺癌和黏液腺癌各有一定的声像图特点,对其特征的分析有助于两种癌的分型诊断。腺癌与黏液腺癌的鉴别有助于减少过浅诊断。     

直肠指检及直肠镜检在诊断早期直肠癌中的价值

目的:探讨直肠指检和直肠镜检在诊断早期直肠癌中的重要作用.方法:从187例临床病人进行直肠指检及直肠镜检分析直肠肿块检出率.结果:中下段直肠癌检出率为100%.上段直肠癌检出率为64.3%.结论:直肠指检和直肠镜检简便、易行、安全,是诊断早期直肠癌的一项最重要的方法.     

三维适形放射治疗局部晚期和术后复发性直肠癌

目的：探讨局部晚期和术后复发性直肠癌三维适形放射治疗（three dimensional conformal radiation therapy,3D-CRT）的临床疗效。方法：60例局部晚期和术后复发性直肠癌均在外照射40Gy后随机分为后程适形放疗组（适形组）30例,常规放疗组（对照组）30例。结果：适形组及对照组有效率分别为86.7%和70.0%,2组差异无统计学意义（P〉0.05）;适形组及对照组1、2、3年生存率分别为80.0%、53.3%、36.7%和56.7%、40.0%、13.3%,P=0.02;1、2、3年局部控制率分别为86.7%、80.0%、50.0%和73.3%、53.3%、30.0%,2组差异均有统计学意义（P=0.0438）;在副反应方面2组差异无统计学意义（P〉0.05）。结论：局部晚期和术后复发性直肠癌常规外照射加三维适形放疗有较好疗效。