Ⅲa期非小细胞肺癌新辅助化疗的临床评价

目的探讨术前新辅助化疗对Ⅲa期非小细胞肺癌预后的影响。方法Ⅲa期非小细胞肺癌患者64例，其中32例术前行长春瑞滨 顺铂化疗2个周期后，间隔2周行手术切除，另32例直接行单一手术切除，观察其疗效。结果新辅助化疗组的手术切除率(93．7％)，术后中位生存时间(32个月)和2年存活率(53．1％)均高于单一手术组。结论新辅助化疗可以提高Ⅲa期非小细胞肺癌的手术切除率及2年存活率，延长患者的中位生存时间。     

新辅助化疗对IIIA期非小细胞肺癌外科治疗的影响

目的 探讨新辅助化疗对ⅢA期非小细胞肺癌外科治疗的影响.方法 全部病例分为新辅助化疗组和单纯手术组.新辅助化疗组术前接受NP方案化疗2周期后手术.单纯手术组直接手术.结果 新辅助化疗组有效率69.2%,手术切除率和完全性切除率分别为94.9%和58.9%,单纯手术组分别为78.4%和35.1%,新辅助化疗组明显高于单纯手术组(P<0.05).结论 术前新辅助化疗安全有效,降低病期,并可明显提高ⅢA期 NSCLC患者的手术切除率和完全性切除率.     

新辅助化疗对ⅢA期非小细胞肺癌外科治疗的影响

目的探讨新辅助化疗对ⅢA期非小细胞肺癌外科治疗的影响。方法全部病例分为新辅助化疗组和单纯手术组。新辅助化疗组术前接受NP方案化疗2周期后手术。单纯手术组直接手术。结果新辅助化疗组有效率69.2%,手术切除率和完全性切除率分别为94.9%和58.9%,单纯手术组分别为78.4%和35.1%,新辅助化疗组明显高于单纯手术组(P<0.05)。结论术前新辅助化疗安全有效,降低病期,并可明显提高ⅢA期NSCLC患者的手术切除率和完全性切除率。     

两种新辅助化疗方案联合手术治疗非小细胞肺癌的疗效比较

目的探讨新辅助化疗联合手术治疗非小细胞肺癌的临床疗效和安全性,提高手术切除率。方法 60例非小细胞肺癌患者采用随机数字表的方法分为观察组和对照组各30例,行全肺切除、肺叶切除或袖式肺叶切除,术前两组均先行两个周期的新辅助化疗(观察组采用GP方案,对照组采用MVP方案)。结果观察组近期有效率高于对照组,手术时间和术中出血均低于对照组,差异均有统计学意义(P0.05)。结论术前采用GP方案新辅助化疗可以获得较好的近期疗效,减少手术时间和出血,值得临床推广应用。     

宫颈鳞状细胞癌ⅠB2期治疗模式探讨

目的 探讨宫颈鳞状细胞癌ⅠB2治疗方法及预后因素.方法 1999年5月至2010年5月,在中国医学科学院肿瘤医院初治、资料完整的宫颈鳞状细胞癌ⅠB2 264例入组.中位年龄43岁(21～60岁),全组中直接手术57例,术前新辅助化疗或新辅助化疗加腔内放疗140例,术前腔内放疗53例,放疗加增敏化疗14例.全组接受手术252例,其中2例因术中病理证实淋巴结转移而仅行淋巴结清扫,后改根治性放疗加化疗,250例行盆腔或加腹主动脉旁淋巴结清扫+Ⅲ型根治性子宫切除.结果 252例淋巴结清扫患者中切除淋巴结<20个47例,≥20个205例,淋巴结无转移190例,有转移62例.250例根治性子宫切除患者中,浅肌层受侵117例,深肌层受侵120例,未注明深度13例.脉管瘤栓阴性206例,阳性44例.高分化21例,中分化127例,低分化105例,未报分化11例.全组患者5年无瘤存活率、总存活率分别为85%、89%.术前化疗、放疗加手术,手术,同步放化疗三组无瘤存活率分别为85.2%、92.9%、52.2%,三组相比差异有统计学意义(P=0.001).淋巴结切除个数<20个与≥20个相比,无瘤存活率分别为77.9%、87.8%,差异临近统计学意义(P=0.057).淋巴结无转移与转移相比有统计学差异,P=0.001.脉管瘤栓阴性与阳性相比差异有显著性(P=0.000).而肌层受侵深度、组织分化程度对预后无影响.直接手术与术前新辅助化疗、放疗相比:淋巴结转移率直接手术组(31.6%)高于术前化疗、放疗组(21.8%),但无统计学差异.脉管瘤栓阳性率直接手术组(35.1%)明显高于术前化疗、放疗组(12.4%),差异有统计学意义(P=0.00).手术组接受术后辅助性放疗合并增敏化疗占71.9%,高于术前化疗、放疗组(62.2%),但无统计学差异.宫颈鳞状细胞癌ⅠB2期5年无瘤存活率、总存活率较高,达85%、89%.结论 术前化疗、放疗加手术和直接手术患者无瘤存活率好于同步放化疗.淋巴结转移数、脉管瘤栓明显影响预后.     

晚期非小细胞肺癌综合治疗的前瞻性研究

目的探讨提高Ⅲ期非小细胞肺癌治疗效果的方法。方法85例Ⅲ期非小细胞肺癌患者随机分为3组,并进行不同顺序的治疗,A组(化疗+手术+放疗)28例,放疗后配合辅助化疗;B组(手术+化疗+放疗)28例;C组(手术+放疗+化疗)29例。比较各组3年生存率、局部区域复发率和远处转移率的差异性。结果A、B、C3组3年生存率分别为75.00%,53.57%,44.83%,其中A组与C组比较差异有显著性意义(P<0.05);3组局部区域复发率分别为7.14%,32.14%,17.24%,其中A组与B组比较差异有显著性意义(P<0.05);各组远处转移率分别为7.14%,10.71%,37.93%,其中A组与C组及B组与C组比较,差异均有显著性意义(P<0.05)。结论术前化疗再手术,配合术后放疗及辅助化疗,可提高治疗Ⅲ期非小细胞肺癌的疗效。     

小细胞肺癌综合治疗32例远期生存分析

目的:分析小细胞肺癌不同综合治疗方式(手术合并化疗及放疗合并化疗)远期生存结果。方法:搜集1989～1999年采用手术或放疗加化疗综合治疗小细胞肺癌32例进行远期生存比较。结果:手术加化疗组中位生存期 19.9月,放疗加化疗组中位生存期 13.8月;局限期病例中位生存期分别为20.8月、18.3月;Ⅲ_a 期病例中位生存期分别为 12.2月、20.2 月;经统计学处理,无显著差异,P>0.05。结论:局限期小细胞肺癌综合治疗采用手术加化疗及放疗加化疗远期生存无差异,Ⅲ_a 期病例两组中位生存期虽无统计学差异,但放疗加化疗组生存期绝对值明显长于手术加化疗组,提示对Ⅲ_a 期小细胞肺癌局部治疗手段采用放疗可能优于手术。小细胞肺癌预后与TNM 分期有关,建议临床作局限、广泛及 TNM 共同分期。     

宫颈癌新辅助化疗的临床体会

目的:探讨宫颈癌术前新辅助化疗疗效。方法:回顾性分析手术治疗的49例宫颈癌患者的病例资料,根据术前是否行化疗分为术前化疗组和直接手术组,比较两组的近期疗效、手术时间、术中出血量、术后留置尿管时间、术中及术后并发症、盆腔淋巴结转移率等。结果:49例术后病理阴道切缘及宫旁切缘均无癌残留。术前化疗组淋巴结阳性6例,占术前化疗人数的17.1%;直接手术组淋巴结阳性5例,占直接手术人数的35.7%,术前化疗组术中出血>400 mL者4例,占术前化疗组11.4%;直接手术组术中出血>400 mL者6例,占直接手术组42.9%。术前化疗组与直接手术组比较,盆腔淋巴结转移显著减少(P<0.01),术中出血量显著减少(P<0.01),两组手术时间、术后留置尿管时间、术中术后并发症等的差异无统计学意义。结论:宫颈癌术前新辅助化疗并不增加手术时间、术中出血量及术后并发症,是比较安全而有效的治疗方法,应用于临床对病灶缩小、术中减少出血,提高手术切净率效果显著。     

术前新辅助放化疗对Ⅰb-Ⅱb宫颈癌近期疗效的影响

目的探讨术前新辅助放化疗对Ⅰb~Ⅱb期宫颈癌近期疗效的影响及其安全性。方法回顾性分析2002年1月至2010年12月经手术治疗的Ⅰb~Ⅱb期宫颈癌118例患者的临床资料。按治疗方法的不同分为直接手术组30例及术前干预（新辅助放化疗）三组：包括术前介入化疗组32例,术前静脉化疗组25例和术前放疗组31例。比较术前新辅助放化疗和直接手术治疗患者的术后客观疗效、病理不良因素发现率、术中出血量及不良反应等。结果直接手术组术后病理不良因素发现率和其中高危因素发现率分别为96.7%和63.3%,明显高于术前介入化疗组（62.5%,37.5%）、静脉化疗组（52.0%,28.0%）和术前放疗组（67.7%,29.0%）,差异均有统计学意义（P均〈0.05）,但术前干预三组间无统计学差异（P〉0.05）。直接手术组术中出血量高于其他三组（P均〈0.05）。术前介入化疗组、静脉化疗组和放疗组客观有效率分别为59.4%、60.0%、71.0%,组间比较差异无统计学意义（P〉0.05）。术前放疗组不良反应发生率45.2%,高于介入化疗组（12.5%,P〈0.05）和静脉化疗组（16.0%,P〈0.05）。结论术前新辅助放化疗可显著降低Ⅰb~Ⅱb期宫颈癌患者术后病理不良因素和高危因素发现率,减少术中出血量,从而改善患者预后。     

支气管动脉灌注化疗联合手术治疗Ⅲ期肺癌疗效观察

目的　观察支气管动脉灌注化疗联合手术对Ⅲ期非小细胞肺癌(NSCLC)的疗效。方法　196例NSCLC患者随机分为两组,灌注化疗联合手术组98例,采用吡柔比星40mg/m2、卡铂400mg/m2 和氟尿嘧啶400mg/m2 灌注化疗,灌注化疗15~20d后手术;单独手术组98例,均单独行手术治疗。结果　灌注化疗联合手术组手术切除率为95. 9%;完全切除率为79. 6%,剖胸探查率为4. 1%,淋巴结清扫阳性率为44. 9%;单独手术组分别为71. 4%、42. 9%、28. 6%和44. 9%;两组比较均有显著差异(均为P<0. 05 )。结论　以吡柔比星为主的术前灌注化疗既能提高Ⅲ期NSCLC患者的手术切除率和完全性切除率,又未明显提高术后并发症和病死率,值得临床推广。     

Neoadjuvant chemotherapy for patients with resectable colorectal cancer liver metastases: A systematic review and meta-analysis

BACKGROUNDIn recent years, neoadjuvant chemotherapy (NAC) has been increasingly used in patients with resectable colorectal liver metastases. However, the efficacy and safety of NAC in the treatment of resectable colorectal liver metastases (CRLM) are still controversial.AIMTo assess the efficacy and application value of NAC in patients with resectable CRLM.METHODSWe searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to December 2020 to collect clinical studies comparing NAC with non-NAC. Data processing and statistical analyses were performed using Stata V.15.0 and Review Manager 5.0 software. RESULTSIn total, 32 studies involving 11236 patients were included in this analysis. We divided the patients into two groups, the NAC group (that received neoadjuvant chemotherapy) and the non-NAC group (that received no neoadjuvant chemotherapy). The meta-analysis outcome showed a statistically significant difference in the 5-year overall survival and 5-year disease-free survival between the two groups. The hazard ratio (HR) and 95% confidence interval (CI) were HR = 0.49, 95%CI: 0.39-0.61, P = 0.000 and HR = 0.48 95%CI: 0.36-0.63, P = 0.000. The duration of surgery in the NAC group was longer than that of the non-NAC group [standardized mean difference (SMD) = 0.41, 95%CI: 0.01-0.82, P = 0.044)]. The meta-analysis showed that the number of liver metastases in the NAC group was significantly higher than that in the non-NAC group (SMD = 0.73, 95%CI: 0.02-1.43, P = 0.043). The lymph node metastasis in the NAC group was significantly higher than that in the non-NAC group (SMD = 1.24, 95%CI: 1.07-1.43, P = 0.004).CONCLUSIONWe found that NAC could improve the long-term prognosis of patients with resectable CRLM. At the same time, the NAC group did not increase the risk of any adverse event compared to the non-NAC group.     

巨块型宫颈癌Ⅰb2～Ⅱb期术前全身新辅助化疗的疗效观察

【目的】探讨术前全身新辅助化疗（NAC）对巨块型宫颈癌的疗效。【方法】选择2000年12月至2005年12月邵阳市中心医院初治病理确诊宫颈癌患者35例,采用PVB（顺铂50mg／m^2 d1＋长春新碱1mg／m^2 d1＋博莱霉素20mg／m^2 d1～d3）静脉化疗1～3疗程并化疗后15～20d行子宫广泛切除＋盆腔淋巴结清扫术（观察组）。与同期单纯手术的病人39例为对照组在术后病理及生存率等方面进行分析对比。【结果】观察组患者化疗有效率为80．00％,所有病人阴道切缘均未见癌细胞,术后5年生存率为77．50％。而对照组患者阴道切缘有4例见癌细胞,5年生存率为52．49％,两者对比差异有显著性（P〈0．05）。【结论】经术前全身辅助化疗配合妇科手术治疗宫颈癌可提高病人生存率。     

局限期小细胞肺癌手术治疗与放化疗疗效比较

目的回顾性分析局限期小细胞肺癌手术为主的综合治疗与单纯放化疗疗效比较。方法收集本院胸外科2001年7月~2010年7月收治的局限期小细胞肺癌患者共75例,均经组织学证实病理,其中32例患者经手术+化疗或放化疗治疗,43例患者行常规放化疗。结果根治手术+放化疗组的中位生存期为40个月,化疗+放疗组的中位生存期为17个月。手术+化(放)疗组的生存时间明显高于单纯放化疗组。结论手术为主的综合治疗能使局限期小细胞肺癌生存期明显延长,较传统的放化疗能使患者获得更好的远期疗效。     

新辅助化疗联合外科保肢手术治疗骨肉瘤远期生存分析

目的探讨骨肉瘤经新辅助化疗联合外科保肢手术的临床疗效。方法采取前瞻性研究方法,将骨肉瘤患者68例根据治疗方式分为观察组(保肢手术+新辅助化疗)38例,对照组(保肢手术+术后常规化疗)30例。采取Kaplan-Meier法及Log-rank检验,估计各组生存时间的生存率以及中位生存时间,比较两组生存时间的差异。结果观察组的中位生存期为71个月,3年、5年生存率分别为73.7%(28/38)、65.8%(25/38);对照组中位生存期为59个月,3年、5年生存率分别为53.3%(16/30)、46.7%(14/30),观察组的生存率明显优于对照组,差异有统计学意义(χ2=19.403,P=0.000)。结论新辅助化疗联合外科保肢手术是治疗骨肉瘤安全、有效的方法,术前积极有效化疗是改善预后的重要环节。     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

目的 探讨术前动脉灌注化疗对进展期结直肠癌的远期临床疗效.方法 选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为2组:试验组68例行术前动脉灌注化疗,方案为:奥沙利铂(艾恒)130mg/m2、羟基喜树碱20 mg/m2、氟脲苷600 mg/m2,经股动脉插管灌注化疗1、2次,8～14 d后接受手术治疗;对照组60例直接手术治疗.观察动脉灌注化疗不良反应及组织学疗效,比较2组手术切除率、手术并发症、术后病理分期及远期生存率.结果 试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ、Ⅱ度.试验组手术切除率为97.1%(66/68)、根治性切除率为96.9%,分别高于对照组的73.3%(44/60)和79.5%(x2=14.848、8.906,P均＜0.05);试验组组织学有效率达72.7%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P＜0.05);试验组中位生存期为53.0个月,1、3、5年生存率分别为95.3%、85.9%、44.6%;对照组的中位生存期为42.0个月,1、3、5年生存率分别为92.6%、75.9%、22.0%,试验组生存率高于对照组,但只有5年生存率差异具有统计学意义(x2=6.385,P＜0.05).术后并发症2组比较差异无统计学意义(P＞0.05).结论 术前动脉灌注化疗对进展期结直肠癌降低临床分期、提高手术切除率尤其是根治性切除率作用和疗效确切,并能提高患者的远期生存率.

Abstract：

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

The role of pulmonary resection in small cell lung cancer

OBJECTIVE: To analyze the outcome of surgical resection for patients with small cell lung cancer (SCLC). PATIENTS AND METHODS: We identified all patients who underwent thoracotomy for SCLC at our institution from January 1985 to July 2002. All patients were staged using the American Joint Committee on Cancer TNM system. RESULTS: The median age of the 77 patients (44 men and 33 women) was 65 years (range, 35-85 years). Operations performed included thoracotomy with biopsy of hilar mass in 10 patients, wedge excision in 30 (6 with talc pleurodesis), segmentectomy in 4, lobectomy in 28, bilobectomy in 3, and pneumonectomy in 2. Mediastinal lymphadenectomy was performed in 50 patients and lymph node sampling in 19. Postoperative therapy Included chemotherapy alone in 20 patients, radiation therapy in 3, and combined chemotherapy and radiation therapy in 40. Median tumor diameter was 4 cm (range, 1.0-10.0 cm). Postsurgical tumor stage was IA in 7 patients, IB in 11, IIA in 8, IIB in 7, IIIA in 30, IIIB in 10, and IV in 4. A total of 19 patients (25%) had complications: atrial arrhythmia in 7 patients, pneumonia in 6, prolonged air leak in 3, and myocardial infarction, postoperative bleeding, and cerebrovascular accident in 1 each. Operative mortality was 3% (2/77). Follow-up ranged from 4 days to 170 months (median, 19 months). At last follow-up, 20 patients were alive. The estimated overall 5-year survival was 27% when excluding the 10 patients who underwent a biopsy without additional surgery. Five-year survival for stage I and II combined (n=33) was 38% compared with only 16% for stage III and IV combined (n=34) (P=.02). Overall median survival was 24 months; median survival for patients who underwent curative surgery was 25 months compared with 16 months for those who had a palliative procedure (P=.34). CONCLUSION: Pulmonary resection in patients with stage I or stage II SCLC is safe with low mortality and morbidity. Curative resection is associated with long-term survival in early stage SCLC in some patients and should be considered in selected patients.     

Palliative care in poor-performance status small cell lung cancer patients: is there a mandatory role for chemotherapy?

Purpose

Small cell lung cancer (SCLC) is an aggressive malignancy but with a high response rate to chemotherapy. Eastern Cooperative Oncology Group performance status (ECOG PS) has been recognized as one of the main prognostic factors in SCLC. There are few data about risk–benefit ratio of chemotherapy over exclusive best supportive care in ECOG PS 3 and 4 patients. This study was performed to assess the outcome of poor ECOG PS SCLC patients that received chemotherapy in our institution.

Methods

A retrospective review of medical records from patients with ECOG PS 3–4 SCLC, who received systemic chemotherapy, was performed between January 2001 and December 2006 at the Instituto Nacional do Cancer, Rio de Janeiro, Brazil.

Results

A total of 40 patients were included. Extensive disease was observed in 85% of patients and 25% had PS 4. The median overall survival was 53 days (64 days for ECOG PS 3 and 7 days for ECOG PS 4). There were 30% of early deaths. On univariate analysis, lactate dehydrogenase value, need for hospital admission, and exposure to radiotherapy had impact on survival. ECOG PS 3 patients had better survival than PS 4 patients, even when adjusted for stage. On multivariate analysis, ECOG PS, combined with stage, sustained a major influence on survival.

Conclusions

Median survival for ECOG PS 4 patients treated with chemotherapy in our series was extremely short with a high rate of early deaths. ECOG PS 3 patients also showed a poor survival. These data suggest that we need a more comprehensive approach and further studies, regarding the palliative care of this high-risk population.     

三种不同化放疗方法对宫颈癌患者术前辅助治疗效果对比研究

目的 观察子宫动脉灌注栓塞化疗、全身静脉化疗和体外放疗在宫颈癌Ⅰb2期到Ⅱb期患者术前辅助治疗中的疗效.方法 选择2017年1月至2020年1月在眉山市人民医院妇科收治的原发性宫颈癌患者220例,在行手术治疗前,依据治疗方式分为子宫动脉灌注栓塞化疗组72例,全身静脉化疗组75例和体外放疗组73例,术后1个月观察3组患者...     

血清NSE、CEA、CA125水平在小细胞肺癌患者诊断和疗效评估中的价值

目的 探讨血清神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、糖类抗原125(CA125)水平在小细胞肺癌(SCLC)患者诊断和疗效评估中的价值.方法 选取郑州人民医院收治的SCLC患者(SCLC组)48例、非小细胞肺癌患者(NSCLC组)53例,另选取同期在我院体检的正常人作为对照组,分别检测各组血清NSE、CE...     

术前新辅助化疗对提高局部晚期非小细胞肺癌生存期的作用

目的通过对局部晚期非小细胞肺癌（Locally advanced nonsmall cell lung cancer,LANSCLC）先行新辅助化疗，后再手术治疗，观察术前新辅助化疗对提高术后5年生存率中的作用。方法对1996年1月至2001年10月本院NSCLC 203例进行前瞻性对照研究。85例行术前新辅助化疗（新辅助化疗组）2～3周期，化疗结束后3～4周手术，另118例直接手术（对照组）。结果新辅助化疗组总有效率68．24％（58／85），病期下调率35．29％（30／85）；手术切除率新辅助化疗组91．25％（73／80），对照组为81．36％（96／118）；两组手术并发症和手术死亡率差异无显著性（P〉0．05），新辅助化疗组术后1、3、5年生存率分别为77．52％、53．85％和35．39％，对照组分别为70．88％、40．32％和24．19％，新辅助化疗组术后生存率显著高于对照组（P〈0．01）。结论术前新辅助化疗安全有效，能降低NSCLC病期，提高手术切除率，改善患者术后长期生存率及生活质量。