联合化疗转移性睾丸癌八例报告

报告８例转移性睾丸癌病人行联合化疗的结果，７例获完全缓解，１例部分缓解。１例死亡，７例随访１２－９８个月（平均５２个月）仍健康存活。表明转移性睾丸癌可以通过以疗治愈；有大块转移灶者必须结合手术切除残余癌块，然后行补救性化疗，并对化疗的适应证，影响化疗效果的因素和并发症的预防等进行讨论。     

对激素抗拒的前列腺癌的联合化疗

目的　探讨阿霉素、丝裂霉素、５氟尿嘧啶联合化疗对激素抗拒的前列腺癌的疗效。　方法　１９９５ 年４ 月至１９９８ 年７ 月治疗１５ 例对激素抗拒的前列腺癌病人。随访５ ～２４ 个月,平均１０个月。　结果　ＣＲ１ 例,ＰＲ２ 例,ＳＤ９ 例。ＣＲ 和ＰＲ 持续６ ～１８ 个月,平均１１ 个月,ＣＲ、ＰＲ 及ＳＤ持续５ ～２４ 个月,平均９ 个月。脱发、恶心呕吐、骨髓抑制是主要副反应。　结论　阿霉素、丝裂霉素、５氟尿嘧啶联合化疗方案可以延缓部分对激素抗拒的前列腺癌的进展。     

紫杉醇及其联合化疗对表浅性膀胱癌化疗敏感性的实验研究

目的探讨紫杉醇及其联合化疗对表浅性膀胱癌的应用前景。方法自１９９５年７月～１９９７年１０月采用肿瘤细胞原代培养技术和ＭＴＴ比色法测定了３０例不同个体膀胱癌细胞及膀胱癌ＥＪ细胞系的化疗敏感性。结果紫杉醇对不同个体的膀胱癌细胞的总敏感率为１６．７％,阿霉素和丝裂霉素分别为１６．７％和２６．７％,三者间差异无显著性,但优于顺铂和噻口替哌;紫杉醇与顺铂或丝裂霉素联合后的协同性最佳,总敏感率均为８３．３％;膀胱癌细胞系的抑制率与不同个体膀胱癌细胞对相同化疗方案的抑制率差异很大。结论紫杉醇联合顺铂或丝裂霉素是可选择的灌注治疗方案;临床上应针对不同病人选择最敏感化疗方案;膀胱癌细胞系的化疗药物敏感性不能代表不同个体膀胱癌细胞的敏感性。     

睾丸癌的研究进展

自上世纪以来人们不断加深对睾丸癌这一罕见疾病的认识和了解，在诊断及治疗方法上不断完善。     

睾丸癌的研究进展

自上世纪以来人们不断加深对睾丸癌这一罕见疾病的认识和了解,在诊断及治疗方法上不断完善。     

转移性膀胱移行细胞癌的全身化疗

MVAC方案(甲氨蝶呤、长春碱、阿霉素、顺铂联合方案)和GC方案(吉西他滨、顺铂联合方案)是目前治疗转移性膀胱移行细胞癌的标准方案，疗效基本相似，治疗总反应率高达50％～70％，完全缓解率为15％～25％，患者的中位生存时间大约为12个月。GC方案的毒副作用相对较轻，具有更优的风险效益比。但仅极少数的此类患者能通过化疗获得治愈，对大多数患者而言只是姑息性治疗。     

转移性膀胱移行细胞癌的全身化疗

MVAC方案 (甲氨蝶呤、长春碱、阿霉素、顺铂联合方案 )和GC方案 (吉西他滨、顺铂联合方案 )是目前治疗转移性膀胱移行细胞癌的标准方案 ,疗效基本相似 ,治疗总反应率高达 5 0 %～ 70 % ,完全缓解率为 15 %～ 2 5 % ,患者的中位生存时间大约为 12个月。GC方案的毒副作用相对较轻 ,具有更优的风险效益比。但仅极少数的此类患者能通过化疗获得治愈 ,对大多数患者而言只是姑息性治疗。     

胰腺癌化疗的应用前景

胰腺癌是一种高度恶性的消化道肿瘤，其发病率呈逐年增加的趋势，在美国为十万分之九，并已成为第四位致死的恶性肿瘤，总的5年存活率仅为3%。手术切除是胰腺癌的首选治疗手段，但由于缺乏早期诊断方法，且胰腺癌早期即可广泛转移，故手术切除率只有20％．术后常出现局部复发和远处转移，5年存活率为10％～30%。因此，人们希望通过化疗来控制肿瘤的复发和远处转移．延长患者的生存时间。     

睾丸鞘膜及精索转移性腺癌1例

患，男，32岁。因“发现右阴囊肿块2周”于2006年6月27日入院。患1年前因右半结肠癌在我院行结肠癌根治术，术后病理检查报告为升结肠腺癌，浸润至浆膜，肠系膜淋巴结转移。体检：右阴囊增大，其内可扪及约7cm×5cm大小肿块，表面不规则，质硬，无触痛，透光试验（-），右睾丸附睾触不清，右精索增粗、变硬。B超检查提示右侧阴囊内及阴囊壁肿块。血HCG、CA199、AFP、CEA均在正常范围。入院后在腰麻下行右睾丸根治性切除术。术中见右睾丸大小颜色正常，表面光滑，右睾丸鞘膜及精索睾丸连接部多发大小不等质硬结节，最大位于精索睾丸连接部.[第一段]     

自体树突状细胞-细胞因子诱导的杀伤细胞联合常规化疗对转移性胰腺癌的疗效分析

目的:探讨自体树突状细胞-细胞因子诱导的杀伤细胞(DC-CIK)联合常规化疗治疗转移性胰腺癌患者的近、远期效果。方法:选取96例转移性胰腺癌患者随机分为对照组与观察组,每组各48例,对照组患者行单纯替吉奥化疗,观察组在替吉奥化疗的基础上联合使用自体DC-CIK治疗,比较两组的近期(两个疗程后)疗效与远期预后。结果:对照组与观察组的缓解率差异无统计学意义(39.58%vs.27.08%,P0.05),但总有效率明显升高(77.08%vs.58.33%,P0.05);两组治疗前T淋巴细胞亚群、IFN-γ与IL-4水平差异均无统计学意义(均P0.05),治疗后,观察组CD3~+细胞、CD4~+细胞、CD4~+/CD8~+比值、IFN-γ水平明显高于对照组(P0.05),CD8~+细胞、IL-4水平明显低于对照组(P0.05)。两组患者的治疗过程中各毒副反应的发生率无明显差异(均P0.05)。观察组患者平均生存期与1、2、3年生存率均明显高于对照组(15.0个月vs.10.0个月;66.67%、29.17%、8.33%vs.43.75%、10.42%、0,均P0.05)。结论:自体DC-CIK联合常规化疗对转移性胰腺癌患者近期疗效、远期预后均具有改善作用。     

Future prospects in the chemotherapy of metastatic nonseminomatous testicular germ-cell cancer

The current aims of chemotherapy in metastatic testicular cancer are to reduce treatment-related toxicity in patients with “good-prognosis” metastatic disease without compromising the efficacy and to improve treatment results in “poor-prognosis” patients according to the IGCCCG classification by the use of more dose-intensive regimens. Three cycles of PEB chemotherapy, consisting of cisplatin, etoposide, and bleomycin, remain the standard treatment for good-prognosis patients despite a number of randomized studies trying to avoid the toxicity of bleomycin or to abandon cisplatin-associated side effects by substitution with the less toxic analogue carboplatin. In patients with intermediate- and poor-prognosis criteria, four cycles of PEB given at 3-weekly intervals are considered routine treatment. The role of high-dose chemotherapy with peripheral blood stem-cell (PBSC) transplantation (HDCT) is currently being investigated for patients who initially present with poor-prognosis metastatic disease and for patients with relapse after previous chemotherapy. Favorable results with long-term survival rates of approximately 75% have been achieved with up-front sequential HDCT in a phase I–II trial of the German Testicular Cancer Study Group (GTCSG) in such patients. A randomized phase III trial comparing conventional dose chemotherapy (4× PEB) with HDCT (2× PEB + 2× HD-CEC) was initiated as a United States intergroup trial in 1996. In patients with relapsed disease, conventional salvage chemotherapy results in only an approximately 20% long-term survival rate. Particularly, primary mediastinal disease and chemotherapy refractoriness represent variables associated with a very poor outcome. HDCT is also employed in relapsed patients to improve the long-term outcome. Long-term toxicity of treatment has become an important issue due to the large group of patients with metastatic disease now being cured with modern treatment strategies. The cumulative dose of cisplatin applied has been identified as a major risk factor for the development of many types of late toxicity. Despite the major advances made in the last 20 years, evaluation of the role of HDCT in both first-line and salvage treatment, investi- gation of new cytotoxic agents in refractory patients, and assessment of the long-term toxicities are major tasks that remain to be addressed in controlled clinical trials.     

Reoperative retroperitoneal lymph-node dissection for testicular germ cell tumor

Purpose  We sought to discuss the indications for reoperative retroperitoneal surgery, preoperative evaluation of patients, distribution of retroperitoneal recurrences and technical considerations for reoperative procedures. In addition, the histologic findings, clinical outcomes and perioperative complications were reviewed. Methods  A PubMED and Medline search was performed to identify reoperative retroperitoneal surgery series for patients with nonseminomatous germ cell tumor. Results  A reliance on cisplatin-based chemotherapy to treat residual disease after RPLND is inadequate for most patients. If retroperitoneal failure does occur, reoperative RPLND should be considered as the recurrence can harbor viable GCT or teratoma, which both necessitate surgical excision. The left para-aortic and left renal hilar regions are the most common sites of retroperitoneal failure. Reoperative retroperitoneal surgery can be performed with an acceptable morbidity as long as surgeons are equipped to handle significant intraoperative complications. Clinical outcomes after reoperative RPLND are influenced by serum tumor markers, histologic findings and completeness of surgical resection. Conclusions  Overall survival rates in men requiring redo RPLND appear significantly lower than similar patients who are successfully treated with their initial RPLND. Given the potential complexity of this operation and its impact on a patient’s prognosis, reoperative RPLND surgery should be limited to specialized quaternary care centers.     

新辅助化疗后行根治性切除术治疗局部转移性膀胱癌患者的临床研究

目的 考察新辅助化疗后行根治性切除术治疗局部转移性膀胱癌患者的临床疗效.方法 回顾性分析局部转移性膀胱癌患者临床资料37例,依据是否接受新辅助化疗分为观察组(20例)和对照组(17例).观察组患者使用顺铂、吉西他滨新辅助化疗后行根治性切除术治疗.对照组患者接受根治性切除术治疗.随访记录患者化疗效果、前后肿瘤大小、不良反应和生存期.结果 化疗后患者治疗有效率75.0％ (15/20),肿瘤直径显著降低(P＜0.01).不良反应总体发生率为70.0％ (14/20),且主要为Ⅰ～Ⅱ级.观察组患者中位生存期41个月显著高于对照组的26个月(P＜0.05).结论 新辅助化疗可以获得较高应答率,显著缩小肿瘤,结合手术治疗可延长患者生存期.     

Sociodemographic disparities in chemotherapy treatment and impact on survival among patients with metastatic bladder cancer

Objective

To evaluate how socioeconomic status and other demographic factors are associated with the receipt of chemotherapy and subsequent survival in patients diagnosed with metastatic bladder cancer.

睾丸肿瘤组织中C－myc基因扩增和表达及其临床意义

为了探讨Ｃ－ｍｙｃ与睾丸肿瘤发生及预后的关系，应用核酸杂交方法检测２７例睾丸肿瘤组织中Ｃ－ｍｙｃ基因扩增。结果显示，仅２例睾丸肿瘤有Ｃ－ｍｙｃ基因扩增。同时用免疫组化方法检测睾丸肿瘤中Ｃ－ｍｙｃ蛋白表达水平，有１２例发现Ｃ－ｍｙｃ蛋白阳性表达，并且与睾丸肿瘤的病理分级和临床分期有关。提示睾丸肿瘤中Ｃ－ｍｙｃ基因的扩增现象并不常见，但睾丸肿瘤恶性程度与Ｃ－ｍｙｃ蛋白表达具有明显相关性，Ｃ－ｍｙｃ蛋白表达可能成为睾丸肿瘤预后的指标。     

Surgery for metastatic renal cell cancer

Renal cell carcinoma (RCC) often presents in its metastatic form, or progresses after curative treatment. While the management of metastatic RCC has historically been mainly surgical, contemporary approaches often incorporate systemic immunotherapy. This review examines the current indications and scope of surgical treatment of patients with metastatic RCC. Surgery is sometimes indicated for symptom palliation at either the primary or secondary sites. However, other less invasive therapies may be equally effective, and should be considered carefully. Cytoreductive surgery prior to immunotherapy appears to confer a survival advantage, but only selected patients are suitable for this treatment regimen. Primary immunotherapy followed by surgical removal of the tumour in partial responders is an alternative treatment strategy, which has not yet been evaluated as in randomized trials. As immunotherapy develops further, the precise timing and role of surgery in multimodality treatment will need to be carefully evaluated. Occasionally, the complete surgical excision of metastases, and the primary tumour, if present, is feasible and this may prolong survival. Empirically, it would seem that such patients should also be treated with adjuvant immunotherapy, as eventual relapse is frequent. Surgery with the aim of inducing spontaneous tumour regression is not justifiable, given the rarity of this phenomenon.     

Combined intensive chemotherapy and radical surgery for incurable gastric cancer

Background: To improve the poor prognosis of patients with advanced incurable gastric cancer, intensive chemotherapy combined with radical surgery was used. Patients and Methods: Thirty patients with incurable gastric cancer were treated with a combination of 5-fluorouracil (370 mg/m²) and leucovorin (30 mg/person), given intravenously for five consecutive days, followed by cisplatinum (70 mg/m²) and etoposide (70 mg/m²) on days 6 and 20, delivered through a catheter placed either in the aorta with its tip at the level of the ninth thoracic vertebra or in the celiac artery. This treatment (FLEP therapy) was repeated twice every 5 weeks. Radical or palliative surgery followed chemotherapy. Results: The overall response rate to the chemotherapy was 50.0% (15 of 30 patients, 95% confidence limit 0.305–0.671). Nineteen patients (15 with a partial response, three showing no change, and one with progressive disease) underwent surgery. Of these, nine underwent curative surgery and 10 palliative surgery. The median survival time was 6.5 months overall, 12.7 months for responders, and 4.7 months for nonresponders. Long-term survivors were exclusively found among patients with distant lymph node metastasis treated by curative surgery (55.6% at 5 years). Conclusions: Favorable results of this small phase II study justify a phase III trial.     

睾丸肿瘤腹膜后淋巴结清扫术39例报告

目的探讨腹膜后淋巴结清扫术(RPLND)在睾丸肿瘤治疗中的意义。方法回顾性分析39例施行RPLND的睾丸生殖细胞肿瘤患者临床资料。年龄20—58岁，中位年龄29岁。左侧17例，右侧22例。精原细胞瘤1例，非精原细胞瘤38例。35例经CT、B超检查，提示15例腹部肿块，其中5例经博来霉素加鬼臼乙叉甙加顺铂方案化疗后肿块仍有残余，另有2例临床Ⅰ期患者经化疗后手术。结果10例临床Ⅰ期患者施行保留性神经的改良清扫术，余29例接受双侧手术。清扫组织未见癌转移者22例，癌转移17例，其中包括临床Ⅰ期4例。对RPLND证实有转移灶者和血AFP或β-HCG升高者均施行化疗。39例患者随访1—149个月，无瘤存活38例，接受保留性神经改良清扫术10例中射精功能恢复满意8例。结论精原细胞瘤的诊断与随访中应警惕存在非精原细胞成分，必要时行RPLND。对于临床Ⅰ期非精原细胞瘤，应积极行保留性神经的改良RPLND术，病理Ⅱ期的患者术后应接受化疗。     

局部晚期和远处转移胰腺癌的姑息治疗

More than 25％ pancreatic cancers are locally advanced and unresectable.For patients underwent pancreatectomy,about 80％ of patients had pancreatic cancer recurrence in 2 years.The aim of palliative treatment for locally advanced and metastatic pancreatic cancer is to relieve the disease-associated symptoms,including biliary obstruction,duodenal obstruction,and intractable abdominal pain.Surgical strategies,such as palliative resection (R1 resection ),biliary drainage and gastroenterostomy have been widely used.During recent years,neoadjuvant chemotherapy and radiation have been recommended as the palliative treatment of choice for patients with locally advanced and metastatic pancreatic cancer.However,The controversy still exists.This article summarized current data of surgical and non-surgical strategies for the treatment of locally advanced and metastatic pancreatic cancer.     

术后髂内动脉和肝动脉联合灌注化疗对直肠癌患者盆腔复发和肝转移的预防作用

目的研究直肠癌根治性切除术后预防性髂内动脉和肝动脉联合灌注化疗对盆腔复发和肝转移的抑制作用。方法84例获得根治性切除的直肠癌DukesB、C期患者,术后41例予以预防性经导管双侧髂内动脉和肝动脉联合灌注化疗,同时结合静脉化疗(观察组);另43例单纯静脉化疗(对照组);随访5年内患者盆腔复发和肝转移的发生情况及生存情况,前瞻性对照研究两组患者的疗效。结果观察组5年内肝转移和盆腔复发的发生率为17.1%和9.8%;对照组则为30.2%和18.6%;两组差异有统计学意义(χ2=4.31,P<0.05)。观察组复发病例的平均无瘤生存期26.2个月,明显长于对照组的15.8个月(t=5.05,P<0.01)。观察组患者5年生存率65.9%,明显高于对照组的56.5%(u=8.68,P<0.01)。Cox风险比例模型分析显示,观察组盆腔复发和肝转移的风险较对照组减少20%[危险度0.7959],5年内死亡的风险同比下降20%[危险度0.8034]。结论直肠癌根治术后早期预防性地进行髂内动脉和肝动脉联合灌注化疗可有效降低和抑制盆腔局部复发率和肝转移的发生率,提高5年生存率。