Spectrum and immunophenotyping of 653 patients with B‐cell chronic lymphoproliferative disorders in China: A single‐centre analysis

The incidence of B‐cell chronic lymphoproliferative disorders (B‐CLPDs) is significantly lower in China than that in western countries. There have been studies involving small cohorts with conflicting results regarding the spectrum of B‐CLPDs in China, and the types and immunophenotyping of B‐CLPDs in China remain largely unexplored. We conducted a retrospective analysis of 653 cases of B‐CLPDs seen in our centre from 2011 to 2015. Four‐colour flow cytometry was used to determine the expression of each immunological marker, and the diagnostic values of the immunological markers were also investigated. Chronic lymphocytic leukaemia (CLL) was the most common type of B‐CLPD, which was consistent with that in west countries. However, the proportions of CLL (55.9%), follicular lymphoma (2.6%), and hairy cell leukaemia (0.2%) were lower, while the proportion of lymphoplasmacytic lymphoma/WaldenstrÖm macroglobulinaemia (5.4%) was higher in China, as compared with western countries. With respect to immunophenotypic characteristics, CD23 (31.7%) was more frequently expressed in mantle cell lymphoma (MCL) in our cohort than that in western countries. Immunophenotyping was useful in differentiating MCL from CLL or B‐cell prolymphocytic leukaemia and lymphoplasmacytic lymphoma/WaldenstrÖm macroglobulinaemia from splenic marginal zone lymphoma. CD200 was of better diagnostic performance (accuracy: 94.6%) in differentiating CLL from MCL compared with CD23 (accuracy: 93.3%). Some cases of B‐CPLDs, however, had no definite diagnoses, which were diagnosed as CD5⁺B‐CPLDs unclassified (7.7%) and CD5^?B‐CPLDs unclassified (15.8%). This is the largest study that systematically explores the spectrum and immunophenotyping of B‐CLPDs in Asia, confirming that spectrum of B‐CLPDs in China was different from that in western countries. The immunophenotypic features of B‐CLPDs were similar between China and western countries, although a few disparities exist. Cases with no definite diagnoses warrant further studies in the future.     

树突状细胞对LPAK抗人肝癌细胞的促进作用

目的观察人血树突状细胞（DC）联合LPAK细胞（L）体外抗人肝癌BEL-7402细胞（B）的杀伤效应,并对死亡细胞进行形态学分析.材料和方法LD组为DC＋L＋B,L组为L＋B,二组均采用L：B为5：1和10：1两种放靶比,应用TUNEL法及杀伤细胞检测技术,比较LD和L组的抗肿瘤效应。结果人血DC联合LPAK细胞与单用LPAK细胞的抗肿瘤活性比较,LD组＞L组（P＜0.01）,但二者均能诱导BEL-7402细胞调亡;调亡的肿瘤细胞是TUNEL阳性,在LD组较L组明显增多。结论DC能明显增强LPAK细胞对人肝癌细胞的杀伤活性,但不改变LPAK细胞诱导肿瘤细胞调亡的死亡模式。     

Solid cancer incidence among Chinese medical diagnostic x‐ray workers, 1950–1995: Estimation of radiation‐related risks

The objective of this study was to estimate solid cancer risk attributable to long‐term, fractionated occupational exposure to low doses of ionizing radiation. Based on cancer incidence for the period 1950–1995 in a cohort of 27,011 Chinese medical diagnostic X‐ray workers and a comparison cohort of 25,782 Chinese physicians who did not use X‐ray equipment in their work, we used Poisson regression to fit excess relative risk (ERR) and excess absolute risk (EAR) dose–response models for incidence of all solid cancers combined. Radiation dose reconstruction was based on a previously published method that relied on simulating measurements for multiple X‐ray machines, workplaces and working conditions, information about protective measures, including use of lead aprons, and work histories. The resulting model was used to estimate calendar year‐specific badge dose calibrated as personal dose equivalent (Sv). To obtain calendar year‐specific colon doses (Gy), we applied a standard organ conversion factor. A total of 1,643 cases of solid cancer were identified in 1.45 million person‐years of follow‐up. In both ERR and EAR models, a statistically significant radiation dose–response relationship was observed for solid cancers as a group. Averaged over both sexes, and using colon dose as the dose metric, the estimated ERR/Gy was 0.87 (95% CI: 0.48, 1.45), and the EAR was 22 per 10⁴PY‐Gy (95% CI: 14, 32) at age 50. We obtained estimates of the ERR and EAR of solid cancers per unit dose that are compatible with those derived from other populations chronically exposed to low dose‐rate occupational or environmental radiation.     

人乳头瘤病毒致癌关键因素的研究进展

人乳头瘤病毒（human papillomavirus,HPV）感染与多种疾病相关,特别是高危型人乳头瘤病毒更是与头颈部鳞癌、生殖器官癌等多种癌症关系密切,其中与宫颈癌的相关性尤为显著。人乳头瘤病毒基因组共分为早期基因编码区（E）、晚期基因编码区（L）和长控制区（LCR）,这些基因各自发挥功能,并与宿主细胞相互作用使正常宫颈组织发生癌变。因此大量的研究工作围绕此展开,本文将对目前关于HPV基因组各功能区基因作用及致癌机制的研究成果加以综述。     

力尔凡合并化、放疗治疗恶性肿瘤的多中心临床研究

目的：评价力尔凡合并化、放疗治疗肿瘤患者的初步疗效和安全性,同时观察对患者免疫功能的影响。方法：157例恶性肿瘤患者,男84例,女73例;分小细胞肺癌（SCLC）、晚期乳腺癌（ABC）和非霍奇金淋巴瘤（NHL）化疗组及非小细胞肺癌（NSCLC）放疗组等4组,每组再随机分为力尔凡治疗组和对照组。结果：近期疗效：小细胞肺癌、晚期乳腺癌和非霍奇金淋巴瘤化疗治疗组的有效率分别为63.2%、71.4?.7%;对照组分别为41.2%、42.1%和63.2%,各化疗治疗组与对照组之间均有显著性差异。放疗治疗组有效率为57.1%,而对照组为20%,两组亦有显著性差异。免疫功能：力尔凡治疗组疗后PPD试验阳性率、NK细胞数、T细胞总数均有明显上升,T8细胞数治疗组疗后则下降,CD4/CD8治疗组疗后亦有一定程度地升高。力尔凡治疗组白细胞下降幅度时显低于对照组。发热、消化道等毒副反应治疗组与对照组之间无显著性差异。结论：本组资料说明力尔凡在一定程度上可增强化、放疗的抗肿瘤作用,提高患者的免疫功能,对抗化、放疗所致的白细胞下降,临床使用耐受性良好。     

基于DWI-ADC值动态监测宫颈癌放化疗疗效的临床研究

目的:通过DWI-ADC值测定动态监测宫颈癌放化疗疗效。方法:对2014年4月至2016年9月我院病理确诊的37例中晚期（FIGO分期Ⅱb-Ⅲb）宫颈鳞癌患者分别于同步放化疗前（A节点）、外照射治疗结束时（B节点）、后装内照射治疗3次时（C节点）、同步放化疗治疗结束时（D节点)行4次常规MRI及DWI检查。在ADC图上绘制ROI测量病灶、正常子宫肌层的ADC值;计算不同时间节点病灶的体积。所有数据经过统计学处理。结果:A、B、C、D时间节点病灶ADC值组间比较有明显差异(P<0.01),从A→D节点病灶ADC值逐步上升,其中ADC值上升最明显的为B节点,增幅32.55%;病灶体积缩小最明显为B-C节点,缩小率为65.64%。D节点病灶与A节点正常子宫肌层的ADC值比较无统计学差异。结论:基于ADC值测定能够更早、更精确、定量地动态评估中晚期宫颈鳞癌同步放化疗效果,并对预后疗效给予准确预测。     

白细胞介素6和hepcidin在弥漫大B细胞淋巴瘤中的表达及其与贫血的相关性

目的：研究白细胞介素6（IL-6）和hepcidin在弥漫大B细胞淋巴瘤（DLBCL）患者中的表达及其在贫血发生中的作用。方法收集诊断时伴或不伴贫血的45例DLBCL患者,在诊断时抽取外周血标本,分别检测IL-6、hepcidin、血清铁蛋白和血红蛋白（Hb）浓度等。以24名健康志愿者作为对照。结果DLBCL患者的血浆hepcidin及IL-6水平分别为（347±171）μg／L、0.27 ng／L（0～9.61 ng／L）,与健康对照者的（175±92）μg／L、0相比,差异均有统计学意义（均P＜0.001）。在高乳酸脱氢酶（LDH）（P＝0.003）、有B症状（P＝0.040）和年龄校正的国际预后指数（IPI）评分＞1（P＝0.010）的患者中血浆hepcidin水平升高,差异均有统计学意义。在男性（P＝0.003）、肿瘤分期Ⅲ～Ⅳ期（P＝0.008）和IPI评分＞1（P＝0.004）的DLBCL患者中IL-6水平升高,差异均有统计学意义。 hepcidin水平与血清铁蛋白高度相关（r＝0.77,P＜0.001）,与IL-6弱相关（r＝0.31,P＝0.030）,与Hb无相关性（r＝-0.12,P＝0.300）。IL-6表达水平与Hb呈负相关（r＝-0.35,P＝0.009）。多因素分析提示,IL-6可以预测贫血（P＝0.03）,而hepcidin不能预测贫血（P＝0.89）。结论 DLBCL患者血浆hepcidin常高表达,但IL-6水平升高在DLBCL患者贫血的发生中起主要作用。     

免疫评分：依据肿瘤组织免疫特性进行预后预测

有效的肿瘤预后指标有利于针对不同病例选择合理的个性化治疗方案,防止过度治疗和不恰当治疗。目前临床普遍采用AJCC/UICC的TNM分期系统,按照原发病灶的病理特征将患者分为四期。越来越多的临床资料显示,在相同TNM分期患者的术后生存周期存在明显差异。最近,国际学者在结直肠癌中提出用免疫评分技术来关注肿瘤的组织免疫特性并进行数字病理学计分,以此来预测患者的生存周期,是一个重要的肿瘤免疫病理学进展,也为预判患者是否具有"预存免疫力"及其是否适合进行个体化肿瘤免疫治疗提供依据。本文将就近年来免疫评分系统的发展过程、应用前景和未来发展进行逐一讨论。     

18F-FDG PET/CT代谢的可重复性研究进展

18F-脱氧葡萄糖(18F-FDG)PET／CT在恶性肿瘤的早期诊断、临床分期、疗效评价、监测复发及肿瘤放疗靶区定位中具有重要价值。为了使PET/CT能够更准确地进行恶性肿瘤的疗效评价,18F-FDG PET／CT代谢的可重复性研究显得尤为重要。本文就传统临床代谢参数值标准化摄取值（SUV）、代谢活性肿瘤体积（MATV）、总病灶糖酵解（TLG）、肿瘤与肝脏比率（TLR）、肿瘤与血液比率(SUR)及近年新兴的PET图像纹理分析等方面的可重复性研究进行概述。