进展期大肠癌新辅助治疗研究现状

近年来,大肠癌的发病率在全球范围内呈逐年增高的趋势,在我国大肠癌发病增速最为显著,上海市肿瘤发病率最新统计显示,大肠癌发病率年均增速超过4％[1].目前大肠癌的治疗主要是以手术治疗为主的综合治疗,术前、术后辅以放化疗、靶向治疗等.对于进展期大肠癌而言,术前新辅助治疗较术后辅助治疗具有更为重要的意义.术前新辅助治疗具有以下特点:(1)降低肿瘤临床分期,提高手术切除率,增加保肛成功率;(2)消灭术前微小转移灶,减少术中转移;(3)指导术后辅助治疗,减少术后复发.因此,术前新辅助治疗作为一种治疗标准在临床上广泛开展,其疗效得到普遍肯定.     

血清恶性肿瘤特异性生长因子检测对乳腺癌新辅助化疗疗效的预测价值

目的:探讨局部进展期乳腺癌新辅助化疗前后血清恶性肿瘤特异性生长因子(TSGF)水平变化及其对疗效的预测价值.方法:对2002/2006收治住院的96例Ⅱb～Ⅲ期乳腺癌患者应用CEF方案进行新辅助化疗.CEF 方案:环磷酰胺(CTX) 500 mg/m2,d1,8;表阿霉素( EPI) 50 mg/m2,d1,8;5-氟尿嘧啶(5-Fu) 500 mg/m2,d1,8.28 d为1 个周期,所有患者完成2 个周期新辅助化疗后评价疗效.于治疗前1 d及治疗2周期后各采外周静脉血2 mL,用光电比色法检测血清TSGF水平.结果:新辅助化疗总有效率为48%(46/96),其中38例(40%)降低了临床分期,完全缓解7例,部分缓解39例,无疾病进展者.96例乳腺癌患者化疗前TSGF阳性率为73%(70/96).TSGF阳性组和阴性组总有效率分别为49%(34/70),46%(12/26),无显著性差异(χ2＝0.044,P=0.833,＞0.05).化疗前血清TSGF水平为(71.1±6.5)×103 U/L;化疗后为(58.6±7.2)×103 u/L,较化疗前显著下降(P＜0.05).其中临床完全缓解和部分缓解患者血清TSGF水平化疗后较化疗前均有一定程度下降(P＜0.05);而病情稳定患者血清TSGF水平较化疗前无显著下降(P＞0.05).结论:血清TSGF水平不足以预测新辅助化疗的疗效,但新辅助化疗前后TSGF水平变化对疗效预测有一定的临床意义.     

The Effect-enhancing and Toxicity-reducing Action of the Extract of Herba Scutellariae Barbatae for Chemotherapy in Hepatoma H22 Tumor-bearing Mice

Objective： To investigate the effect-enchancing and toxicity-reducing action of the extract of Ban Zhi Lian （半枝莲 Herba Scutellariae Barbatae, EHSB） for chemotherapy in hepatoma H22 tumor-bearing mice. Methods： The tumor-bearing mice were divided into 6 groups randomly： a model group, a high dose EHSB group, a low dose EHSB group, a 5-fluorouracil （5-FU） group, a 5-FU＋high dose EHSB group and a 5-FU＋low dose EHSB group, and with a normal group set as the controls. All the groups were treated for 10 days. The life prolongation rate, toxic reactions of chemotherapy, WBC count, the body weight, tumor weight, thymus index and spleen index, and phagocytic function of intra-abdominal macrophages were investigated in the H22 tumor-bearing mice. Results： The increase of the body weight in both the 5-FU＋EHSB groups was significantly higher than that in the 5-FU group, with the toxic reactions such as anorexia, abdominal distension and emaciation significantly alleviated. Growth of the tumor was significantly inhibited in the high dose EHSB group, the 5-FU group, the 5-FU＋high dose EHSB group, and the 5-FU＋low dose EHSB group. The survival time in the 5-FU＋high dose EHSB group and the 5-FU＋low dose EHSB group was significantly prolonged as compared with that of the 5-FU group. The life prolongation rate was 98.72% in the 5-FU＋high dose EHSB group and 52.11% in the 5-FU＋low dose EHSB group. Growth of the transplanted tumor was significantly inhibited in the high dose EHSB group, the 5-FU group, the 5-FU＋high dose EHSB group, the 5-FU＋low dose EHSB group. The tumor inhibition rate in the high dose EHSB group, the 5-FU group, the 5-FU＋high dose EHSB group and the 5-FU＋low dose EHSB group was 36.98%, 42.26%, 65.28% and 52.45%, respectively. 5-FU combined with a high-dose EHSB could significantly enhance the tumor inhibition rate （P〈0.05）. The thymus index and the spleen index significantly increased in the high dose EHSB group, and atrophy of the immunological organs induced     

乳头血性溢液的诊断与治疗

目的:总结乳头血性溢液的诊断和治疗方法,为临床合理诊断治疗提供依据.方法:回顾性分析1998年至2006年本院收治的220例乳头血性溢液病例.结果:乳腺癌的细胞学诊断准确率50.85%,钼靶X线片诊断准确率76.27%,联合诊断准确率86.44%,冰冻活检准确率100%,联合诊断准确率优于乳头溢液涂片法和X线钼靶摄片法,差异具有统计学意义(P＜0.05).其中导管内乳头状瘤60.91%(134/220),乳腺癌26.82%(59/220),囊性增生、炎症、导管扩张症12.27%(27/220).结论:联合诊断可提高准确率,手术治疗及术中冰冻活检是合理治疗方式.     

^153钐-乙二胺四甲基膦酸联合伊班磷酸钠缓解骨转移性癌疼痛

目的 ^153钐-乙二胺四甲基膦酸(^153Sm-EDTMP)联合伊班磷酸钠控制多发性骨转移癌疼痛，探讨其疼痛缓解率。方法 106例多发性骨转移癌患用^153Sm-EDTMP联合伊班磷酸钠治疗，观察骨痛缓解及生活质量提高情况。结果 严重( )：CR23例，PR16例，MR3例，NR3例。中度( )CR18例，PR15例，MR3例，NR2例。轻度( )：CR14例，PR7例，NR2例。止痛有效率87．7％，生活质量明显提高，无严重毒副反应。结论 ^153Sm-EDTMP联合伊班磷酸钠治疗多发性骨转移安全有效。     

小儿卵巢肿瘤116例诊治分析

本院收治小儿卵巢肿瘤116例,其中良性100例,恶性16例。本组资料显示畸胎瘤随年龄增加其恶性率增高,强调了早期手术的重要性,并讨论了甲胎蛋白在恶性生殖细胞瘤诊治中的重要意义及化疗对提高生存率的重要作用     

Clinical Effects of Shenqi Fuzheng Injection in the Neoadjuvant Chemotherapy for Local Advanced Breast Cancer and the Effects on T-lymphocyte Subsets

Objective： To evaluate clinical effects of Shenqi Fuzheng Injection （参芪抉正注射液） in the neoadjuvant chemotherapy for local advanced breast cancer and the effects on T-lymphocyte subsets. Methods： During the period from 2000 to 2005, 126 patients with local advanced breast cancer were treated with the neoadjuvant chemotherapy. They were randomly divided into the following two groups： a control group of 61 cases treated by chemotherapy alone and a study group of 65 cases treated by chemotherapy plus Shenqi Fuzheng Injection, All the cases of both groups were given the CEF （CTX 500 mg/m^2, d1, 8; EP140 mg/m^2, d1, 8; and 5-Fu 500 mg/m^2, d1,8） regimen. The clinical effects, the effects on T-lymphocyte subgroup and NK cells, and the toxic side effects were observed. Results： All the patients completed two cycles of the chemotherapy, and the efficacy and the toxic side effects were evaluated. For the primary tumor in the breast, the total effective rate was 69.2% （45/65） in the study group and 49.2% （30/61） in the control group with a statistically significant difference in the intergroup comparison （x^2=5.251, P=0.022, 〈 0.05）. There was no progression of the disease in both the groups, and there were no grade IV toxic side effects in the two groups. The major toxic responses were myelosuppression and gastrointestinal reaction, which were milder in the study group than the control group, and with a shorter recovery course in the former than the latter. Besides, an obvious rise of the T-lymphocyte subgroup and NK cells was found in the study group after the neoadjuvant chemotherapy, with a very significant difference from the controls （P〈0.01）. Conclusions： Shenqi Fuzheng Injection can improve and regulate immune function of the patients with local advanced breast cancer given the neoadjuvant chemotherapy, and therefore it can enhance the curative effect and reduce the side effect as well.     

乳腺浸润性导管癌磁共振表观扩散系数值与预后因子表达的相关性分析

目的 探讨乳腺浸润性导管癌磁共振扩散加权成像(DWI)表观扩散系数(ADC)值与淋巴结转移状态,雌激素受体(ER)、孕激素受体(PR)和cerbB2表达的关系.方法 选取自2008-04-2010-04采用b=800 s/mm2的DWI检出的49个乳腺浸润性导管癌病灶作为研究对象.测定病灶的ADC值,病灶切除后取相应标本,记录淋巴结转移情况,免疫组化技术测定病灶的ER、PR和cerbB2表达情况.对不同淋巴结转移状态和不同预后因子表达状态与病灶的ADC值的关系进行分析.结果本组49个浸润性导管癌病灶中,伴有淋巴结转移18个.ER、PR、cerbB2表达阳性率分别为55.1%、61.2%和51.0%.有无淋巴结转移的病灶平均ADC值之间比较无显著性差异(P=0.382).ER、PR和cerbB2表达阴性的病灶与表达弱阳性、阳性和强阳性的病灶的平均ADC值之间比较均无显著性差异(P值均<0.05).病灶平均ADC值与淋巴结转移状态、ER、PR和cerbB2的表达均不具有相关性(r值分别为0.063,-0.311,-0.261和0.333,P值均>0.05).结论 DWI的ADC值尚不能用于乳腺癌预后的间接评价和个体化治疗方案的选择.     

半枝莲提取物对H22肝癌荷瘤小鼠化疗的增效减毒作用

目的：探讨半枝莲提取物（Scutellaria barbata extract，ESB）在荷瘤小鼠化疗中的增效减毒作用。 方法：将接种H22肝癌细胞的实体瘤和腹水瘤小鼠各分为模型组、ESB高剂量组、ESB低剂量组、5-氟尿嘧啶（5-fluorouracil ,5-FU）组、5-FU＋ESB高剂量组、5-FU＋ESB低剂量组，另设正常对照组，连续给药10d。观察荷瘤小鼠抑瘤率、生命延长率和毒性反应，测小鼠瘤质量、体质量、胸腺指数和脾指数；各组小鼠采血计白细胞数。检测其腹腔巨噬细胞吞噬功能。 结果：5－FU＋ESB组体质量增加量明显高于5－FU单药组，而且厌食、腹胀及消瘦等毒性反应明显减轻。与模型组相比，5－FU＋ESB高剂量与5-FU＋ESB低剂量组生存时间明显延长，生命延长率分别为61．46％和23．59％。高剂量ESB、5-FU、5-FU＋低剂量ESB和5-FU＋高剂量ESB均可明显抑制荷瘤小鼠移植瘤的生长，其抑瘤率分别为36．98％、42．26％、52．45％和65．28％，高剂量ESB与5-FU合用可显著增加荷瘤小鼠移植瘤抑瘤率（P〈0．05）。高剂量ESB能明显增加小鼠胸腺指数和脾指数，且5-FU＋高剂量ESB与5－FU＋低剂量ESB均可改善化疗导致的免疫器官萎缩。5－FU组白细胞数明显下降，5-FU＋ESB组白细胞数有回升趋势。高、低剂量ESB与5-FU配伍均可明显改善5-FU所致小鼠腹腔巨噬细胞吞噬功能降低，与单用5-FU组相比较，吞噬率分别提高78．55％和43．97％，吞噬指数分别提高81．63％和44．90％。 结论：ESB能显著增强5-FU对小鼠H22移植瘤的抑制作用，减轻毒性反应，延长生存时间，改善荷瘤小鼠的免疫功能，具有一定的增效减毒作用。