前列腺根治性切除术治疗前列腺癌骨转移或淋巴结转移患者的生存预后分析

目的 探讨前列腺根治性切除术对前列腺癌骨转移或淋巴结转移患者生存预后的影响.方法 将美国SEER数据库2004年至2013年间收录的淋巴结转移或骨转移的647例前列腺癌患者纳入研究,其中单独骨转移非手术组129例,单独骨转移手术组129例,单独淋巴结转移非手术组131例以及单独淋巴结转移手术组131例,无转移非手术组1...     

Mutational Analysis of Triple-Negative Breast Cancer Using Targeted Kinome Sequencing

PurposeTriple-negative breast cancer (TNBC) does not have defined therapeutic targets and is currently treated with chemotherapy only. Kinase dysregulation triggers cancer cell proliferation and metastasis and is a crucial therapeutic target for cancer. In this study, targeted kinome sequencing of TNBC tumors was performed to assess the association between kinome gene alterations and disease outcomes in TNBC.MethodsA kinome gene panel consisting of 612 genes was used for the targeted sequencing of 166 TNBC samples and matched normal tissues. Analyses of the significantly mutated genes were performed. Genomic differences between Asian and non-Asian patients with TNBC were evaluated using two Asian TNBC datasets (from Seoul National University Hospital [SNUH] and Fudan University Shanghai Cancer Center [FUSCC]) and three non-Asian TNBC datasets (The Cancer Genome Atlas [TCGA], METABRIC, and Gustave Roussy). The prognostic value of kinome gene mutations was evaluated using tumor mutational burden (TMB) and oncogenic pathway analyses. Mutational profiles from the TCGA were used for validation.ResultsThe significantly mutated genes included TP53 (60% of patients), PIK3CA (21%), BRCA2 (8%), and ATM (8%). Compared with data from non-Asian public databases, the mutation rates of PIK3CA p.H1047R/Q were significantly higher in the SNUH cohort (p = 0.003, 0.048, and 0.032, respectively). This was verified using the FUSCC dataset (p = 0.003, 0.078, and 0.05, respectively). The TMB-high group showed a trend toward longer progression-free survival in our cohort and the TCGA TNBC cohort (p = 0.041 and 0.195, respectively). Kinome gene alterations in the Wnt pathway in patients with TNBC were associated with poor survival in both datasets (p = 0.002 and 0.003, respectively).ConclusionComprehensive analyses of kinome gene alterations in TNBC revealed genomic alterations that offer therapeutic targets and should help identify high-risk patients more precisely in future studies.     

PET／CT代谢体积对进展期肠型胃癌新辅助化疗疗效的价值

目的探讨基于肿瘤^18F-FDG摄取的MTV在肠型胃癌新辅助化疗（NAC）疗效评价中的应用价值。方法回顾性分析NAC前后均行^18F-FDGPET／CT检查的41例肠型胃癌患者（男28例,女13例）,根据术后病理分级分为有效组和无效组。对化疗前后的原发灶SUVmax减少率、MTV减少率与病理分级的关系进行Spearman分析,利用ROC曲线分析比较MTV减少率、SUVmax减少率预测病理学反应的效能。同时以术后病理为“金标准”,利用x^2检验比较以传统影像学为基础的实体瘤疗效评价标准（RECIST）1．0与PET／CTMTV减少率预测NAC后病理学反应的准确性。结果41例患者中,有效组20例,无效组21例。化疗前后SUVmax减少率、MTV减少率与病理分级的r分别为0．434和0．763（均P〈0．01）,预测病理学反应的AUC分别为0．789和0．943,差异有统计学意义（Z=2．114,P〈0．05）。以MTV减少率49．4％为评价化疗有效的阈值,其预测病理学反应灵敏度为90．0％（18／20）,特异性为90．5％（19／21）,准确性高于RECIST1．0[90．2％（37／41）和80．5％（33／41）;x^2=7．14,P〈0．05]。结论在FDG摄取的胃癌患者中,^18F-FDGPET／CT可用于NAC治疗反应的评价。MTV可作为评价治疗反应有效性的重要指标。     

血清胸苷激酶1检测对恶性肿瘤诊断及疗效评估的意义

目的探讨血清胸苷激酶1（TK1）作为肿瘤细胞增殖标志物对恶性肿瘤诊断及疗效评估的意义。方法应用免疫印迹-增强化学发光法检测恶性肿瘤组（53例）治疗前后、体格检查组（49例）以及健康对照组（18名）的血清TK1水平。治疗前与治疗后比较用配对t检验,治疗前和后分别与健康对照组、体格检查组比较采用两独立样本均数比较t检验。结果恶性肿瘤组治疗前STK1为0．3—11．3（2．4±2．0）pmol／L;恶性肿瘤组治疗后STK1为0．3～5．0（0．9±0．8）pmol／L;体格检查组STK1为0．1～2．1（0．8±0．3）pmol／L;健康对照组STK1为0．5～1．2（0．7±0．2）pmol／L。恶性肿瘤组治疗前与治疗后之间STK1水平差异有统计学意义（t=5．257,P〈0．0001）。恶性肿瘤组治疗前与健康对照组和体格检查组STK1水平比较,差异均有统计学意义（t=3．568和5．460,P=0．001和〈0．0001）,而恶性肿瘤组治疗后与健康对照组和体格检查组STK1水平比较,差异均无统计学意义（t=1．056和0．715,P均〉0．05）。结论血清TK1检测细胞增殖有较高的特异性和灵敏度,对临床监测恶性肿瘤疗效和在体格检查中进行恶性肿瘤风险筛查具有重要意义。     

加速康复外科联合腹腔镜手术对胃癌患者术后肠道生物屏障稳定性的影响研究

目的探讨加速康复外科(ERAS)联合腹腔镜手术对于胃癌患者术后肠道生物屏障稳定性、免疫功能及应激反应的临床研究。 方法回顾性分析2016年1月至2018年6月期间收治的胃癌患者88例资料,患者均进行腹腔镜胃癌根治术治疗,按照治疗干预方案不同分为ERAS组和传统组。ERAS组42例患者采用ERAS干预,传统组46例患者给予常规治疗。采用SPSS 20.0进行数据分析,术后各临床指标、肠道菌属数目等计量资料采用 ±s表示,独立t检验;术后并发症、病理分级等计数资料采用χ²检验;P<0.05表示差异有统计学意义。 结果ERAS组患者术后肛门通气时间、发热时间、下床活动时间、首次进食时间、住院时间显著短于传统组(P<0.05);术后ERAS组患者粪便各菌属数量明显多于传统组(P<0.05);术后3 d ERAS组患者血清CD4^＋、CD4^＋/CD8^＋ 、IgG、IgM、IgA明显优于传统组(P<0.05);术后ERAS组患者应激反应较传统组低,血清IL－6、CRP、TNF－α水平明显低于对照组,差异均有统计学意义(P<0.05)。 结论加速康复外科联合腹腔镜手术对于胃癌患者术后肠道生物屏障、术后免疫功能、应激反应等具有重大意义,且可有效促进患者术后康复,值得临床推广。     

保留幽门和迷走神经的胃部分切除手术对早期胃癌的疗效观察

目的 探讨保留幽门和迷走神经的胃部分切除手术（PPG）对早期胃癌的疗效.方法 回顾性分析1995年8月至2005年12月对52例早期胃癌患者行保留幽门和迷走神经的胃部分切除术（PPG组）的临床资料和随访结果;并与同期行远端胃切除术伴淋巴结清除的159例早期胃癌患者（对照组）的临床资料进行比较.结果 PPG组早期胃癌的淋巴结转移率为9.6%,对照组淋巴结转移率为17.0%;两组比较,差异无统计学意义（P＞0.05）.PPG组淋巴结清除范围D1为25%,D1＋α（α=No.7）为25%,D1＋β（β=No.8a和No.9）为34.6%,D2为15.3%;对照组121例（76.1%）D2以下,33例（20.7%）D2,5例（3.1%）D3;两组比较,差异无统计学意义（P＞0.05）.术后累计5年生存率PPG组为92.3%,对照组93.1%,两组差异无统计学意义（P=0.881）.其中淋巴结不同清除程度的累计5年生存率PPG组：D1为100%,D1＋α为92.3%,D1＋β为88.9%,D2为87.5%;对照组：D1为92.3%,D1＋α为93.3%,D1＋β为91.7%,D2为93.9%;两组比较,差异无统计学意义（P＞0.05）.PPG组术后的复发率为5.7%,对照组则为5.6%,两组差异无统计学意义（P＞0.05）.结论 PPG对于早期胃癌的治疗是有效的.     

青石棉污染区恶性肿瘤的影像学调查

目的通过影像学调查以了解1998年以来青石棉污染造成的恶性肿瘤患病情况.方法搜集云南省大姚县人民医院1998年6月1日至2001年12月31日间来我院就诊做CT及X线检查的病例与非污染区同省禄丰县人民医院同期同样病例资料进行对比,重点探讨胸膜间皮瘤及肺癌.结果观察组就诊病人CT检查6 615例,检出恶性肿瘤258例,检出率为3.9%;对照组就诊病人CT检查4 854例,检出恶性肿瘤132例,检出率为2.72%.观察组肺癌66例,检出率为1.00%,胸膜间皮瘤51例,检出率为0.77%;对照组肺癌50例,检出率为1.03%,胸膜间皮瘤1例,检出率为0.02%.观察组就诊病人X线检查14 044例,检出恶性肿瘤57例,检出率为0.41%;对照组就诊病人X线检查16 024例,检查出恶性肿瘤35例,检出率为0.22%.观察组肺癌42例,检出率为0.3%,胸膜间皮瘤6例,检出率为0.04%;对照组肺癌25例,检出率为0.16%,胸膜间皮瘤1例,检出率为0.01%.结论在X线及CT检查中,青石棉污染区恶性肿瘤患病率以肺癌、胸膜间皮瘤最高.     

卡培他滨节律化疗对胃癌肿瘤血管生成的影响

目的:探讨卡培他滨节律化疗对胃癌肿瘤血管生成的影响,并观察其抑瘤效果。方法:建立裸鼠人胃癌移植瘤模型,观察肿瘤生长情况和毒副作用。采用实时定量PCR测定肿瘤组织中血管内皮生长因子(VEGF)mRNA的表达水平,用免疫组织化学染色测定CD31和VEGF的表达。结果:体内试验证实低剂量卡培他滨明显抑制了肿瘤的生长,毒副作用小,且肿瘤组织内的微血管密度(MVD)及VEGF表达均下降。结论:卡培他滨节律化疗能够有效抑制裸鼠胃癌移植瘤的生长及微血管的形成,且无明显的毒副作用。     

Intraoperative microwave inactivation in‐situ of malignant tumors in the scapula

Objective: To explore the feasibility and effect of microwave in situ inactivation of malignant primary or metastatic tumors in the scapula. Methods: Seventeen patients (12 men, 5 women, mean age 48 years [range, 13–59 years]) with malignant primary or metastatic tumors involving the scapula were treated by microwave inactivation between June 1998 and February 2008. There were12 malignant primary bone and 5 metastatic tumors. In 14 cases Area Sl was involved and in 3 cases both Areas S1 and S2. All 17 cases were by making a dorsal arc‐ or “∩‐” shaped incision to expose the tumor, protecting the surrounding soft tissues with a copper grid, and then heated the tumors locally with 2450 MHz microwave to 50°C for 20 min, after which all or some of the necrotic tumor tissue was removed, preserving the support role of the scapula. Results: The operation time was 60–180 min (mean 120 min) and blood loss was 300–1000 mL (mean 460 mL). No serious intraoperative or postoperative complications occurred in any patient. The patients were followed up for 3 months to 10 years (mean 4.2 years). Three patients with Ewing's sarcoma in the scapula had pulmonary, cerebral and systemic multiple metastases and died 8～24 months after surgery. Three patients with malignant fibrous histiocytoma died of pulmonary and systemic multiple metastases 10～22 months after surgery; one patient had recurrence 6 months after surgery and survived with tumor. Five patients with metastatic tumor in the scapula died of non‐scapular metastatic tumor 6～14 months after surgery. The other five patients with primary malignant bone tumors had no recurrence or metastasis during follow‐up. Three cases had restricted extension of the shoulder joint with unrestricted protraction and retroflexion after surgery. Conclusion: In situ microwave inactivation features simple surgery, reliable effects and patient acceptability, making it an ideal surgical method for malignant tumors in the scapula.     

恶性肿瘤合并甲状腺功能亢进的临床分析

目的 探讨恶性肿瘤合并甲状腺功能亢进的治疗经验.方法 回顾性分析2004年5月至2010年5月天津医科大学总医院普外科收治的10例合并甲状腺功能亢进的恶性肿瘤患者的临床资料.结果 4例患者先行甲状腺次全切除术后再行肿瘤根治术,5例用药物控制甲状腺功能亢进症状后直接行肿瘤根治术,1例入院时甲状腺功能亢进已得到控制,顺利施行手术.术后3例出现类似甲状腺危象的临床表现,全组无手术死亡.术后均行化疗,其中1例因白细胞减少被迫停止化疗.结论 手术治疗合并甲状腺功能亢进的恶性肿瘤前应根据患者的不同情况选择最佳的方法(手术或药物)控制甲状腺功能亢进;合理的术前用药、有效的术后管理可以降低手术风险,使患者安全地通过围手术期;先期行甲状腺的次全切除是可行的治疗选择.