肿瘤休眠及其机制研究进展

肿瘤休眠(tumordormancy)是临床上普遍存在的一种现象,也是恶性肿瘤细胞的生物学特征之一,休眠细胞的长期存在是恶性肿瘤难以彻底根治的主要原因,也是导致肿瘤复发和远处转移的根源之一。本文从临床上发现肿瘤休眠存在、肿瘤休眠概念的演进、肿瘤休眠动物模型的建立、肿瘤休眠的分子及调控机制,以及肿瘤休眠的诱导、维持、再激活等方面进行了综述。旨在为开发诱导肿瘤休眠的药物和应用肿瘤休眠疗法根治肿瘤提供有益的线索。     

Clinical Application of Layered Anastomosis During Esophagogastrostomy

The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma. This abstract was accepted as a free paper and oral presentation at International Surgical Week 2007, Abstract 320, Montreal, Canada, August 2007     

nm23-H1基因逆转人高转移大细胞肺癌细胞L9981转移表型的分子机制

背景与目的:nm23-H1基因已被证明是转移抑制基因,转染野生型nm23-H1基因可以逆转肿瘤的恶性转移表型,但是nm23-H1基因抑制或逆转肺癌转移的分子机制却知之甚少,我们在建立转nm23-H1基因的人高转移大细胞肺癌细胞株L9981-nm23-H1的基础上,进一步探讨nm23-H1基因抑制肺癌转移的分子机制。方法:应用MTT法和改良的Boyden小室法分析转基因前后细胞的体外增殖能力及体外侵袭力的变化,体内实验分析转基因前后细胞在裸鼠体内的成瘤性及肺转移能力的改变,同时应用RT-PCR和Westernblot分别检测各组细胞中转移相关基因β-catenin、E-Cadherin、CD44S、CD44V6、MMP-2、TIMP-1、VEGF、基因mRNA及蛋白表达水平。结果:(1)转基因细胞株L9981-nm23-H1的体外增殖能力[(0%vs.(19.5±2.9)%]、克隆形成能力(10.3±0.7vs.21.7±1.3)及侵袭力显著低于L9981细胞(31.0±3.0vs.151.0±6.3)(P<0.01);(2)nm23-H1基因在裸鼠体内的抑瘤率显著增高(82.6%vs.0%),且转染nm23-H1基因的L9981细胞裸鼠体内移植瘤肺转移显著降低(0%vs.100%)(P<0.01);(3)nm23-H1基因能够上调β-catenin、E-Cadherin、TIMP-1基因mRNA及蛋白表达,下调VEGF、CD44V6和MMP-2基因mRNA及蛋白表达(P<0.01);(4)nm23-H1表达上调CD44S基因mRNA表达(P<0.01),而对其蛋白表达     

单向式全胸腔镜肺癌切除术的学习曲线分析

目的 分析单向式全胸腔镜肺癌切除术的学习曲线.方法 前瞻性收集2006年5月至2009年4月由两名医师完成的125例全胸腔镜肺癌切除术的临床资料.将手术病例按主刀医师分为A(n=24)、B(n=101)两组,并将B组按时间顺序根据患者例数分为B1(n=25)、B2(n=25)、B3(n=25)、B4(n=26)组.A组手术医师开展胸腔镜手术2年,B组手术医师开展胸腔镜手术5年.比较各组的手术时间、术中失血量、清扫淋巴结数目、中转开胸率、术后并发症发生率.结果 与B组比较,A组手术时间较长[(237±85)min比(187±43)min,P=0.013],而术中失血量、清扫淋巴结数目、中转开胸率、术后并发症发生率两组间差异无统计学意义(P＜0.05).A组与B1组比较也有相同结果.B组中从B1组到B4组手术时间逐渐缩短、术中失血量逐渐减少,但差异无统计学意义(P＜0.05).而B组中前50例(B1+B2)与后51例(B3+B4)比较术中失血量减少[(122±141)ml比(87±81),P=0.009].结论 在开展完全胸腔镜肺癌切除的早期阶段,手术时间会较长,这在腔镜手术经历较短的医生更明显,但并发症发生率无显著增加.完成50例全胸腔镜肺癌切除手术可作为评价熟练掌握该手术的指标.     

肺重复癌发生机制和诊断预测的研究进展

Due to the advanced diagnostic technique and better understanding for multiple primary lung cancers(MPLC),the increasing incidence of MPLC has been reported.Very often,MPLC are misdiagnosed as metastasis because of lacking efficient molecular biomarkers for prediction and diagnosis.Studies on the molecular mechanism for tumorgenesis and progression of MPLC may therefore facilitate the discovery of biomarkers for disease diagnosis and prognosis,so that an individual and rational treatment can be achieved.We ...     

Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients

AIM: To evaluate the risk of esophagectomy for carcinoma of the esophagus in the elderly (70 years or more) compared with younger patients (< 70 years) and to determine whether the short-term outcomes of esophagectomy in the elderly have improved in recent years. METHODS: Preoperative risks, postoperative morbidity and mortality in 60 elderly patients (> or = 70 years) with esophagectomy for carcinoma of the esophagus were compared with the findings in 1782 younger patients (< 70 years) with esophagectomy between January 1990 and December 2004. Changes in perioperative outcome and short-time survival in elderly patients between 1990 to 1997 and 1998 to 2004 were separately analyzed. RESULTS: Preoperatively, there were significantly more patients with hypertension, pulmonary dysfunction, cardiac disease, and diabetes mellitus in the elderly patients as compared with the younger patients. No significant difference was found regarding the operation time, blood loss, organs in reconstruction and anastomotic site between the two groups, but elderly patients were more often to receive blood transfusion than younger patients. Significantly more transhiatal and fewer transthoracic esophagectomies were performed in the elderly patients as compared with the younger patients. Resection was considered curative in 71.66% (43/60) elderly and 64.92% (1157/1782) younger patients, which was not statistically significant (P>0.05). There were no significant differences in the prevalence of surgical complications between the two groups. Postoperative cardiopulmonary medical complications were encountered more frequently in elderly patients. The hospital mortality rate was 3.3% (2/60) for elderly patients and 1.1% (19/1 782) for younger patients without a significant difference. When the study period was divided into a former (1990 to 1997) and a recent (1997 to 2004) period, operation time, blood loss, and percentage of patients receiving blood transfusion of the elderly patients significantly improved from the former period to the recent period. The hospital mortality rate of the elderly patients dropped from the former period (5.9%) to the recent period (2.3%), but it was not statistically significant. CONCLUSION: Preoperative medical risk factors and postoperative cardiopulmonary complications after esophagectomy are more common in the elderly, but operative mortality is comparable to that of younger patients. These encouraging results and improvements in postoperative mortality and morbidity of the elderly patients in recent period are attributed to better surgical techniques and more intensive perioperative care in the elderly.     

nm23、上皮型钙粘素和β-连环素在非小细胞肺癌中的表达及其与转移和预后的关系

背景与目的:近年来关于nm23、上皮型钙粘素(E-cadherin)和连环素(Catenins)与肿瘤关系的研究比较多,但不同研究得到的结果差异较大。而且近年来的研究显示,nm23、E-cadherin和Catenins还参与细胞信号转导,使它们在肿瘤转移过程中的作用可能具有多面性。本实验检测nm23、E-cadherin和β-Catenin在一组非小细胞肺癌(non-sm allcelllang cancer,NSCLC)中的表达水平,试图了解它们与非小细胞肺癌转移和预后的关系,以及它们之间的相互关系。方法:采用免疫组化(SP法)检测112例NSCLC和30例肺良性病变组织中nm23、E-cadherin和β-Catenin的表达水平。结果:(1)nm23、E-cadherin和β-Catenin在肺癌组织中表达水平(分别为53.0%,53.1%和47.2%)显著低于癌旁肺组织中的表达水平(分别为64.8%,79.7%和80.6%)和肺良性病变组织中的表达水平(分别为76.9%,83.5%和85.6%);(2)nm23、E-cadherin和β-Catenin在有淋巴结转移的肺癌组织中的表达水平(分别为48.0%,47.3%和41.2%)显著低于无淋巴结转移者(分别为65.0%,60.5%和60.3%),在Ⅲ期和Ⅳ期NSCLC的表达水平(分别为44.8%,46.6%和38.1%)均显著低于Ⅰ期、Ⅱ期NSCLC(分别为67.2%,64.3%和63.1%);(3)nm23、E-cadherin和β-Catenin高表达组5年生存率(分别为39.29%,35.85%和37.29%)均显著     

Lung Adenocarcinoma has a Higher Risk of Lymph Node Metastasis than Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

World Journal of Surgery - Controversy still exists in which subtype of non-small-cell lung cancer [squamous cell carcinoma (SCC) or adenocarcinoma] is more likely to have lymph node (LN)...     

胸段食管鳞癌区域淋巴结组间转移强度分析及重点淋巴结清扫

目的 分析胸段食管癌各组淋巴结的转移强度以及影响淋巴结转移的因素,为手术重点清扫提供依据.方法 对手术切除的730例食管癌患者的临床资料进行分析.结果 730例患者中,隆突下淋巴结转移15例(2.1%),食管旁淋巴结转移166例(22.7%),贲门旁淋巴结转移67例(9.2%),胃左动脉旁淋巴结转移90例(12.3%).隆突下淋巴结转移的单因素分析显示与肿瘤长度和分化程度有关(P＜0.05),多因素分析显示与各因素均无关;食管旁淋巴结转移的单因素与多因素分析均显示与肿瘤长度、侵袭程度和分化程度有关(P＜0.05);贲门旁淋巴结转移和胃左动脉旁淋巴结转移的单因素与多因素分析均显示与肿瘤位置和侵袭程度有关(P＜0.05).结论 食管癌术中行胸腹腔二野淋巴结清扫有重要的临床意义,特别应重点清扫食管旁、贲门旁和胃左动脉处淋巴结;而对一些病变未侵及食管全层、病变长度＜3 cm、胸上段或下段的食管癌患者可不做隆突下淋巴结清扫.     

食管胃分层吻合法的应用与实验观察

目的通过临床和动物实验观察食管胃分层吻合法的临床应用结果及吻合口愈合质量。方法采用食管胃分层吻合法施行食管癌、贲门癌手术1024例,同期用该手术方法做动物实验并观察吻合口情况。将24只犬采用抽签法分成两组,实验组:12只,采用食管胃分层吻合法;对照组:12只,采用传统吻合方法作为对照。分别在术后5d、8d、14d和42d测量两组大体标本的吻合口口径、瘢痕长度、瘢痕厚度,组织学观察炎性细胞数、成纤维细胞数和毛细血管数,并进行表皮生长因子(EGF)和转化生长因子β1(TGF-beta1)的免疫组织化学实验(LsAB法)。结果临床结果:术后分别随访至3个月,1024例患者术后无吻合口瘘发生,仅6例发生轻度狭窄,经扩张一次缓解。实验结果:实验组黏膜对合良好、吻合口柔软、瘢痕薄,术后早期炎性细胞数和成纤维细胞数增多(P<0.05),术后第42d炎性细胞数和成纤维细胞数减少(P<0.05);对照组吻合口瘢痕厚、黏膜对合不齐、常有肌层暴露,早期炎性细胞数和成纤维细胞数较少,而术后8～14d明显增加,一直持续到术后42d仍有增加的趋势。实验组细胞因子早期活跃,高表达,至术后42d时仅有少量表达;而对照组早期表达低,术后第8d明显增加,第42d仍有较高表达。结论食管胃分层吻合法患者吻合口愈合质量高、瘢痕小,其细胞增生和生长因子的表达有利于伤口正常愈合且达到了一期愈合的标准,值得临床推广应用。