吡柔比星膀胱灌注化疗联合GC静脉化疗方案在T1G3期膀胱肿瘤患者术后的应用观察

目的:探讨吡柔比星膀胱灌注化疗联合GC(吉西他滨+顺铂)静脉化疗治疗TIG3期膀胱肿瘤的临床疗效。方法:将78例TIG3期膀胱肿瘤患者分为两组,A组采用GC静脉化疗方案治疗,B组在A组治疗基础上联合吡柔比星膀胱灌注化疗方案治疗,比较两组的治疗效果。结果:B组治疗总有效率及1年生存率明显高于A组,不良反应发生率明显低于A组,差异有统计学意义(P<0.05)。结论:TIG3期膀胱肿瘤采用吡柔比星膀胱灌注联合GC化疗方案治疗,能有效提升生存率,减少化疗后的不良反应。

Decreased expression of type Ⅱ tumor suppressor gene RARRES3 in tissues of hepatocellular carcinoma and cholangiocarcinoma

AIM: To analyze the expression of retinoic acid receptor responder 3 (RARRES3) protein in paraffin-embedded tissues of hepatocellular carcinoma (HCC) and cholangiocarcinoma(CC), and the correlation of RARRES3 production with tumor differentiation.METHODS: Expression of RARRES3 in tissues from 21CC (10 well-, 7 moderately- and 4 poorly-differentiated)and 32 HCC was determined by immunohistochemistry.RESULTS: Among 21 CC tissues, RARRES3 was detected in 8 (80%) of 10 well-differentiated tumors. Only 2 (18.2%)out of 11 tumors with moderate or poor differentiation showed positive RARRES3 expression. RARRES3 expression in well-differentiated CC was significantly higher than that in tumors with moderate or poor differentiation (Fisher exact test, P＜0.01). Expression of RARRES3 was not different between early (Ⅰ and Ⅱ) and late (Ⅲ and Ⅳ) stages of CC.Among 30 HCC tissues, 17 (56.7%) weakly expressed RARRES3 in HCC cells, and 25 (83.3%) normal tissues adjacent to HCC expressed the protein. RARRES3 expression was significantly decreased in HCC tissues compared to that in adjacent normal tissues (logistic regression analysis, OR = 0.27, 95% CI (0.11-0.62), P＜0.01).CONCLUSION: Expression of RARRES3 is positively correlated to well-differentiated CC, which supports the role of RARRES3 in malignant epithelial differentiation of the tumor. The decrease in RARRES3 expression in tissues of HCC and CC with moderate and poor differentiation suggests that altered RARRES3 expression may play a role in the carcinogenesis of the liver and biliary tract.

T1G3膀胱癌187例临床分析及预后研究

目的分析T1G3膀胱癌的临床特点及复发、进展、死亡的风险因素，提高对T1G3膀胱癌的认识和治疗效果。方法收集1998年1月至2006年10月天津市泌尿外科研究所诊断为T1G3膀胱癌且资料完整的患者187例。男162例，女25例。年龄35—92岁，平均66岁。进行临床流行病学调查并随访预后情况。寿命表法估计1、2、3、5年复发率、进展率及死亡率。将年龄、性别、出现症状至就诊时间、有无肾积水、手术方式、术后是否即刻灌药、膀胱灌注药物种类、肿瘤直径、肿瘤数量、肿瘤形态、有无原位癌、复发次数、初次复发时间≤6个月作为变量，分别进行肿瘤复发、疾病进展、死亡的Kaplan—meier单因素及Cox多因素生存分析。结果本组患者随访12～111个月，平均46个月。肿瘤复发100例（53．5％），进展61例（32．6％），死亡37例（19．8％）。1、2、3、5年肿瘤复发率分别为35．0％、60．0％、63．0％、65．0％，疾病进展率分别为12．0％、27．0％、34．0％、38．0％，死亡率分别为0、11．0％、17．0％、26．0％。肿瘤直径、肿瘤数量、即刻灌注、初次复发时间≤6个月是T1G3膀胱癌复发的危险因素；肿瘤形态、原位癌、初次复发时间≤6个月、复发次数是T1G3膀胱癌进展的危险因素。肿瘤进展是患者死亡的危险因素。结论肿瘤直径≥3cm、多发、初次复发时间≤6个月的T1G3膀胱癌患者更容易复发，应加强随访，即刻膀胱灌注可以降低T1G3膀胱肿瘤复发的风险。对肿瘤形态呈结节状、合并原位癌、初次复发时间≤6个月、多次复发等进展高危风险因素的T1G3膀胱肿瘤患者，应早期行膀胱切除。