European vs 2015-World Health Organization clinical molecular and pathological classification of myeloproliferative neoplasms

The BCR/ABL fusion gene or the Ph^1-chromosome in the t(9;22)(q34;q11)exerts a high tyrokinase acticity,which is the cause of chronic myeloid leukemia(CML).The1990 Hannover Bone Marrow Classification separated CML from the myeloproliferative disorders essential thrombocythemia(ET),polycythemia vera(PV)and chronic megakaryocytic granulocytic myeloproliferation(CMGM).The 2006-2008 European Clinical Molecular and Pathological(ECMP)criteria discovered 3variants of thrombocythemia:ET with features of PV(prodromal PV),"true"ET and ET associated with CMGM.The 2008 World Health Organization(WHO)-ECMP and 2014 WHO-CMP classifications defined three phenotypes of JAK2^(V617F)mutated ET:normocellular ET(WHO-ET),hypercelluar ET due to increased erythropoiesis(prodromal PV)and ET with hypercellular megakaryocytic-granulocytic myeloproliferation.The JAK2^(V617F)mutation load in heterozygous WHO-ET is low and associated with normal life expectance.The hetero/homozygous JAK2^(V617F)mutation load in PV and myelofibrosis is related to myeloproliferative neoplasm(MPN)disease burden in terms of symptomaticsplenomegaly,constitutional symptoms,bone marrow hypercellularity and myelofibrosis.JAK2 exon 12mutated MPN presents as idiopathic eryhrocythemia and early stage PV.According to 2014 WHO-CMP criteria JAK2 wild type MPL^(515)mutated ET is the second distinct thrombocythemia featured by clustered giant megakaryocytes with hyperlobulated stag-horn-like nuclei,in a normocellular bone marrow consistent with the diagnosis of"true"ET.JAK2/MPL wild type,calreticulin mutated hypercellular ET appears to be the third distinct thrombocythemia characterized by clustered larged immature dysmorphic megakaryocytes and bulky(bulbous)hyperchromatic nuclei consistent with CMGM or primary megakaryocytic granulocytic myeloproliferation.

Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres

BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm(MiNEN)is a rare diagnosis,mainly encountered in the gastro-entero-pancreatic tract.There is limited knowledge of its epidemiology,prognosis and biology,and the best management for affected patients is still to be defined.AIM To investigate clinical-pathological characteristics,treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres.Patient data were retrospectively collected from medical records.Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN.Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1.Kaplan-Meier analysis was applied to estimate survival outcomes.Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions(univariate)and Cox-regression analysis(multivariable).RESULTS Sixty-nine consecutive patients identified;Median age at diagnosis:64 years.Males:63.8%.Localised disease(curable):53.6%.Commonest sites of origin:colon-rectum(43.5%)and oesophagus/oesophagogastric junction(15.9%).The neuroendocrine component was;predominant in 58.6%,poorly differentiated in 86.3%,and large cell in 81.25%,of cases analysed.Most distant metastases analysed(73.4%)were occupied only by a poorly differentiated neuroendocrine component.Ninety-four percent of patients with localised disease underwent curative surgery;53%also received perioperative treatment,most often in line with protocols for adenocarcinomas from the same sites of origin.Chemotherapy was offered to most patients(68.1%)with advanced disease,and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion.In localised cases,median recurrence free survival(RFS);14.0 months(95%CI:9.2-24.4),and median overall survival(OS):28.6 months(95%CI:18.3-41.1).On univariate analysis,receipt of perioperative treatment(vs surgery alone)did not improve RFS(P=0.375),or OS(P=0.240).In advanced cases,median progression free survival(PFS);5.6 months(95%CI:4.4-7.4),and median OS;9.0 months(95%CI:5.2-13.4).On univariate analysis,receipt of palliative active treatment(vs best supportive care)prolonged PFS and OS(both,P<0.001).CONCLUSION MiNEN is most commonly driven by a poorly differentiated neuroendocrine component,and has poor prognosis.Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted kidney.Historically,allograft nephrectomy has been considered the only reasonable option.More recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIM To review outcomes of AT for the treatment of renal allograft tumours.METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist.PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney allograft.Only original manuscripts describing actual cases and edited in English were considered.All relevant articles were accessed in full text.Additional searches included all pertinent references.Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale.Data on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and analysed.Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was provided.RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients.Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo.Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons.Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance imaging.Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC.Maximal tumour diameter ranged from 5 to 55 mm.The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0.Neoplasms were managed by RFA (n = 78),CA (n = 15),MWA (n = 3),HIFU (n = 3),and IRE (n = 1).Overall,3 episodes of primary treatment failure were reported.A single case of recurrence was identified.Follow-up ranged from 1 to 81 mo.No cancer-related deaths were observed.Complication rate was extremely low (mostly < 10%).Graft function remained stable in the majority of recipients.Due to the limited sample size,no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients.Properly designed clinical trials are needed to validate this therapeutic approach.

Use of blood-based biomarkers for early diagnosis and surveillance of colorectal cancer

Early screening for colorectal cancer(CRC) holds the key to combat and control the increasing global burden of CRC morbidity and mortality. However, the current available screening modalities are severely inadequate because of their high cost and cumbersome preparatory procedures that ultimately lead to a low participation rate. People simply do not like to have colonoscopies. It would be ideal, therefore, to develop an alternative modality based on blood biomarkers as the first line screening test. This will allow for the differentiation of the general population from high risk individuals. Colonoscopy would then become the secondary test, to further screen the high risk segment of the population. This will encourage participation and therefore help to reach the goal of early detection and thereby reduce the anticipated increasing global CRC incidence rate. A blood-based screening test is anappealing alternative as it is non-invasive and poses minimal risk to patients. It is easy to perform, can be repeated at shorter intervals, and therefore would likely lead to a much higher participation rate. This review surveys various blood-based test strategies currently under investigation, discusses the potency of what is available, and assesses how new technology may contribute to future test design.

Effect of a region-wide incorporation of an algorithm based on the 2012 international consensus guideline on the practice pattern for the management of pancreatic cystic neoplasms in an integrated health system

AIM To examine the practice pattern in Kaiser Permanente Southern California(KPSC), i.e., gastroenterology(GI)/surgery referrals and endoscopic ultrasound(EUS), for pancreatic cystic neoplasms(PCNs) after the regionwide dissemination of the PCN management algorithm.METHODS Retrospective review was performed; patients with PCN diagnosis given between April 2012 and April 2015(18 mo before and after the publication of the algorithm) in KPSC(integrated health system with 15 hospitals and 202 medical offices in Southern California) were identified.RESULTS2558(1157 pre-and 1401 post-algorithm) received a new diagnosis of PCN in the study period. There was no difference in the mean cyst size(pre-19.1 mm vs post-18.5 mm, P = 0.119). A smaller percentage of PCNs resulted in EUS after the implementation of the algorithm(pre-45.5% vs post-34.8%, P < 0.001). A smaller proportion of patients were referred for GI(pre-65.2% vs post-53.3%, P < 0.001) and surgery consultations(pre-24.8% vs post-16%, P < 0.001) for PCN after the implementation. There was no significant change in operations for PCNs. Cost of diagnostic care was reduced after the implementation by 24%, 18%, and 36% for EUS, GI, and surgery consultations, respectively, with total cost saving of 24%.CONCLUSION In the current healthcare climate, there is increased need to optimize resource utilization. Dissemination of an algorithm for PCN management in an integrated health system resulted in fewer EUS and GI/surgery referrals, likely by aiding the physicians ordering imaging studies in the decision making for the management of PCNs. This translated to cost saving of 24%, 18%, and 36% for EUS, GI, and surgical consultations, respectively, with total diagnostic cost saving of 24%.

PVSG and WHO vs European Clinical,Molecular and Pathological Criteria for prefibrotic myeloproliferative neoplasms

The Polycythemia Vera Study Group(PVSG),World Health Organization(WHO) and European Clinical,Molecular and Pathological(ECMP) classifications agree upon the diagnostic criteria for polycythemia vera(PV) and advanced primary myelofibrosis(MF). Essential thrombocythemia(ET) according to PVSG and 2007/2008 WHO criteria comprises three variants of JAK2V617 F mutated ET when the ECMP criteria are applied. These include normocellular ET,hypercellular ET with features of early PV(prodromal PV),and hypercellular ET due to megakaryocytic,granulocytic myeloprolifera-tion(ET.MGM). Evolution of prodromal PV into overt PV is common. Development of MF is rare in normocellular ET(WHO-ET) but rather common in hypercellular ET.MGM. The JAK2V617 F mutation burden in heterozygous mutated normocellular ET and in heterozygous/homozygous or homozygous mutated PV and ET.MGM is of major prognostic significance. JAK2/MPL wild type ET associated with prefibrotic primary megakaryocytic and granulocytic myeloproliferation(PMGM) is characterized by densely clustered immature dysmorphic megakaryocytes with bulky(bulbous) hyperchromatic nuclei,which are never seen in JAK2V617 F mutated ET,and PV and also not in MPL515 mutated normocellular ET(WHO-ET). JAK2V617 mutation burden,spleen size,LDH,circulating CD34+ cells,and pre-treatment bone marrow histopathology are mandatory to stage the myeloproliferative neoplasms ET,PV,PMGM for proper prognosis assessment and therapeutic implications. MF itself is not a disease because reticulin fibrosis and reticulin/collagen fibrosis are secondary responses of activated polyclonal fibroblasts to cytokines released from the clonal myeloproliferative granulocytic and megakaryocytic progenitor cells in ET.MGM,PV and PMGM.

雌、孕激素对子宫内膜癌细胞孤儿受体ERRα的调控作用

目的:探讨孤儿受体ERRα与雌激素(E)、孕激素(P)之间的相互关系及其在子宫内膜癌发病中的作用。方法:采用逆转录聚合酶链反应(RT PCR)方法,检测不同浓度(10-10, 10-8, 10-6 mol/L)17β雌二醇(17βE2 )作用于Ishikawa细胞系不同时间(0min, 15min, 30min和24h)后ERRαmRNA的变化,并应用ER拮抗剂ICI182780同时作用细胞,观察是否可阻断E2 对ERRα的调控作用;检测不同浓度孕酮( 10-8, 10-7, 10-6, 10-5 mol/L)作用于Ishikawa细胞系24h后ERRαmRNA的变化。结果: 10-10 mol/L17βE2 作用于Ishikawa细胞系15min, 30min及24h后ERRαmRNA水平与未加E2 相比均稍有增加,而10-8, 10-6 mol/L17βE2 作用于细胞系15min, 30min及24h后ERRαmRNA明显减小,以10-8 mol/L作用后减少最明显。同时加入E2 和ICI182780作用于细胞系后,E2对ERRαmRNA的减小作用被阻断。10-8mol/L孕酮作用于细胞系24h后,ERRαmRNA与对照组相比无明显变化,但加入10-7, 10-6和10-5 mol/L孕酮后,ERRαmRNA表达均出现明显增加。结论: 17βE2 可减少子宫内膜癌细胞系Ishikawa细胞ERRαmRNA的表达,此减少作用是通过ER介导完成的。孕酮可增加ERRαmRNA的表达。

Extent of surgical resections for intraductal papillary mucinous neoplasms

Intraductal papillary mucinous neoplasms(IPMNs) can involve the main pancreatic duct(MD-IPMNs) or its secondary branches(BD-IPMNs) in a segmental of multifocal/diffuse fashion.Growing evidence indicates that BDIPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively.For surgery,clarification is required on:(1) when to resect an IPMN;(2) which type of resection should be performed;and(3) how much pancreas should be resected.In recent years parenchyma-sparing resections as well as laparoscopic procedures have being performed more frequently by pancreatic surgeons in order to decrease the rate of postoperative pancreatic insufficiency and to minimize the surgical impact of these operations.However,oncological radicality is of paramount importance,and extended resections up to total pancreatectomy may be necessary in the setting of IPMNs.In this article the type and extension of surgical resections in patients with MD-IPMNs and BD-IPMNs are analyzed,evaluating perioperative and long-term outcomes.The role of standard and parenchyma-sparing resections is discussed as well as different strategies in the case of multifocal neoplasms.

1969-2003年子宫内膜癌发病率及发病因素分析

目的通过分析35年间子宫内膜癌的病例,了解子宫内膜癌发病在35年间的变化特点。方法回顾性分析中山医院1969年3月-2003年12月收治的子宫内膜癌病例209例,以年代为限分为3组,1969-1979年第1组25例,1980-1989年第2组41例,1990-1999年第3组57例,2000年1月-2003年12月为第4组86例。采用对照研究的方法回顾性分析4组病例占同期妇科住院病例的比例、对发病例数、发病年龄、生育和月经情况、合并高血压、糖尿病及肥胖进行比较分析。结果4组病例分别是同期妇科住院病例的0.39%、0.68%、0.84%和17.4%。第4组是第1、2、3组的44.6倍、25.6倍、20.7倍,第3组是第1、2组的2.2倍、1.2倍,第2组是第1组的1.7倍。子宫内膜癌病例数以每10年几何对数的速度增长,第4组的年平均数是第1组的10倍。发病年龄每10年增大1岁,P=0.0328。第3、4组流产数明显多于第1、2组P=0.036,P=0.003。第4组绝经年龄和行经年限增加P=0.0444,P=0.0020。第3、4组合并糖尿病、肥胖病例明显增加P=0.0114,P=0.0282。结论我国目前子宫内膜癌的病例增长迅速与国外一致,发病年龄并未年轻化,同国外相近。近10年糖尿病、肥胖发病率增加、绝经延后和行经年限增加是子宫内膜癌发病率增加的因素之一。

Response of Subcutaneous Xenografts of Endometrial Cancer in Nude Mice to Inhibitors of Phosphatidylinositol 3-Kinase/Akt and Mitogen-Activated Protein Kinase (MAPK) Pathways: An Effective Therapeutic Strategy for Endometrial Cancer

Objective: This study was designed to explore whether inhibition of the extracellular-regulated kinase (ERK) and phosphatidylinositol-3-kinase (PI3K) signaling pathways can inhibit the growth of xenografts of endometrial cancer cell lines with different estrogen receptors (ER) profiles in vivo and to provide preliminary laboratory basis for the probability of endometrial adenocarcinoma treatment with blockage of the two pathways, especially to endometrial cancer with low ER status. Methods: Human endometrial cancer Ishikawa bearing ER and HEC-1Awith low ER status cells were subcutaneously injected into BALB/c nude mice to establish endometrial cancer xenograft tumor models. The effects of PI3K/Akt inhibitor LY294002, MAPK/ERK1/2 inhibitor PD-98059 and their combinations on the growth of the xenograft tumors and apoptotic state of Ishikawa and HEC-1Acells were tested in vivo using the inhibitory rate, the terminal deoxynucleotidyl transferase-mediated nick-end labeling assay, H/E-stain. Western blot analysis was used to detect the alterations of activated ERK (P-ERK) and AKT (P-AKT) during this process. Results: LY294002, a PI3K/Akt pathway inhibitor, induced significant suppression in the growth of both Ishikawa and HEC-1Acell xenograft tumors, concomitant with increased apoptosis in xenografts as evidenced by TUNEL. A similar effect was also observed when the MAPK/ERK1/2 signaling pathway was inhibited by PD98059. Concurrent inhibition of the PI3K/Akt and MAPK/ERK1/2 pathways showed enhanced anti-tumor effects in vivo as indicated by increased apoptosis. At the same time, the levels of P-ERK and P-AKT in both xenograft tumors decreased, and their levels in combination group was the lowest. Conclusions: PD98059, LY294002 and their combinations showed remarkable inhibitory effects on xenograft tumors of endometrial carcinoma cell lines with different expression status of ER in vivo through blockage of PI3K/Akt and MAPK/ERK1/2 signaling pathways. This suggests that targeting these pathways may be an effective therapeutic strategy against endometrial carcinomas, especially for ER-negative cancers which show poor response to endocrinal therapy.

胃肠道间质瘤60例中c-kit和PDGFRA基因突变的检测

目的: 探讨c kit基因和PDGFRA基因在我国胃肠道间质瘤(GIST)中的突变状况。方法: 用PCR扩增和直接测序的方法,检测60例GISTc kit基因9号、11号、13号和17号外显子突变以及PDGFRA基因12号和18外显子突变。结果: 60例GIST中kit基因突变率为63. 3%,绝大多数为杂合性突变,少数为纯合性突变。其中以编码近膜区的11号外显子突变最为常见(58. 3% );其次为编码胞外区的9号外显子突变(3. 3% );偶见编码胞内酪氨酸激酶结构域的13号外显子突变(1. 7% ),是一个新的突变位点L641P;未检出17号外显子突变。11号外显子的突变位点多集中在5′端的经典热点(42. 9% ),表现为密码子第557 -560的点突变和框内缺失。第二个热点位于11号外显子的3′端,为框内串联重复。后者主要发生在胃部,女性患者多见。60例GIST中PDGFRA基因突变率为5%,表现为编码胞内酪氨酸激酶结构域的18号外显子D842V点突变,且均为CD117阴性。未见编码近膜区的12号外显子突变。结论:CD117阳性GIST主要表现为c kit突变,分布在11号外显子经典热点和3′端热点,后者与老年女性胃GIST相关。PDGFRA基因突变主要见于CD117阴性GIST,多发生在后腹膜,具高度侵袭危险性。

Spatial autocorrelation analysis of 13 leading malignant neoplasms in Taiwan: a comparison between the 1995-1998 and 2005-2008 periods

Spatial autocorrelation methodologies, including Global Moran’s I and Local Indicators of Spatial Association statistic (LISA), were used to describe and map spatial clusters of 13 leading malignant neoplasms in Taiwan. A logistic regression fit model was also used to identify similar characteristics over time. Two time periods (1995-1998 and 2005-2008) were compared in an attempt to formulate common spatio-temporal risks. Spatial cluster patterns were identified using local spatial autocorrelation analysis. We found a significant spatio-temporal variation between the leading malignant neoplasms and well-documented spatial risk factors. For instance, in Taiwan, cancer of the oral cavity in males was found to be clustered in locations in central Taiwan, with distinct differences between the two time periods. Stomach cancer morbidity clustered in aboriginal townships, where the prevalence of Helicobacter pylori is high and even quite marked differences between the two time periods were found. A method which combines LISA statistics and logistic regression is an effective tool for the detection of space-time patterns with discontinuous data. Spatio-temporal mapping comparison helps to clarify issues such as the spatial aspects of both two time periods for leading malignant neoplasms. This helps planners to assess spatio-temporal risk factors, and to ascertain what would be the most advantageous types of health care policies for the planning and implementation of health care services. These issues can greatly affect the performance and effectiveness of health care services and also provide a clear outline for helping us to better understand the results in depth.

鞍区胶质瘤的CT和MRI诊断

目的分析鞍区胶质瘤的CT和MRI特点及临床发病特征。资料与方法经手术病理证实的鞍区胶质瘤8例,其中7例位于鞍上,1例位于鞍内。3例行CT检查,5例行MRI检查。结果鞍上胶质瘤体积较大,呈不规则分叶状,边界光滑锐利,基本没有瘤周水肿,瘤内偏上方多发囊变,无明显钙化及出血,少数可沿视觉通路生长,CT平扫稍低或等密度,MRI检查T1WI呈稍低、低信号,T2WI高信号,CT及MR增强扫描,肿瘤实性部分可见显著强化。此外,临床上这些患者就诊时多有眼部症状,而均无下丘脑及垂体内分泌异常症状。鞍内胶质瘤位置偏后,瘤周无水肿,瘤内可有多发微囊变,无明显钙化及出血。结论鞍上胶质瘤有比较典型的CT和MRI特点,结合患者临床发病特点,有助于提高其术前诊断率;鞍内胶质瘤易误诊,对有多发微囊变的位置偏后的鞍内肿瘤,应考虑到本病可能。

A new breakthrough:ESD using a newly developed grasping type scissor forceps for early gastrointestinal tract neoplasms

Endoscopic submucosal dissection(ESD) has allowed the achievement of histologically curative en bloc resection of gastrointestinal neoplasms regardless of size,permitting the resection of previously non-resectable tumors.The ESD technique for treatment of early gastric cancer has spread rapidly in Japan and a few other Asian countries due to its excellent eradication rate compared to endoscopic mucosal resection.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation) have limited their use worldwide.We developed the grasping type scissor forceps(GSF) to resolve such ESD-related problems.Our animal and preliminary clinical studies showed that ESD using GSF is a safe(no intraoperative complication) and technically efficient(curative en bloc resection rate 92%) method for dissection of early gastrointestinal tumors.The use of GSF is a promising option for performing ESD on early stage GI tract tumors both safely and effectively.

Metformin: A possible drug for treatment of endometrial cancer

Metformin is a widely used first-line drug for treatment of type 2 diabetes mellitus. In recent years, it has been reported that administration of metformin can reduce carcinogenic risk and inhibit proliferation of cancer cells including those from glioma and breast cancer. The underlying mechanism is thought to involve increased LKB-1 phosphorylation induced by metformin, followed by LKB-1 phosphorylation and activation of AMP-activated protein kinase (AMPK), which then inhibits the mammalian target of rapamycin (mTOR) pathway and results in inhibition of cell proliferation. In endometrial cancer, metformin causes cell cycle arrest in vitro, reduces hTERT mRNA, inhibits the mTOR pathway via AMPK, and is involved in inhibition of phosphorylation of S6 ribosomal protein (S6RP). Metformin promotes expression of progesterone receptor by an action opposite to that of insulin-like growth factor-2 (IGF-2) when used in combination with medroxyprogesterone acetate. This enhances the antitumor effect and this approach may be applicable in a clinical setting.

广东地区鼻咽癌放疗后放射性脑病患者生存质量的研究

目的 研究鼻咽癌放疗后放射性脑病患者生存质量的变化及其与神经系统症状的相关性。方法 采用世界卫生组织生存质量量表简表(WHOQOL-BREF)、LENT/SOMA放射性损伤评估量表对病例组和对照组进行评定,并将文献提供的一般人群对照作为正常对照。结果 病例组在社会关系领域、总的健康和总的生活评分方面与对照组间差异有显著性意义(P<0.05)。病例组在生理、心理、社会关系、总的生活和总的健康评分与一般人群对照组间差异有显著性意义(P<0.05)。球麻痹症状与生存质量社会关系领域、总的生活健康评分呈负相关(P<0.05)。结论 除环境领域外, 放射性脑病对生命质量的其他方面存在一定的负性影响。球麻痹症状的存在对生存质量产生了较大的负性影响。

^(18)F-FDG PET与^(67)Ga全身显像对淋巴瘤分期的临床价值

目的 探讨1 8F 脱氧葡萄糖(FDG)PET显像与6 7Ga全身显像对淋巴瘤患者分期的临床价值。方法 经组织病理检查诊断为淋巴瘤的2 3例患者,治疗前均行1 8F FDGPET显像与6 7Ga全身显像。PET显像为静脉注射1 8F FDG 111～185MBq(按体重2 2 2MBq kg) ,4 5～5 0min后行全身显像。6 7Ga全身显像为静脉注射370MBq6 7Ga ,4 8～72h后行前位和后位颈、胸、腹和盆腔局部全身显像。图像分析采用定性分析方法,有异常放射性摄取增高的部位为阳性病变。结果 1 8F FDGPET显像2 3例患者均阳性,共发现5 3个病灶;6 7Ga全身显像示19例( 82 6 % )阳性,发现4 4个病灶( 83 0 % )。肿瘤病灶35 8% ( 19个)在头颈部,2 0 8% ( 11个)在腹部,34 0 % ( 18个)在纵隔,9 4 % ( 5个)在盆腔。1 8F FDGPET与6 7Ga全身显像结果比较示,在19例患者中4 4个病灶两者显像结果一致。PET显像发现的5 3个病灶中,6 7Ga全身显像有9个病灶阴性,分别位于头颈部( 1个)、腹部( 4个)、盆腔( 2个)和腋窝( 2个) ,病灶直径范围为0 6～3 2cm。结论 1 8F FDGPET显像在淋巴瘤分期中明显优于6 7Ga全身显像。6

三维适形放疗治疗早期宫颈癌的临床观察

目的探讨三维适形放疗(3DCRT)对宫颈癌的近期疗效及并发症的发生率。方法2001年1月至8月对收治的30例宫颈癌患者施行3DCRT,所有病例放疗前行CT检查,用Redplan3.5作出三维适形计划,靶区剂量DT45Gy,观察放疗近期疗效及消化道和膀胱的放疗反应。同期对照组50例同条件病例采用常规放疗技术,观察内容同3DCRT组。结果3DCRT给肿瘤区提供了较理想的靶区适合度,可提高靶区剂量,使周围正常组织如膀胱、直肠得到有效的保护,患者对放疗的耐受性提高。0级的消化道反应3DCRT组和常规放疗组分别为33%和0(P<0.01);I级消化道反应两组分别为57%和92%(P<0.01);Ⅰ级泌尿道反应两组分别为13%和16%,两组比较差异无统计学意义(P>0.05)。两组病例近期有效率和1、2年生存率比较差异无统计学意义。结论3DCRT的放疗近期有效率等同于常规放疗,急性消化道反应明显低于常规放疗组。

维甲酸诱导甲状腺癌细胞摄碘的实验研究

目的 探讨全反式维甲酸(ATRA)诱导甲状腺癌细胞系的钠碘同向转运体(NIS)表达及其碘摄取。方法 通过ATRA诱导甲状腺癌细胞系滤泡状甲状腺癌细胞株(FTC 133)、乳头状甲状腺癌细胞株(W3)及未分化甲状腺癌细胞株( 85 0 5C)后,经逆转录 聚合酶链反应(RT PCR)及Westernblot检测甲状腺癌细胞系的NISmRNA及其蛋白质表达,并测定甲状腺癌细胞系诱导后的摄碘变化。结果 ATRA诱导甲状腺癌细胞系4 8h后,FTC 133和W3的NISmRNA及蛋白质表达增高,85 0 5C未见变化;ATRA诱导甲状腺癌细胞系2周后,FTC 133和W3的摄碘增高。结论 ATRA能诱导分化型甲状腺癌细胞摄碘增高。

^(18)F-FDG PET显像探查原发肿瘤灶的价值

目的:探讨18F-氟脱氧葡萄糖(18F-FDG)PET显像在原发肿瘤不明患者中的诊断价值以及对治疗方案的影响。方法:采用临床随访、分析活组织检查和病理结果对PET检查的32例原发肿瘤不明转移癌的患者进行回顾性分析。结果:32例患者中18F-FDG PET发现可疑原发灶16例,其中6例经手术病理证实;经随访,5例临床证实为原发灶;5例临床排除原发灶的诊断。另有2例PET显像未找到原发灶的患者经随访排除转移性癌的诊断。18F-FDGPET对原发灶的检出率为36.7%(11/30)。PET共提示了35处转移病灶,CT/M R只提示了27处转移病灶。结论:①18F-FDG PET显像对探查转移性肿瘤的原发灶和制定治疗方案具有很好的临床价值;②建议在CT/M R未能找到原发灶时,应进行18F-FDG PET显像。