中国近十年子宫内膜癌治疗进展的科学知识图谱分析

目的分析中国近十年子宫内膜癌治疗进展的科学知识图谱。方法用科学计量学软件CiteSpaceⅢ处理中国知网有关子宫内膜癌治疗进展的题录数据,从数据可视化的视角对该领域的研究现状进行分析。一方面,运用Excel等软件对子宫内膜癌治疗进展发文的时间分布、学科分布和期刊分布做统计分析;另一方面,运用CiteSpaceⅢ软件做了作者合作、机构合作、关键词共现知识图谱。结果我国子宫内膜癌治疗进展的研究是从2012年开始兴起,研究的领军人物较少,研究领域主要集中在肿瘤学和妇产科学,我国子宫内膜癌治疗进展的研究机构间缺乏合作,研究热点集中在子宫内膜癌治疗进展等方面。结论整体上我国子宫内膜癌治疗进展的研究处于初级阶段,需要我们推进到技术实现等实质阶段。

子宫内膜癌螺旋断层放疗与静态调强放疗的剂量学比较

背景与目的:螺旋断层放疗(helical tomotherapy,HT)在很多肿瘤治疗中体现了剂量学优势,但目前尚没有子宫内膜癌术后全盆腔HT的报道。本研究通过比较子宫内膜癌术后全盆腔HT与固定机架角静态调强放疗(step-and-shoot intensity-modulated radiation therapy,SaS-IMRT)剂量学的差异,探讨子宫内膜癌术后全盆腔HT是否具有剂量学优势。方法:选择10例接受子宫内膜癌术后全盆腔放疗患者,对每例患者分别设计全盆腔SaS-IMRT和HT计划。比较两组计划的靶区、危及器官和正常组织剂量分布。结果:SaS-IMRT和HT计划的平均PTV100是95.6%和95.8%(P=0.72)。两组计划平均适形指数都是0.87,平均均匀性指数是1.10和1.07(P=0.00)。与SaS-IMRT计划相比,HT计划直肠和膀胱平均剂量分别下降了1.3Gy和3.0Gy,小肠加结肠、盆腔骨接受中低剂量照射的体积增加,盆腔骨平均剂量增加1.1Gy。HT计划正常组织V5、V10、V20分别增加13.0%、18.0%和5.0%(P=0.00),平均剂量增加2.5Gy(P=0.00)。结论:与SaS-IMRT比较,HT靶区剂量更均匀,能够更好地保护膀胱和直肠。小肠和结肠、盆腔骨及正常组织接受中低剂量照射的体积增加,其临床意义尚需进一步研究。

基于计算机辅助药物设计及网络药理学探析复方补中益气汤对子宫内膜癌的作用机制研究

目的:通过网络药理学和计算机辅助药物设计,找出补中益气汤的潜能成分,并探讨其成为治疗子宫内膜癌的药物的可能性。方法:从DisGeNET和BisoGenet应用程序中收集与子宫内膜癌相关的基因和蛋白质以及从中医药数据库中收集复方中药补中益气汤的成分,运用Cytoscape建立网络关系图,并用CytoNCA筛选出能影响子宫内膜癌的蛋白质。再运用Surflex-Dock对补中益气汤的10种中草药的534个成分与子宫内膜癌相关的蛋白质进行柔性分子对接及分析其在活性位点的结合模式,并使用FAF-Drugs3和OSIRIS进行分子结构的筛选以预测其吸收、分布、代谢、排泄和毒性(ADMET)。结果:补中益气汤的六氢西红柿红素、八氢西红柿红素、新橙皮苷和橙皮苷这4个化合物与子宫内膜癌相关的蛋白质有好的结合亲和力与良好的药物特性。结论:从研究和文献中发现这4个化合物与癌症相关,有望进一步研究成为治疗子宫内膜癌的药物。

射线能量对子宫内膜癌调强放疗计划质量的影响

目的研究射线能量对子宫内膜癌术后全盆腔调强放射治疗计划质量的影响。方法选择10例子宫内膜癌术后患者，对每例患者分别设计6和18MV的全盆腔调强放射治疗计划。所有计划均使用相同的布野方案和剂量体积约束。比较两组计划的靶区、危及器官和正常组织的剂量分布。结果6和18MV计划的平均PTV100分别是95．6％和95．3％（检验值P=0．26），Dmean分别是52．55Gy和52．60Gy（P=0．54），适形指数分别是0．87和0．88（P：0．03），均匀性指数均为1．10（P：0．38）。18MV计划较6MV计划正常组织的平均积分剂量下降了2．4％（P=0．001），小肠和结肠的平均V30和V50分别下降了4．2％（P=0．006）和3．3％（P=0．046），其他危及器官的剂量分布间差异元统计学意义。结论对于子宫内膜癌的术后全盆腔调强放射治疗，18MV计划比6MV计划剂量分布的适形度更好，能够更好地保护正常组织、小肠和结肠。两组计划靶区的覆盖度和剂量分布的均匀性，以及直肠、膀胱和盆腔骨的保护相当。

子宫内膜癌术后适形与调强及螺旋断层放疗的非肿瘤组织积分剂量比较

目的:比较子宫内膜癌术后全盆腔3D-CRT、SaSIMRT和HT的非肿瘤组织积分剂量。方法:选择10例子宫内膜癌术后患者,分别设计其3D-CRT、SaSIMRT和HT全盆腔放疗计划。比较三组计划的危及器官和正常组织积分剂量(ID)。结果:3D-CRT、SaSIMRT和HT计划平均适形指数分别为0.61、0.87和0.87,平均均匀性指数分别为1.08、1.10和1.07。与3D-CRT比较,SaSIMRT和HT小肠+结肠、直肠、膀胱、盆腔骨ID更低(P<0.05),SaSIMRT正常组织ID下降19.50Gy-L,但HT正常组织ID增加11.85Gy-L。与SaSIMRT相比,HT直肠和膀胱ID分别下降0.08Gy-L和0.51Gy-L,但盆腔骨和正常组织ID分别增加1.65Gy-L和31.35Gy-L。结论:与3D-CRT相比,子宫内膜癌术后全盆腔SaSIMRT和HT改善了剂量分布适形度,降低了直肠、膀胱、小肠和结肠、盆腔骨ID。与SaSIMRT比较,HT靶区剂量更均匀,膀胱、直肠ID更低。与3D-CRT比较,SaSIMRT正常组织ID更低,HT正常组织ID有所增加。

芦荟有效成分与子宫内膜癌相关蛋白分子对接及药物特性

通过计算机辅助药物设计的方法,研究草药芦荟中的成分对子宫内膜癌相关蛋白如AKT1,mTOR,VEGFR2的结合能力并分析其中的潜在有效成分作为子宫内膜癌的抗癌药物的可能性。运用Surflex-Dock和ACD/Labs Percepta Profilers软件对芦荟中的33种成分与3个已知蛋白质结构进行柔性分子对接和ADMET的预测,并分析其打分函数和结合位点的对接情况。结果显示对接得分高且ADMET特性好的为Aloenin,其它得分较好的有7-(beta-Xylosyl)cephalomannine和Chrysophanol8-O-beta-D-(6'-O-malontl)glucopyranoside,而Aloenin具有最好的潜在药物特性,可做相关的生物活体和临床相关研究来进一步了解它的确切功效,从而研发一种治疗子宫内膜癌的新药。

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

The standard treatment of endometrial cancer or atypical hyperplasia is surgical removal of the uterus and ovaries. In early stage disease this has an excellent chance of cure but results in infertility. Although the majority of patients are postmenopausal an increasing number of patients with atypical hyperplasia or endometrial cancer are presenting with a desire to retain their fertile potential. In the last 8 years a number of studies have been published involving 403 patients with endometrial cancer and 151 patients with Atypical hyperplasia treated with high dose progestagens. The response rate is 76.2% and 85.6% respectively with endometrial cancer having a recurrence rate of 40.6%. There is a 26% recurrence rate in atypical hyperplasia. Overall 26.3% of those wishing to conceive had a live baby. Although concerns exist about the risks of medical treatment, those that fail this treatment do not appear to have a significantly poorer prognosis although 20 patients(3.6%) had either ovarian cancer or metastatic disease discovered during treatment or follow up.

Adjuvant Pelvic Radiotherapy vs.Sequential Chemoradiotherapy for High-Risk StageⅠ-ⅡEndometrial Carcinoma

Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ） （51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.

The therapeutics and prognosis of endometrial cancer

Objective: To investigate the relative factors in the prognosis of endometrial cancer. Methods: From 1991 to 1999, 125 patients with endometrial cancer were treated in our hospital. Among them, 96 cases were received operation. Their clinical and pathological data were analyzed retrospectively. Results: The overall survival rate at 5-year were 77.6%, stage I to stage IV were 85.9%, 68.8%, 53.8% and 0%, respectively. The survival rates at 5-year in histological grade 1, grade 2 and grade 3 were 100%, 77.1% and 38.1% respectively. There’s no significant difference between grade 1 and grade 2 (P > 0.05). As to grade 1 and grade 3, grade 2 and grade 3, there were significant differences (P < 0.05). The survival rate was 100% in patients with endometrium or superficial myometrial invasion and 35.3% in cases of deeper invasion (P < 0.01). Conclusion: Therapy based on operation is presently accepted as the first line management of endometrial cancer. Clinical stage, histo- logical grade, depth of myometrial invasion and lymph node metastasis are relative factors of prognosis.

Laparoscopic surgery in endometrial carcinoma staging operation:analysis of 39 cases

Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.

Diagnosis and treatment of endometrial carcinoma

Approximately 6000 endometrial cancer death occurs annually worldwide, predominantly noticed in postmenopausal women. The current diagnostic and therapeutic research tnals for endometrial carcinoma are giving new clues to select best postoperative adjuvant treatment especially in high risk disease. Transvaginal ultrasound and hysteroscepy endometrial biopsies are tending to replace the dilation and curettage in establishing a diagnosis. The standard primary treatment of endometrial carcinoma is surgery but to select best adjuvant therapy, the risk of disease recurrence is determined by certain pathological factors and also by surgical stage. The most commonly used adjuvant therapy is radiation therapy but satisfactory results have not been noticed in high-risk endometrial carcinoma. On the basis of review of current research guidelines it is indicated that hormonal or chemotherapeutic agents must be added with radiation therapy to improve prognosis and efficacy in endometrial carcinoma after surgery.

Clinical results and histological changes following preoperative interventional treatment of the aggressive subtype of endometrial cancer

Objective: The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy. Methods: Fifteen cases of endometrial carcinoma were performed intra-arterial chemotherapy and embolization before operation with carboplatin or cisplatin, epirubicin or ADM, and all the cases were performed the arterial chemoembolization with KMG or gel-foam particles mixed with 1/3 total drug dose after 2/3 total drug dose perfusion through the bilateral feeding arteries. Of 15 cases, there were 5 cases with uterine papillary serous carcinoma, 3 cases with endometrial clear cell carcinoma, and 7 cases with endometrial adenosquamous carcinoma. Results: Fifteen cases of endometrial carcinoma were performed operations after 3–4 weeks of intra-arterial chemotherapy and embolization. In these cases, 3 were found mass necrosis and lymphocyte cells infiltration in the tumor tissues but no carcinoma cells, which was noted as histological complete remission (HCR). After intra-arterial chemotherapy and embolization 3–4 weeks, the expression of proliferating cell nuclear antigen (PCNA) was obviously reduced (P < 0.001). Conclusion: The preoperative intra-arterial chemotherapy and embolization can improve the operability of resection in patients with aggressive subtype of endometrial carcinoma, reduce the expression of PCNA, adjust malignancy of endometrial carcinoma, and improve prognosis.