培美曲赛联合顺铂治疗非小细胞肺癌的疗效及生存情况

【目的】以客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）为主要观察指标,分析培美曲赛联合顺铂治疗非小细胞肺癌（NSCLC）的临床疗效。【方法】120例中晚期NSCLC患者,根据化疗方案不同分为培美曲赛组（培美曲赛＋顺铂,n=60）和紫杉醇组（多西紫杉醇＋顺铂,n=60）,两组患者均化疗≥2个周期,比较两组疗效,化疗期间毒副反应发生情况及PFS。【结果】培美曲塞组ORR、DCR分别为41.67%（25/60）、80.00%（48/60）,明显高于紫杉醇组的23.33%（22/60）、63.33%（38/60）（P〈0.05）。两组主要毒副反应总发生率比较差异无显著性（P〉0.05）,但培美曲塞组毒副反应以Ⅰ-Ⅱ度为主,紫杉醇组恶心或呕吐、白细胞减少、贫血、血小板减少的Ⅲ-Ⅳ度毒副反应发生率高于培美曲塞组（P〈0.05）。培美曲塞组、紫杉醇组PFS分别为（15.49±0.79）、（14.02±0.71）个月,两组比较差异有显著性（P〈0.05）。【结论】与多西紫杉醇联合顺铂相比,培美曲赛联合顺铂可有效提高NSCLC患者的ORR、DCR,延长PFS,且不会加重毒副反应。

Benefit of neoadjuvant concurrent chemoradiotherapy for locally advanced perihilar cholangiocarcinoma

To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).METHODSWe retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.RESULTSThe median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (P = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (P = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (P = 0.01).CONCLUSIONNACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.

Radiotherapy for 65 patients with advanced unresectable hepatocellular carcinoma

AIM: To evaluate the efficacy of radiotherapy (RT) in patients with advanced unresectable hepatocellular carcinoma (HCC). METHODS: A total of 65 patients were treated with RT in the Korea University Medical Center. The median age of the patients was 60 years, and 86.2% were men. 18.5% and 81.5% of the patients were diagnosed as TNM stage Ⅲ and Ⅳ-A, respectively. Treatment response was assessed 4 mo after initiation of RT. Tumor regression rate 1 mo after initiation of RT (TRR1m) was also assessed. Duration of survival was calculated from the initiation of RT. RESULTS: The objective treatment response was 56.9%. The 12 mo survival rate was 34.7%. Predictive factors for survival were Child-Pugh grade, α-fetoprotein level and treatment response. An objective response was achieved more frequently in patients with TRR1m ≥ 20% than in those with TRR1m < 20% (P < 0.001). CONCLUSION: RT is effective in treating advanced HCC with a tumor response rate of 56.9%.

Dose surgical sub-specialization influence survival in patients with colorectal cancer?

AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival.These variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree groups.Patients in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ cancers.Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P<0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.

Surgical outcomes in patients with T4 gastric carcinoma: a retrospective study of 162 patients

Objective: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. We evaluated the survival benefit of resection in this group of patients. Methods: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 49) with patients with non-curative resection (n = 113) from 1980 to 2000. Results: Curative resection was performed in 49 (30.2%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 9.3% and the median survival time was 12 months for all 162 registered patients. The 5-year survival rates in patients after curative and non-curative resection were 14.3% vs 7.1% respectively. These values differed considerably between the two groups (P = 0.033). Operative type and curability were independent statistically significant prognostic parameters. Conclusion: Curability was an independent prognostic factor among all registered patients. Patients with T4 gastric carcinoma might be benefited from curative resection.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Impact of adjuvant chemotherapy delay on survival in cancer breast patients

Objective： The proper time to commence adjuvant chemotherapy after primary surgery for breast cancer is unknown. It is usually prescribed within 2-3 months after definitive surgery. The aim of this retrospective study was to assess the impact of adjuvant chemotherapy （CT） delay beyond 3 weeks （ 21 days） in premenopausal patients with ER-absent tumors being treated for early stages breast cancer on overall survival （OS） and disease-free survival （DFS）. Methods： This retrospective study was conducted through revision of medical records of premenopausal patients diagnosed with early stage ｜-｜IIA breast cancer and ER-absent tumors who received adjuvant CT after definitive surgery at the Department of Clinical Oncology, Ain-Shams University Hospitals. Results： Between 2005 and 2008, 105 patients were retrospectively analyzed and included. Patients were divided into 2 groups： Group A including 48 patients who started adjuvant CT 〈 21 days of surgery and group B which included 57 patients who had CT delay 〉 21 days. Both groups were matched demographically. Comparisons of overall survival, and disease-free survival between group A and group B patients all favored group A. At 5-year the OS rates were 87% and 73% for groups A and B respectively （P = 0.001）, while DFS rates were 85% and 64% in groups A and B respectively （P = 0.001）. Analysis of other prognostic factors （age, T, N, grade, HER2 status, surgery type, CT type, local radiotherapy received） were analyzed. Only nodal status predicted for worse DFS （P = 0.05） and OS （P = 0.006）. Conclusion： Delay in initiating adjuvant chemotherapy for early stage breast cancer patients with ER-absent tumors was associated with a decrease in both OS and DFS rates.

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective: The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.Methods: A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed.Between January 1998 and May 2004,133 patients were enrolled.Several factors such as age,sex,skip metastasis,number of N2 lymph node stations,type of resection,histology,adjuvant therapy etc.,were recorded and analyzed.SPSS 16.0 software was used.Results: Overall 5-year survival for 133 patients was 32.33%,5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively,and 5-year survival for cN0–1 and cN2 sub-groups were 37.78% and 20.93% respectively.COX regression analysis revealed that number of N2 station (P = 0.013,OR: 0.490,95% CI: 0.427–0.781) and cN status (P = 0.009,OR: 0.607,95% CI: 0.372–0.992) were two favorable prognostic factors of survival.Conclusion: Number of N2 station and cN status were two favorable prognostic factors of survival.In restrict enrolled circumstances,after combined therapy made up of surgery and postoperative adjuvant therapy have been performed,satisfied survival could be achieved.

Current treatment for colorectal liver metastases

Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected cases.However,only a minority are resectable at the time of diagnosis.Continuous research in this field aims at increasing the percentage of patients eligible for resection,refining the indications and contraindications for surgery,and improving overall survival.The use of surgical innovations,such as staged resection,portal vein embolization,and repeat resection has allowed higher resection rates in patients with bilobar disease.The use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic resection.Ablative techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical candidates.Current management of colorectal liver metastases requires a multidisciplinary approach,which should be individualized in each case.

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factorsfor advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymiccarcinoma were retrospectively analyzed according to Masaokastage criteria. There were 29 Stage Ⅲ patients and 16 StageⅣ patients (13 Stage ⅣA patients and 3 Stage ⅣB patients).According to the World Heath Organization Histological Criteria(2004), 25 cases were identified as low-grade and 20 caseswere identified as high-grade. All diagnoses were confirmedby biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwentbiopsy alone. Forty-two patients received radiotherapy with amedian dose of 60 Gy, and 37 patients underwent conventionalradiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed andapproximately 1-2 cm^2 surrounding the tumor (according topreoperative imaging). Expanded irradiation volume coveredthe full mediastinal and pericardium areas (with or withoutprophylactic irradiation in the supraclavicular area). Five casesreceived stereotactic radiotherapy. Thirty-one patients were alsotreated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. Theoverall 3-year survival rate was 57.8%, and the median survivalwas 45 months. Univariate statistical analysis showed that thehistological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated withgross total resection and 55.0% in those who underwent biopsyonly. The 3-year survival rate was 59.5% in patients treatedwith conventional radiotherapy and 80% in those treated withstereotactic radiotherapy. The 3-year survival rate was 64.5% inpatients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatmentand surgery achieved better outcomes for Stage Ⅳ patients thanradiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymiccarcinoma, complete resection and postoperative radiotherapy orfractionated stereotactic radiotherapy constitute the best treatmentsolution. Chemotherapy can also be used in combination toimprove prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.

Investigation of the Effect of Neoadjuvant Chemotherapy on Stage Ⅱ Breast Cancer

OBJECTIVE To investigate the effect of neoadjuvant chemotherapy in treatment of Stage Ⅱ breast cancer. METHODS The data from 113 patients with breast cancer of the same pathologic type in Stage Ⅱ,during the period of 1995 to 2001,were analyzed retrospectively.Among the patients,47 were treated with neoadjuvant chemotherapy,and 66 received no adjuvant therapy before surgery（control group）.After the patients of the neoadjuvant chemotherapy group had received 2 courses of chemotherapy with the CMF regimen,the surgical procedure was conducted. RESULTS Complete remission（CR）was attained in 9 of the 47 cases receiving neoadjuvant chemotherapy and partial remission（PR）was reached for 22 cases.The rate of breast-conserving surgery was enhanced from 22.73%to 46.81%（P〈0.05）in the neoadjuvant treatment group. There was no difference in the 5-year overall survival（OS）and disease-free survival（DFS）rate between the two groups（P〉0.05）,but the 5-year OS and DFS of the cases with clinical tumor remission was higher compared to the control group（P〈0.05）. CONCLUSION Neoadjuvant chemotherapy can enhance the rate of breast conservation for Stage Ⅱ breast cancer and may improve the prognosis of the cases with clinical remission.

THYMIC CARCINOMA(REPORT OF 14 CASES)

This paper reports of 14 cases of thymic carcinoma. Most of them with symptoms of chest pain, cheststuffy and discomfort, but without combined with extrathoracic syndromes, The tumors always were largein size and frequently invaded adjacent organs, hence with low resection rate. ln this series, complete re-section of tumor only 2 cases, partial resection in 7 cases, exploratory thoracotomy in 5 cases. Thymic car-cinoma was an extremely malignant tumor with extensive invasion intrathoracally and early metastasis ex-trathoracally. The common sites of metastasis were bone, liver,lung and extrathoracic lymph nodes. Adju-vant therapy postoperatively was given to all patients. Follow-up of lbo 8 years showed 1O cases death,ofwhich 5 cases died within the first year after surgery,3 cases within the second year. Four patients werestill alive so far, in which 3 patients were within 1. 5 years postoperatively. Pathological studies revealed 9cases of squamous epithe1ial cell thymic carcinoma, 3 of lymphoepithelioma - like thymic carcinoma and 2 ofsmall cell undifferentiate thymic carcinoma.

Memory Safety Based on Probabilistic Memory Allocation

Some unsafe languages,like C and C++,let programmers maximize performance but are vulnerable to memory errors which can lead to program crashes and unpredictable behavior.Aiming to solve the problem,traditional memory allocating strategy is improved and a new probabilistic memory allocation technology is presented.By combining random memory allocating algorithm and virtual memory,memory errors are avoided in all probability during software executing.By replacing default memory allocator to manage allocation of heap memory,buffer overflows and dangling pointers are prevented.Experiments show it is better than Diehard of the following aspects:memory errors prevention,performance in memory allocation set and ability of controlling working set.So probabilistic memory allocation is a valid memory errors prevention technology and it can tolerate memory errors and provide probabilistic memory safety effectively.

Clinical analysis of long-term survivors for unresectable hepatocellular carcinoma

Objective:The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellular carcinoma(HCC).Methods:Between 1999 and 2003, a total of 166 patients underwent multimodality therapy for unresectable HCC.All patients underwent multimodality therapy, such as transarterial chemoembolization(TACE), chemotherapy, local ablative therapy, and/ or Chinese traditional medicine.Thirty-nine(23.5%) patients survival ≥ 1 years, and 10(6.0%) patients survived ≥ 3 years.These 39 patients surviving over 1 year were investigated in this study.Eighteen clinical and biologic variables were assessed using univariate and multivariate analyses.Results:TNM staging and tumor extension were isolated by univariate analysis.Only tumor extension was independent risk factors by multiple regression analysis.Of these, 25.6%(10 of 39) survived over 3 years.These 10 patients surviving over 3 years were investigated further.By the end of June 2004, follow-up varied from 3 years and 2 months to 5 years and 1 month.Six patients were still alive with free of disease.Conclusion:Tumor extension was demonstrated to be prognostic of long-term survivors.Multimodality therapy may make a major contribution to achieving long-term survival in patients with unresectable HCC.

老年进展期胃癌术中植入氟尿嘧啶缓释剂化疗的疗效观察

目的 探讨胃癌根治术中腹腔内植入氟尿嘧啶缓释剂对老年进展期胃癌患者的临床疗效及安全性.方法 76例老年进展期胃癌患者按胃癌根治术中腹腔内是否植入氟尿嘧啶缓释剂分为试验组和对照组,每组38例.试验组胃癌根治术中腹腔内植入氟尿嘧啶缓释剂,对照组单纯行胃癌根治术.观察比较两组不良反应及并发症发生情况,复发及生存率.结果 两组术后不良反应及并发症发生情况比较差异均无统计学意义（P＞0.05）.试验组术后2年内复发率为5.26％（2/38）,对照组为21.05％（8/38）,两组比较差异有统计学意义（P＜0.05）.试验组术后1、3年生存率分别为94.74％（36/38）、63.16％（24/38）,对照组分别为81.58％（31/38）、36.84％（14/38）,两组1年生存率比较差异无统计学意义（P＞0.05）,3年生存率比较差异有统计学意义（P＜0.05）.结论 胃癌根治术中腹腔内植入氟尿嘧啶缓释剂,老年进展期胃癌患者可安全应用,并可明显降低复发率,不增加术后不良反应及并发症,大大提高患者中、远期生存率.

Survival rate:an indicator of the management of acquired immune deficiency syndrome using Traditional Chinese Medicine

Complementary and alternative medicine,including Traditional Chinese Medicine(TCM),has been used as therapy against acquired immune deficiency syndrome(AIDS) for almost 30 years. Based on evaluation indicators for AIDS treatment using TCM,we discuss why the survival rate(which has been used widely in Western Medicine) should be adopted as a new important indicator of TCM treatment for AIDS. We advise that further prospective or retrospective cohort studies should be carried out to confirm this hypothesis.

Integrated Chinese-western therapy versus western therapy alone on survival rate in patients with non-small-cell lung cancer at middlelate stage

OBJECTIVE: To compare the effects of integrated Chinese-Western therapy versus Western therapy alone on the survival rate of patients with non-small-cell lung cancer (NSCLC) at middle-late stage and to evaluate prognostic factors. METHODS: We selected 98 inpatients with middle-late stage NSCLC diagnosed from March 2009 to March 2011 and randomly divided them into two groups, with 49 cases in each group, and the clinical data were analyzed retrospectively.The control group was treated by the combined methods of Western Medicine, including chemotherapy, supportive treatment and symptomatic treatment. The observation group was treated by injection and prescriptions of Chinese medicine based on Traditional Chinese Medicine syndrome differentiation and by the same combined methods of western treatment used in the control group. After treatment, the survival rates of the patients were compared by the stage of cancer and evaluation of 24 prognostic factors analyzed by a Cox regressionmodel, and the clinical data were statistically analyzed. RESULTS: The survival rates of all patients were over 90.0% at 1 and 3 months after treatment with no significant differences between the two groups (P>0.05); In the observation group the survival rates at 6 months and 1 year were 93.4% and 42.8%, respectively, being superior to 85.6% and 18.3% in the control group (P<0.05). The median survival time in the observation group was superior to the control group (P<0.05); The effects of 24 prognostic factors were significantly better in the observation group than in the control group (P<0.05). CONCLUSION: Integrated Chinese-western therapy can significantly improve the survival rate in patients with middle-late stage NSCLC and improve prognostic factors compared with western therapy alone.