伽玛刀立体定向放疗在恶性肿瘤骨转移癌患者中的应用效果评价

目的探讨伽玛刀立体定向放疗在恶性肿瘤骨转移癌患者中的应用效果。方法将96例恶性肿瘤骨转移癌患者随机分为观察组(n=48)与对照组(n=48),观察组采用伽玛刀立体定向放疗,对照组采用非定向性常规放疗。比较两组的骨转移灶治疗效果、疼痛缓解情况及生活质量改善情况。结果观察组骨转移灶治疗客观有效率为93.75%,高于对照组的77.08%(P<0.05)。治疗后10 d,观察组疼痛缓解总有效率为87.50%,高于对照组的45.83%(P<0.05)。治疗后6个月,观察组生活质量改善总有效率为87.50%,高于对照组的47.92%(P<0.05)。结论伽玛刀立体定向放疗对恶性肿瘤骨转移癌患者的应用效果显著,可明显减轻患者的疼痛感,改善其生活质量。

复方桑枝合剂配合唑莱膦酸钠治疗恶性肿瘤骨转移癌重度疼痛72例临床观察

目的:观察复方桑枝合剂联合唑莱膦酸钠治疗恶性肿瘤骨转移癌重度疼痛的临床疗效,并探讨其作用机制。方法:选取住院病例72例,随机分组,其中治疗组38例,对照组34例,两组均给予唑莱膦酸钠,硫酸吗啡缓释片(美施康定),治疗组加用复方桑枝合剂,共治疗1月。观察疼痛缓释率,硫酸吗啡缓释片使用剂量变化,不良反应等。结果:两组均可减少患者疼痛的程度,其中治疗组疼痛缓解率与对照组比较无统计学意义;但硫酸吗啡缓释片使用剂量少于对照组(P<0.05);不良反应发生率治疗组低于对照组(P<0.05)。结论:复方桑枝合剂配合唑莱膦酸钠对骨转移癌引起的重度疼痛具有镇痛迅速,疗效确切,能明显减少吗啡的使用量,明显提高了患者的生活质量。

意外胆囊癌组织层粘连蛋白受体的表达与肿瘤转移的关系研究

目的探讨意外胆囊癌组织层粘连蛋白受体（LN—R）表达与肿瘤组织学类型、分化程度、临床分期及转移的关系。方法对49例意外胆囊癌患者的临床资料进行回顾性分析，采用免疫组织化学法（EnVision二步法）对胆囊癌组织进行LN—R的检测。结果LN—R的阳性表达率为71．4％（35／49），LN—R的阳性表达与肿瘤临床分期密切相关；592％（29／49）的患者术后发现肿瘤转移；LN—R阳性组及LN—R阴性组肿瘤转移率分别为686％（24／35）及357％（5／14），两组比较差异有统计学意义（P〈0，05）。结论意外胆囊癌组织LN—R的表达与否与肿瘤临床分期及转移率有关，LN—R的阳性表达提示转移可能性大，需严格把握再次根治手术指征。

PTTG和FGF2表达与前列腺癌骨转移的关系研究

目的:探讨垂体肿瘤转化基因(PTTG)和碱性成纤维细胞生长因子(FGF2)的表达与前列腺癌(PCa)骨转移的关系。方法:37例PCa患者,分为无转移组和骨转移组,采用免疫组织化学链霉亲合素-生物素-过氧化物酶复合物(SABC)法,检测其癌组织中PTTG和FGF2蛋白的表达情况。结果:骨转移组PTTG和FGF2蛋白的表达程度均高于无转移组,两组比较有显著性差异。且PTTG蛋白的表达与FGF2蛋白相关。结论:PTTG、FGF2的蛋白表达可能在PCa的骨转移过程中发挥重要作用,且二者具有协同作用。

眼球内脉络膜转移癌的影像学表现

目的描述脉络膜转移癌的CT和MRI表现,探讨其诊断、鉴别诊断价值。方法回顾性分析10例经手术病理和临床证实的脉络膜转移癌病例,其中4例行CT扫描检查,10例均行MRI检查。结果 CT扫描显示眼球后部呈偏平状,密度不均的略高密度肿块,中度异常对比强化。MRI检查T1WI呈中等信号,T2WI呈中低信号(与玻璃体相比),较大的肿瘤伴有视网膜脱离。结论 CT和MRI对脉络膜转移癌等眼球内病变均可作出定位、定性的影像学诊断。MRI对脉络膜转移癌表现具有明显特征性。

32例腹腔淋巴结转移癌三维适形放疗的临床疗效分析

目的分析三维适形放射治疗（3-DCRT）在化疗后残留或无效的腹腔淋巴结转移癌的疗效。方法分析2003年5月～2006年4月采用（3-DCRT）技术治疗化疗后残留或无效的腹腔淋巴结转移癌患者32例，接剂量-时间-分割方式：2—6Gy／次，2—5次／周，8～25次，总剂量40～52Gy／8～25次。结果31例患者顺利完成了治疗，一例患者完成40Gy／20次／4周，有效率（CR＋PR）81．3％（26／32），近期疗效与化疗后肿瘤大小有关，病灶越大，肿瘤负荷越大，疗效越差，化疗后病灶残留者疗效明显，化疗后无效及进展的疗效差（χ2=19．75P〈0．001）。联合中药岩舒（复方苦参）可缓解疼痛，症状缓解率为95％（19／20）（χ2=4．55P〈0．05），能提高患者的生存质量。1年、2年生存率分别为50％、18．75％。结论3-DCRT对化疗后残留或无效的腹腔淋巴结转移癌有肯定的疗效，联合中药岩舒（复方苦参）可缓解疼痛，但1年、2年生存率低，特别是对肿瘤范围大的患者，应该寻找更有效的治疗方法，各种综合治疗、同期放化疗、基因靶向治疗的应用，有待于临床研究。

放射性核素骨显像与X线摄片法诊断骨转移癌的临床评价

２５６例恶性肿瘤９９ｍＴｃ－ＭＤＰ骨显像及Ｘ线摄片检查对比结果表明，放射性核素骨显像发现异常率（８３．９％）明显高于Ｘ线摄片的病变发现率（６１．７％）。骨显像显示多发性转移灶（占８６．９％）显著高于Ｘ线片（占２５．７％），说明核素骨显像可作为恶性肿瘤早期寻找骨转移癌的常规检查方法，结合Ｘ线检查可提高其检出率。

CD44v6基因在宫颈癌组织中的表达及其临床意义

目的:探讨CD44v6基因在宫颈癌组织中的表达情况及其临床意义。方法:用免疫组织化学S-P法,检测56例宫鳞癌,32例宫颈腺癌中CD44v6蛋白的表达情况并分析相关的临床病理因素。结果:CD44v6表达与宫颈癌组织学类型无关;无论宫颈腺癌或鳞癌,淋巴结转移组中CD44v6阳性表达明显高于无淋巴结转移组（P<0.05）;CD44v6表达与宫颈癌临床分期、病理分级、病灶大小无关（P>0.05）。结论:CD44v6在宫颈癌淋巴结转移及癌细胞分化过程中可能起着重要作用,对早期预测癌细胞的转移潜能、判断宫颈癌预后具有一定的临床意义。

两种不同放疗分割方式治疗恶性肿瘤骨转移癌痛的疗效对比分析

目的对比分析大分割放疗和常规分割放疗治疗恶性肿瘤骨转移癌痛的疗效。方法选取浙江大学医学院附属第二医院接受治疗的60例恶性肿瘤骨转移患者,将其分为大分割放疗组和常规分割放疗组,每组各30例,每组采用相应的放疗分割方式,对比两组患者治疗前后的VAS疼痛评分、治疗后的止痛效果及止痛起效时间。结果两组患者治疗后的VAS疼痛评分较治疗前显著降低,差异有统计学意义,P<0.05;治疗后组间VAS疼痛评分无明显差异,差异无统计学意义,P>0.05。大分割放疗组的止痛有效率为80.0%,止痛起效时间在1周以内的占到了70.0%,与常规分割放疗组无明显差异,P>0.05,差异无统计学意义。结论大分割放疗和常规分割放疗方式治疗恶性肿瘤骨转移癌痛均具有较好的疗效,应根据患者的具体病情合理选择治疗方案。

注射用门冬氨酸鸟氨酸对消化道肿瘤肝转移癌化疗药物致肝损害的保护作用及不良反应

目的:探讨注射用门冬氨酸鸟氨酸在消化道肿瘤肝转移癌化疗中对肝脏的保护作用及不良反应。方法:将60例消化道肿瘤肝转移癌患者随机分为两组,患者均给予FOLFOX方案化疗。对照组30例:单用FOLFOX化疗;治疗组30例:FOLFOX方案化疗+注射用门冬氨酸鸟氨酸静脉滴注。所有患者在化疗前及化疗后第5天、14天检测血生化指标和血氨并观察不良反应。结果:治疗后对照组患者血清谷草转氨酶(AST)、丙氨酸转氨酶(ALT)、血清总胆红素(TBIL)及血氨水平明显升高(P<0.05),而治疗组患者血清指标和血氨水平在化疗前后无明显变化(P>0.05)。两组不良反应相似,但消化道反应治疗组Ⅲ°～Ⅳ°明显升高,与对照组相比,差异有统计学意义(P<0.05)。结论:门冬氨酸鸟氨酸在消化道肿瘤肝转移癌患者化疗过程中起到保护肝功能的作用,但增加了消化道不良反应。

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

目的 比较FOLFOX-6方案全身化疗与传统以氟尿嘧啶为主的肝动脉灌注化疗对结直肠癌术后肝转移病人的疗效并分析影响结直肠癌术后肝转移病人的预后因素.方法 46名结直肠癌术后肝转移病人随机分配到全身化疗组（实验组）和介入治疗组（对照组）,对比观察近远期疗效、毒副作用和生活质量.将影响预后的临床特征和治疗方式进行单因素和多因素分析.结果 实验组、对照组总生存率差异有统计学意义（P=0.048）,中位生存时间分别为15.0个月和11.2个月（P＜0.05）;治疗总有效率两组差异有统计学意义（50%和10%;P=0.011）;两组治疗期间的PS评分差异无统计学意义（P=0.126）.毒副作用除骨髓抑制、腹痛外,其它比较差异均无统计学意义.单因素分析显示,原发病灶是否浸润浆膜、肝转移灶分布、肝转移病灶最大直径、肝转移灶数目、原发癌有无淋巴结转移以及治疗方式与预后相关.多因素分析后发现,肝转移灶最大直径、肝转移病灶数目、原发癌灶是否浸透浆膜层和治疗模式为影响预后的独立因素.结论 以草酸铂为主的FOLFOX-6方案比传统的以氟尿嘧啶为主的肝动脉灌注化疗有更好的治疗缓解率和远期疗效;肝转移灶最大直径＞5 cm、肝转移灶多发和原发病灶浸透浆膜层提示病人预后不良,采取以草酸铂为主的全身化疗,预后更好.传统药物介入治疗需要改进,局部介入与全身治疗结合的方式值得进一步探究.

Hilar Cholangiocarcinoma with Synchronous Metastases to Breast and Skeletal Muscle: A Case Report and Literature Review

Hilar cholangiocarcinoma has been reputed as a slow growth tumor in the past. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report herein a case of hilar cholangiocarcinoma with synchronous metastases to skeletal muscle and breast, and review the literature. The patient was a 48-year-old woman who presented with jaundice and weight loss. An inoperable hilar cholangiocarcinoma was diagnosed. She was treated with a combination of endoscopic plastic stent biloiary drainage and three-dimensional conformal radiotherapy （3DCRT）. Good response was achieved. Ten months later, she exhibited with a painful metastatic mass in the muscle rectus femoris of left thigh and a painless mass in the left breast. She underwent operation to relieve the pain, but died from liver failure after 8 months. The literature only offers isolated cases of cholangiocarcinoma with distant metastases, of which the common sites were cervical lymph node, bone, and portal venous system. Most patients were presented with multiple metastases with extensive local disease.

Expression of COX-2 in Different Subtypes of Gastric Intestinal Metaplasia and Gastric Carcinoma by Tissue Microarray

Objective: To study the expression of cyclooxygenase-2 (COX-2) protein in different subtypes of intestinal metaplasia (IM) and gastric carcinoma, evaluate the possibility of COX-2 forecasting the risk of malignant potential of IM, and the relationship between COX-2 expression and gastric carcinogenesis. Methods: Forty cases of chronic atrophic gastritis (CAG) with IM, 40 cases of gastric carcinoma and corresponding paracancerous tissues were selected to construct a tissue microarray. High iron diamine/alcian blue (HID/AB) staining and Hematoxylin and Eosin (HE) staining was used to classify IM and gastric carcinoma, and the expression of COX-2 protein detected in different subtypes of IM and gastric cancer by using immunohistochemistry. Results: The positive expression rate of COX-2 was 45.65%, 59.38% and 77.27% in IM foci in CAG, IM foci in paracancerous tissues, and intestinal-type gastric carcinoma, respectively, significantly higher than in diffuse-type gastric cancer (16.67%)(P<0.05, 0.005 and 0.005, respectively), and the expression intensity of COX-2 protein showed a increased tendency gradually in the sequence of IM foci in CAG→IM foci in paracancerous tissues→intestinal-type gastric carcinoma (P<0.005). The positive expression rate of COX-2 protein in type Ⅲ IM was significantly higher than in type Ⅰ and type Ⅱ IM (P<0.005 and 0.05, respectively), and the expression intensity also showed a increased tendency gradually from type Ⅰ to type Ⅲ IM (P<0.005). Conclusion: The expression level of COX-2 was increased gradually along with the increase of the risk of malignancy of IM, and its expression level may be a useful index to forecast the risk of malignant potential of IM. COX-2 expression was associated with intestinal-type gastric carcinoma, but it might also have some role in the carcinogenesis of diffuse-type gastric carcinoma.

An Analysis of Prospective Outcome of Re-resection for Recurrent Live Cancer and Extrahepatic Metastases,a Follow-up of 267\Cass

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results. Key words prospective outcome - re-resection - primary liver cancer - recurrence - extrahepatic metastases

The Relationship between the Expression of p27^(Kip1),p53 and the Infiltration,Metastasis and Prognosis in Gastric Carcinoma

Objective: To study the relationship between the expression of p27Kip1 and p53, and the infiltration, metastasis and prognosis in gastric carcinoma. Methods: The expression of p27Kip1 and p53 at protein level was determined by immunohistochemical assay (two-step method) in 100 cases of gastric carcinoma. Results: Of the 100 cases, the positive rate of p27Kip1 and p53 expressions were 44% and 49%, respectively. In the group of gastric carcinomas with deep infiltration (infiltration group), lymph nodes metastasis group (metastasis group) and death-within-5-years group (death group), the expression of p27Kip1 was statistically lower (_P<0.05). In the metastasis group and death group, the expression of p53 was significantly higher (P<0.05). The results of the monovariate analysis revealed that the 5-year survival rate of the high p27Kip1 expression group was 70.59%, which is higher than those of the low p27Kip1 expression group (54.55%) and the negative experession group (26%). The 5-year survival rate of the high p53 expression group was 19.23%, which was lower than those of the p53 low expression group (43.75%) and the negative group (53.19%). Cox multivariate analysis showed that p27Kip1, like p53, was an independent prognostic index. But p27Klpl protein expression was a stronger independent survival predictor (RR=3.06) than p53 expression (RR=2.33). Conclusion: The low expression of p27Kip1 and the high expression of p53 reflected the more frequent invasion and metastasis, which resulted in the reduced survival of patients. As an independent markers of the gastric carcinoma, the expression of p27Kip1 is more useful than that of p53 in the prognosis prediction of gastric carcinoma.

Effect of Bcl-2 Antisense Oligodeoxynucleotides on Human Lung Carcinoma Transplanted Subcutaneously in Nude Mice

Objective： To investigate the inhibitory effects of the Bcl-2 antisense oligodeoxynucleotides （ASODN） on tumor formation and growth of human lung carcinoma transplanted subcutaneously in nude mice. Methods： Human NCI-H460 cells treated with Bcl-2 ASODN or nonesense oligodeoxynucleotide （NSODN） and untreated NCI-H460 cells were respectively implanted subcutaneously into nude mice. When the diameters of tumor were above 0.5 cm after untreated NCI-H460 cells injection, the mice bearing tumor were randomly divided into three groups： saline control group, Bcl-2 ASODN group, NSODN group. ODN was directly injected into the tumor body for 3 weeks. The weight and volume of subcutaneous tumors were measured, and the morphology of tumor cells was observed. Results： The tumorigenic ability of the treated NCI-H460 cells by Bcl-2 ASODN was reduced. The mean time at which tumor can be detected was prolonged up to 12.6 days （P〈0.01）. The maximum tumor growth inhibitory rate was 87.5%. In therapeutic efficacy, growth of tumor was significantly inhibited in Bcl-2 ASODN group as compared with that in NSODN group, saline-treated group （P〈0.01）. The NSODN control was ineffective. In comparison with NSODN-treated, saline-treated mice, those treated with Bcl-2 ASODN showed a significant decrease in median weight of subcutaneous tumors （P〈0.01）. The growth inhibitory rate was 71.0% in ASODN group. Conclusion： Bcl-2 ASODN could inhibit tumor formation and tumor growth in nude mice.

Expression of Hypoxia Inducible Factor lα and Its Significance in Non-small Cell Lung Cancer

Objective： To explore the expression level and its clinical significance of hypoxia inducible factor 1α （HIF-1α ） in non-small lung cancer. Methods： The expression of HIF-1α was detected in 68 human non-small lung cancer samples by immunohistochemistry. Results： （1） Thirty-nine （57.35%） out of the 68 human non-small lung cancer samples was positive for HIF-1α ; （2） The positive rate of HIF-1α in adenocarcinoma and squamous carcinoma was 54.76% （23/42） and 61.54% （16/26） respectively. No significant difference was found between adenocarcinoma and squamous carcinoma of non-small lung cancer in the expression of HIF-1α （P〉0.05）. The positive rate of HIF-1α in middle-high differentiation was 74.28% （26/35）, significantly higher than in low differentiation （39.39%, 13/33） （P〈0.05）; （3） The positive expression of HIF-1α was not correlated to the sexes, ages, tumor stage and lymph node status. Conclusion： The expression of HIF-1α is higher in non-small lung cancer and is correlated to differentiation.

CD44v6 in peripheral blood and bone marrow of patients with gastric cancer as micro-metastasis

AIM： To detect the expression of CD44 correlated with the ability of micro-metastasis in peripheral blood and bone marrow of patients with gastric cancer and to deduce its clinical significance. METHODS： Preoperative peripheral blood and bone marrow specimens from 46 patients with gastric cancer and 6 controls were studied by semi-quantitative RTPCR amplification of CD44v6mRNA. Preoperative and postoperative peripheral blood specimens from 40 patients with gastric cancer and 14 controls were studied by quantitative RT-PCR amplification of CD44v6mRNA in the corresponding period. RESULTS： Semi-quantitative RT-PCR amplification showed that CD44v6mRNA expression of peripheral blood and bone marrow was positive in 39 （84.8%） and 40 （86.9%） of 46 patients with gastric cancer, respectively. In peripheral blood, CD44v6mRNA expression was positive for diffuse type in 30 （93.8%） of 32 patients and for intestinal type in 9 （64.3%） of 14 patients. On the other hand, in bone marrow, CD44v6mRNA expression was positive for diffuse type in 31 （96.9%） of 32 patients and for intestinal type in 10 （71.4%） of 14 patients. There was a significant difference between the diffuse type and intestinal type. Quantitative RTopCR amplification demonstrated that CD44v6mRNA was not expressed in the peripheral blood of controls and CD44v6mRNA expression was positive for preoperative peripheral blood in 40 patients with gastric cancer, the expression levels being from 4.9 × 10^2 to 3.2× 10^5 copies/g RNA. The average expression level of CD44v6mRNA in peripheral blood was 3.9 × 10^10 copies/g RNA. The expression levels of CD44v6mRNA in peripheral blood in gastric cancer patients after curative operation increased from 5.5 × 100 to 7.6 × 10 copies/g RNA （P = 0.00496）. After curative operation, the expression level decreased markedly. CONCLUSION： Semi-quantitative and quantitative RTPCR amplification for CD44v6mRNA is a sensitive and specific method for the detection of micro-metastasis in peripheral blood and bone marrow, which might be used as an indicator of tumor burden and therapeutic effect.

Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer

AIM: To evaluate the role of peritoneal lavage cytology (PLC) and carcinoembryonic antigen (CEA) determination of peritoneal washes (pCEA) in predicting the peritoneal metastasis and prognosis after curative resection of gastric cancer.METHODS: PLC and radioimmunoassay of CEA were performed in peritoneal washes from 64 patients with gastric cancer and 8 patients with benign diseases.RESULTS: The positive rate of pCEA (40.6%) was significantly higher than that of PLC (23.4%) (P<0.05).The positive rates of PLC and pCEA correlated with the depth of tumor invasion and lymph node metastasis (P<0.05). pCEA was found to have a higher sensitivity and a lower false-positive rate in predicting peritoneal metastasis after curative resection of gastric cancer as compared to PLC. The 1-, 3-, and 5-year survival rates of patients with positive cytologic findings or positive pCEA results were significantly lower than those of patients with negative cytologic findings or negative pCEA results (P<0.05). Multivariate analysis indicated that pCEA was an independent prognostic factor for the survival of patients with gastric cancer.CONCLUSION: Intraoperative pCEA is a more sensitive and reliable predictor of peritoneal metastasis as well as prognosis in patients with gastric cancer as compared to PLC method.