Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Research progress on venous thrombosis development in patients with malignant tumors

The coexistence of venous thromboembolism(VTE)within patients with cancer,known as cancer-associated thrombosis(CAT),stands as a prominent cause of mortality in this population.Over recent years,the incidence of VTE has demonstrated a steady increase across diverse tumor types,influenced by several factors such as patient management,tumor-specific risks,and treatment-related aspects.Furthermore,mutations in specific genes have been identified as potential contributors to increased CAT occurrence in particular cancer subtypes.We conducted an extensive review encompassing pivotal historical and ongoing studies on CAT.This review elucidates the risks,mechanisms,reliable markers,and risk assessment methodologies that can significantly guide effective interventions in clinical practice.

A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Pilot Study of Molecular Mechanism on Vasculogenic Mimicry in Bi-directional Differentiated Malignant Tumors

Objective: To investigate the role of collagen IV and PAS positive substancesecreted by tumor cells in vasculogenic mimicry (VM) and the effects of VM on tumor cells expressingVEGF. Methods: 158 cases of bi-direction differential malignant tumor specimens withparaffin-embedded were enrolled into our study and made tissue microarray which were dual-stainedwith CD31-PAS and stained with collagen IV. The difference of the areas and distribution withpattern surrounded by between CD31 and PAS positive respectively were identified via grid-counting,as well as the difference of VEGF expression with VE absent and present. Results: The basementmembrane of VM was both PAS and collagen IV positive. VEGF expression in the bi-directiondifferential malignant tumor was higher VM-absent than VM-present and the difference wasstatistically significance in malignant melanoma and alveolar rhabdomyosarcoma (P 【 0.05).Conclusion: PAS positive substance and collagen IV compose the wall of VE and VE could provide theoxygen and nutrition for tumor growth and progression.

Clinicopathologic features and prognostic factors of malignant eyelid tumors

AIM:To investigate the clinical characteristics and prognosis of patients with malignant eyelid tumors.·METHODS:This was a retrospective,non-randomized,clinical reviews.Between January,2002 and December,2011,75 cases with histologically confirmed malignant eyelid tumors were evaluated.Patients’ charts were reviewed for clinical information,treatment procedure,and disease course.Survival analysis in terms of recurrence-free survival was performed using age,sex,location of tumor and histopathological type.The followup ranged from 1 to 78 months(mean=21 months).·RESULTS:The 75 eyelid tumors included 35 basal cell carcinoma(BCC,46.7%),22 sebaceous gland carcinoma(SGC,29.3%),7 squamous cell carcinoma(SCC,9.3%),10 malignant melanoma(MM,13.3%),and 1 Merkel cell carcinoma(MCC,1.3%).Recurrence developed in 17cases(22.7%).The recurrence rate of BCC(4/35,11.4%)was significant lower than MM(6/10,60.0%,P 【0.001).The mean interval of recurrence was 21 months(range 3-62) for all eyelid tumors.Tumor located at canthus had higher recurrence rate(50%) compared with those located at eyelid(19%,P 【0.05).Histological type was independent variable for recurrence by Cox regression analysis.·CONCLUSION:It is important to achieve a negative tumor margin in canthus located malignant eyelid tumor.Clinicians should have a high level of suspicion for recurrence according to histological type when treating patients with eyelid tumor.

Clinical Research on the Changes of Plasma TFPI and uPA System in Malignant Tumor

Objective: To investigate the expression levels and significance of TFPI, uPA, uPAR and PAI in malignant patients. Methods: The levels of TFPI, uPA and uPAR were measured by using ELISA and the level of PAI was determined by method of chromogenic substrates in 44 patients with malignant solid tumors (group A1) and 30 patients with acute leukemia (AL, group A2). Results: The levels of TFPI, uPA, and uPAR in group A1 were higher than those in normal control group (group B). TFPI, uPAR levels in group A2 were higher than those in group B, while the level of PAI in group A2 was lower than that in group B. Among the groups, TFPI was increased in the combined infection group; PAI decreased in the hemorrhage group; TFPI, uPA, uPAR and PAI increased in relapsing and metastasis group; TFPI decreased in one-week dead group, while uPA and uPAR increased. Conclusion: The patients with malignant solid tumor and AL had different anticoagulation or fibrinolysis states. TFPI, uPA, Upar and PAI can be used to evaluate the disease condition and the prognosis.

A retrospective study of 2228 cases with eyelid tumors

AIM： To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015. METHODS： In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin： epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location. RESULTS： Most eyelid tumors were epidermal in origin（1080, 48.5%）, followed by miscellaneous（885, 39.7%） and adnexal tumors（263, 11.8%）. Among all the tumors, 292（13.1%） were malignant lesions, 1910（85.7%） benign and 26（1.1%） premalignant lesions. Most malignant tumors originated from epidermal cells（60.0%）, followed by adnexal cells（34.6%）. The most common malignant tumors were basal cell carcinomas（56.5%） followed by sebaceous carcinoma（34.6%）, squamous cell carcinomas（3.8%） and lymphoma/plasmocytoma（1.7%）. The benign and premalignant eyelid lesions mostly originated from epidermal cells（46.4%） followed by miscellaneous cell sources（45.2%）, including melanocytic nevus（33.8%）, seborrheic keratosis（13.7%）, squamous cell papilloma（13.0%） and epidermal cysts（11.5%）. CONCLUSION： Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Surgically treated primary malignant tumor of small bowel:A clinical analysis

AIM:To evaluate the clinical presentation,treatment and survival of patients with primary malignant tumor of small bowel(PMTSB).METHODS:Clinicopathologic data about 141 surgically treated PMTSB patients(91 males and 50 females) at the median age of 53.5 years(range 23-79 years) were retrospectively analyzed.RESULTS:The most common initial clinical features of the patients were intermittent abdominal discomfort or vague abdominal pain(67.4%),abdominal mass(31.2%),bowel obstruction(24.1%),hemotochezia(21.3%),jaundice(16.3%),fever(14.2%),coexistence of bowel perforation and peritonitis(5.7%),coexistence of gastrointestinal bleeding and shock(5.0%),and intraabdominal bleeding(1.4%).Ileum was the most common site of tumor(44.7%),followed by jejunum(30.5%)and duodenum(24.8%).PMTSB had a nonspecific clinical presentation.Segmental bowel resection(n=81)was the most common surgical procedure,followed by right hemicolectomy(n=15),pancreaticoduodenectomy(n=10),and others(n=19).Twenty-seven adenocarcinoma patients and 13 malignant lymphoma patients received adjuvant chemotherapy with 5-fluorouracil and cyclophosphamide,adriamycin,vincristine and prednisone,respectively.Information about 120 patients was obtained during the follow-up.The median survival time of PMTSB patients was 20.3 mo.The 1-,3-and 5-year survival rate was 75.0%(90/120),40.0%(48/120)and 20.8%(25/120),respectively.Adenocarcinoma was found in 73.7%(42/57),21.1%(12/57)and 15.8%(9/57)of the patients,respec-tively.Gastrointestinal stromal tumor was observed in 80.0%(20/25),72.0%(18/25)and 36.0%(9/25)of the patients,respectively.Carcinoid was detected in 100.0%(15/15),80.0%(12/15)and 46.7%(7/15)of the patients,respectively.Malignant lymphoma was demonstrated in 69.2%(9/13),30.8%(4/13)and 0%(0/13)of the patients,respectively.CONCLUSION:En bloc resection is the principal therapy for most PMTSB and chemotherapy is the important treatment modality for malignant lymphoma and other malignant tumors of small bowel which cannot be radically removed.

Structure and function of Septin 9 and its role in human malignant tumors

The treatment and prognosis of malignant tumors are closely related to the time when the tumors are diagnosed;the earlier the diagnosis of the tumor,the better the prognosis.However,most tumors are not detected in the early stages of screening and diagnosis.It is of great clinical significance to study the correlation between multiple pathogeneses of tumors and explore simple,safe,specific,and sensitive molecular indicators for early screening,diagnosis,and prognosis.The Septin 9(SEPT9)gene has been found to be associated with a variety of human diseases,and it plays a role in the development of tumors.SEPT9 is a member of the conserved family of cytoskeletal GTPase,which consists of a P-loop-based GTP-binding domain flanked by a variable N-terminal region and a C-terminal region.SEPT9 is involved in many biological processes such as cytokinesis,polarization,vesicle trafficking,membrane reconstruction,deoxyribonucleic acid repair,cell migration,and apoptosis.Several studies have shown that SEPT9 may serve as a marker for early screening,diagnosis,and prognosis of some malignant tumors,and have the potential to become a new target for anti-cancer therapy.This article reviews the progress in research on the SEPT9 gene in early screening,diagnosis,and prognosis of tumors.

A CLINICOPATHOLOGICAL ANALYSIS OF 22 CASES OF MULTIPLE MALIGNANT TUMORS

To get a better understanding of the location,pathophysiology,etiology and prognosis of multiple malignant tumors (MPMT),we evaluated the medical records of 22 patients with MPMT.Our results suggested that radiotherapy and chemotherapy might play an important role in the pathogenesis of MPMT and follow up is important in detecting a secondary primary malignant tumor (PMT) at an early stage.Surgical removal of tumors is the first choice therapy for MPMT.

Characteristics of Chinese Families in Which Children and Both Parents Are Diagnosed with Malignant Tumors:A Retrospective Study

Objective To characterize Chinese families in which both parents and at least one child are diagnosed with malignant diseases and provide reference for cancer screening or early detection in people whose both parents are diagnosed with cancer.Methods Medical records of all clients to the center of cancer screening and prevention of the National Cancer Center/Cancer Hospital between January 2008 and February 2018 were screened to select families in which both parents and at least one child were diagnosed with malignant diseases.The cancer profiles of fathers,mothers,sons and daughters,their age distribution at diagnosis,and similarity of cancers between two generations were analyzed.The proportions of each cancer in males and females of the cohort were compared with corresponding data from the National Cancer Center Registry of China(NCCRC)in 2013.Results Totally 13S families were identified from records of 33200 clients.Proportion of lung cancer in fathers(40/135,29.6%)and in mothers(38/135,28.1%)were higher than the national data(23.9%in males and 14.9%in females,respectively).The proportion of breast cancer in daughters(35/109,32.1%)was higher than that of mothers(14/135,10.4%)and the national data(17.1%),In 71 father-son pairs of cancer,46.5%(33/71)were of the same systematic disease,and 16.9%(12/71)were of the same cancer.These two indexes were 31.2%(n=34)and 10.1%(n=l 1),respectively in the 109 father-daughter pairs of cancer,36.6%(n=26)and 8.5%(n=6)respectively in the 71 mother-son pairs of cancer,and 31.2%(n=34)and 20.2%(n=20)respectively in the 109 mother-daughter pairs of cancer.Sons were more likely to suffer from cancers originated from the same system as father s cancer than daughters(χ^(2)=4.299,P<0.05),and daughters were more likely to suffer from the same cancer as their mother's cancer than sons(χ^(2)=4.506,P<0.05).The age(mean±standard deviation)of the daughters(52.4±12.7)and the sons(59.4±10.9)at diagnosis were significantly younger than the fathers(65.5±12.2)and the mothers(65.7±12.5)(all P<0.001)・Conclusions For people whose both parents are diagnosed as cancer,screening or early detection examinations should cover a full range of cancers rather than the cancers their father and mother have suffered,or cancers stemmed from the same system as their parents cancers.We suggest screening or early detection program for these special population start earlier than that for the general population,with emphasis on cancers derived from digestive system for males and women-specific cancers,i.e.,breast cancer,ovarian cancer,cervical cancer and uterine cancer for females.

Special Expression of Thy-1 in Different Malignant Tumors

Objective： To investigate the expression status of Thy-1 in malignant cancerous tissues and to evaluate whether Thy-1 could be a potential tumor marker. Methods： Immunohistochemistry method was used to examine Thy-1 expressions in different malignant tumor tissues. We used a monoclonal antibody specific for Thy-1 and the indirect Catalysis Signal Amplification method. With the help of tissue microarray （TMA）, we examined expression the status of Thy-1 in 1451 different types of malignant tumor tissues, 144 normal tissues and benign lesions. Results： All the malignant tumor cells were grouped as one group （malignant cells group） and normal or benign tumor tissue cells as another group （normal cells group）. Among the entire 1451 malignant cases group, positive Thy-1 expression with diffuse and strong staining was observed in 734 （734/1451; 50.59%） cases. In the benign cases only 6 chronic cervicitis cases showed weak staining for Thy-1. All the normal tissue showed negative staining. One-Way ANVOA analysis showed F value between these two groups was 147.229 （P〈0.0001）. Conclusion： A significantly stronger expression of Thy-1 in malignant tumors was observed. Special overexpression of Thy-1 in malignant tumors suggests that Thy-1 might be a potential novel tumor marker with respect to cancer progression. Chronic cervicitis has some relationship with cervix carcinoma. When it develops into atypical hyperplasia, it will be a precancerous lesion for cervix carcinoma. In this research we found weak staining for Thy-1 in chronic cervicitis lesion, so Thy-1 may play a crucial role in carcinogenesis for cervix carcinoma. The research about the relationship between Thy-1 expressions in cancer cells and in precancerous lesion will provide some clues to understand the mechanism for carcinogenesis process.

High incidence combination of multiple primary malignant tumors of the digestive system

BACKGROUND Clinical reports of multiple primary malignant tumors(MPMTs)in the digestive system are increasing.In China,although the survival rate of patients with MPMTs is increasing,the quality of life is very low.Many patients have reached the advanced stage when the second primary tumor is found,resulting in no early intervention and treatment.This is due to the misunderstanding of MPMTs by clinicians,who treat such tumors as metastases.Therefore,before a patient has a second primary tumor,doctors should understand some common combinations of digestive system MPMTs to provide clinical guidance to the patient.AIM To explore the high incidence combination of digestive system MPMTs under heterochronism and synchronization.METHODS A total of 1902 patients with MPMTs at Peking Union Medical College Hospital were analyzed retrospectively.They were divided into metachronous MPMT and synchronous MPMT groups,and then the high incidence combinations of the first primary cancer and the second primary cancer in metachronous cancer and synchronous cancer were sorted.Sex and age differences between metachronous and synchronous tumors were tested by the chi square test and t test,respectively.A P value<0.05 was considered as statistically significant,and SPSS version 26.0(SPSS Inc.,Chicago,Illinois,United States)was used for statistical analysis.RESULTS Among the 1902 patients with MPMTs confirmed by pathology,1811(95.2%)cases were secondary primary cancers,89(4.7%)cases were tertiary primary cancers,and 2(0.1%)cases were quaternary primary cancers.Most(88.2%)of the secondary primary cancers were identified as metachronous multiple primary cancers six months after diagnosis of the first primary cancer.The top ten most common MPMTs in the first primary cancer group ranged from high to low as follows:Breast cancer,thyroid cancer,nonuterine cancer,lung cancer,colon cancer,kidney cancer,uterine cancer,bladder cancer,rectal cancer,and gastric cancer.The highest incidence rate of the first primary cancer in male metachronous cancer was lung cancer(11.6%),the highest incidence rate of the second primary cancer was still lung cancer(24.9%),the highest incidence rate of the first primary cancer in female metachronous cancer was breast cancer(32.7%),and the highest incidence rate of the second primary cancer was lung cancer(20.8%).Among them,breast cancer,nonuterine cancer and uterine cancer were female-specific malignant tumor types,and thyroid cancer also accounted for 79.6%of female patients.The top five metachronous cancer combinations,independent of female-specific malignant tumor types and thyroid cancer,were colon cancer and lung cancer(26 cases),kidney cancer and lung cancer(25 cases),rectal cancer and lung cancer(20 cases),gastric cancer and lung cancer(17 cases),and bladder cancer and lung cancer(17 cases).The most common synchronous cancer combination was colon cancer and rectal cancer(15 cases).CONCLUSION Screening for lung cancer should be performed six months after the detection of colon cancer while rectal cancer screening should be performed within six months.

Role of tumor-associated macrophages in common digestive system malignant tumors

Many digestive system malignant tumors are characterized by high incidence and mortality rate.Increasing evidence has revealed that the tumor microenvironment(TME)is involved in cancer initiation and tumor progression.Tumor-associated macrophages(TAMs)are a predominant constituent of the TME,and participate in the regulation of various biological behaviors and influence the prognosis of digestive system cancer.TAMs can be mainly classified into the antitumor M1 phenotype and protumor M2 phenotype.The latter especially are crucial drivers of tumor invasion,growth,angiogenesis,metastasis,immunosuppression,and resistance to therapy.TAMs are of importance in the occurrence,development,diagnosis,prognosis,and treatment of common digestive system malignant tumors.In this review,we summarize the role of TAMs in common digestive system malignant tumors,including esophageal,gastric,colorectal,pancreatic and liver cancers.How TAMs promote the development of tumors,and how they act as potential therapeutic targets and their clinical applications are also described.

Iodine-125 seed implantation in the treatment of malignant tumors

Malignant tumors are major causes of morbidity and mortality in China.Despite advances in surgical,radiological,chemotherapeutic,molecular targeting,and immunotherapeutic treatments,patients with malignant tumors still have poor prognoses.Low-dose-rate brachytherapy,specifically 125I seed implantation,is beneficial because of its high local delivery dose and minimal damage to surrounding tissues.Consequently,it has gained increasing acceptance as a treatment modality for various malignant tumors.In this study,we explored the fundamental principles,clinical applications,and new technologies associated with 125I radioactive seed implantation.

Treatment of Pathological Fractures of the Proximal Femur Due to Advanced Metastasis of Highly Malignant Tumors: A Clinical Controlled Study of Enterostenosis Reconstruction and Conservative Treatment

Objective: To investigate whether different treatment methods have an impact on the quality of life and life span after fracture of patients with proximal femoral pathological fractures caused by advanced metastasis of highly malignant tumors. Methods: Karnofsky performance status (KPS) and visual analogue score (VAS) were counted at the time of admission and 2 months after the treatments. Survival analysis was implemented to compare the median survival time and 6-month survival rate of the 2 groups. Musculoskeletal score (MSTS) was used to evaluate limb function in the surgical group at 2 months after the treatment. Results: There was no significant difference in KPS score and VAS score between the two groups at the time of admission (p > 0.05). At 2 months after treatment, the KPS score of the surgical group was higher than that of the conservative group (P < 0.05), and the VAS score of the survivors of the surgical group was lower than that of the conservative group (P < 0.05). Survival analysis showed that the median survival time and 6-month survival rate after fracture in the surgical group were higher than those in the conservative group (P < 0.05). After 2 months of treatment, the average MTST score of survivors in the surgical group was 20.38 ± 0.9 (16 - 26 points). Conclusion: Surgical intervention can benefit patients with pathological fractures of the proximal femur due to metastasis of highly malignant tumors in terms of quality of life and survival. Local tumor resection and endoparasitic replacement, which can be tolerated by most patients, can effectively reconstruct the limb function of these patients and restore their self-care ability.

Value of ^(99m)Tc-MDP SPECT/CT fusion imaging and CT in evaluating the extent of mandibular invasion by malignant tumor of oral cavity

Objective： The aim of our study was to compare the value of computed tomography （CT） and 99mTc-methylene- diphosphonate （MDP） SPECT （single photon emission computed tomography）/CT fusion imaging in determining the extent of mandibular invasion by malignant tumor of the oral cavity. Methods： This study had local ethical committee approval, and all patients gave written informed consent. Fifty-three patients were revealed mandibular invasion by malignant tumor of the oral cavity underwent CT and SPECT/CT. The patients were divided into two groups： group A （invasion-periphery-type） and group B （invasion-center- type）. Two radiologists assessed the CT images and two nuclear medicine physicians separately assessed the $PECT/CT images in consensus and without knowledge of the results of other imaging tests. The extent of bone involvement suggested with an imaging modality was compared with pathological findings in the surgical specimen. Results： With pathological findings as the standard of reference, Group A： The extent of mandibular invasion by malignant tumor under- went SPECT/CT was 1.02 _＋ 0.20 cm larger than that underwent pathological findings. And the extent of mandibular invasion underwent CT was 1.42 ＋ 0.35 cm smaller than that underwent pathological examination. There were significant difference among the three methods （P 〈 0.01）. Group B： The extent of mandibular invasion by malignant tumor underwent SPECT/CT was 1.3 ＋ 0.39 cm larger than that underwent pathological examination. The extent of mandibular invasion underwent CT was 2.55 ＋ 1.44 cm smaller than that underwent pathological findings. There were significant difference among the three methods （P 〈 0.01）. The extent of mandibular invasion underwent SPECT/CT was the extent which surgeon must excise to get clear margins. Conclusion： SPECT/CT fusion imaging has significant clinical value in determining the extent of mandibular inva- sion by malignant tumor of oral cavity.

A clinical trial of cytokine induced killer cells treating patients with malignant tumor after radiochemotherapy

Objective: Our study investigated the immunity changes and life quality changes after the treatment of cytokine induced killer (CIK) cells for patients with malignant tumor after radiochemotherapy, and explored the therapeutic effects of CIK cells on these patients. Methods: Thirty-one patients with malignant tumor after radiochemotherapy were treated with CIK cells. Before and after CIK cells being transfused back, the immunity indexes of the peripheral blood of these cases were detected and the changes of life quality of these cases were compared. Results: After radiochemotherapy, the percentage of CD3+, CD4+ cells declined, the percentage of CD8+ cells rose; the ratio of CD4+/CD8+ declined, and the percentage of CD16+, CD56+ cells declined. As all the above indexes compared with that of normal people, the difference was significant (P < 0.05). After CIK cells therapy, the above indexes improved (P < 0.05). Life quality improved significantly after CIK cells therapy (P < 0.05). Conclusion: Radiochemotherapy can inhibit the immunity in patients with malignant tumor. CIK cells therapy is safe and effective. It may improve the recent immunity and life quality of the patients, which suggesting that it may be an alternative maintenance treatment for patients with malignant tumor after radiochemotherapy.

Clinical significance of serum vascular endothelial growth factor in advanced malignant tumors

Objective： To elucidate the clinical significance of serum vascular endothelial growth factor （VEGF） level in pa- tients with advanced cancer. Methods： Enzyme linked immunosorbent assay （ELISA） was used to determine the serum VEGF concentration in 40 patients with advanced cancer [non-small cell rung cancer （NSCLC）, esophageal cancer （EC） and nasopharyngeal carcinoma （NPC）] before and after chemotherapy and 10 healthy volunteers as control group. Results： The serum VEGF concentrations in 40 cases of advanced cancer patients were significantly higher than those of 10 healthy control cases [（477.07 ± 374.10 ） pg/mL vs （139.09 ± 133.41 ） pg/mL; P = 0.016]. The serum VEGF concentrations in patients with NSCLC, EC and NPC were （518.53 _± 378.99） pg/mL, （399.21 ± 393.69） pg/mL and （500.68 ± 348.48） pg/mL, respectively. The differences were all statistically significant as compared with healthy control group （P values were 0.011,0.044 and 0.019, respectively）. The serum VEGF concentrations of the patients in response to chemotherapy was significantly lower than those of the same patients before they undergoing chemotherapy [（400.41 ± 332.84） pg/mL vs （777.10 ± 666.01） pg/mL; P = 0.034]. Conclusion： The serum VEGF level might be a novel and promising tumor marker of advanced malignancies and a predictor of disease progression, prognosis and therapeutic efficacy,