宫颈小细胞癌的诊治进展

宫颈小细胞癌是一种高度恶性妇科肿瘤,其病因与HPV密切相关。历史上诊断标准不一,命名混乱,治疗以综合治疗为主,术后化疗采用VAC/PE/TP方案可明显改善早期病人预后。该文对宫颈小细胞癌的病理学、分子生物学及诊断、治疗上的研究进行了综述。     

宫颈小细胞癌的诊治进展

宫颈小细胞癌是一种高度恶性妇科肿瘤，其发病病因与ＨＰＶ密切相关。历史上诊断标准不一，命名混乱，迄今尚无较为统一的治疗措施，术后化疗采用ＶＡＣ／ＰＥ方案可明显改善早期病人预后。目前主张综合治疗。     

宫颈小细胞癌26例临床病理特征及预后分析

摘 要：［目的］ 探讨宫颈小细胞癌的临床病理特征及预后。［方法］ 收集收治的26例宫颈小细胞癌患者的临床资料和随访结果,回顾性分析患者人乳头瘤病毒感染状态（human papillomavirus,HPV）、病理特点、治疗效果及预后。［结果］ 患者中位年龄45岁,Ⅰa~Ⅱa期9例,Ⅱb ~Ⅳ期17例,15例合并HPV感染（13例HPV18感染,2例HPV16感染）。16例患者接受手术、放疗或化疗的单一或两种治疗,10例患者接受手术、放疗和化疗三种方法联合治疗（综合治疗方法）。中位随访时间37个月,至2019年2月,16例患者死亡,总生存率38.5%。合并HPV感染的患者生存率相比未感染HPV患者有下降趋势,但差异无统计学意义（33.3% vs 45.5%,P=0.171）。病理免疫组化诊断标志物突触素（synaptophysin,SYN）、嗜铬粒蛋白A（chromogranin A,CgA）及神经细胞黏附分子56（neuronal cell adhension molecules 56,CD56）,三项均阳性患者与其中两项阳性患者相比,生存率差异无统计学意义;而FIGO 2009分期、淋巴结转移、脉管癌栓及治疗方式与患者生存期明显相关。［结论］ 宫颈小细胞癌患者总体预后较差,初诊分期Ⅱb以上、淋巴结转移、脉管癌栓提示预后较差。采用综合治疗的患者生存率明显具有优势,推荐所有分期患者使用。     

宫颈小细胞癌2例

宫颈小细胞癌（small cell carcinoma of cervix，SCCC）罕见，治疗效果差，早期即可发生盆腔淋巴结和远处转移。本院收治2例SCCC，结合文献讨论其诊断、生物学特性及临床特点，治疗和预后.[第一段]     

宫颈小细胞癌诊治临床案例分析

目的:探讨宫颈小细胞癌临床诊治体会。方法:对19例宫颈小细胞癌患者临床资料进行回顾性分析,内容包括临床影像检查结果、病理诊断结果、治疗方案、治疗效果以及随访结果等。结果:19例宫颈小细胞癌患者中,全部患者病理检查标本均对Syn标记结果呈阳性,73.68%的患者医学影像检查结果可知体内肿瘤形态呈菜花型,对比结果具有统计学意义。13例患者实施手术治疗,所有患者均实施新辅助化疗（NAC）,其中6例患者接受了同步放、化疗治疗方案。6例患者治疗后发生淋巴结转移,复发部位大多为肺部,其中2例患者出现1枚淋巴结转移、4例患者出现2~6枚淋巴结转移。结论:对宫颈小细胞癌患者进行全面检查并准确判断病情,根据患者实际情况选择合适的治疗方案,可有效延长患者生存期。     

血清鳞状细胞癌抗原在宫颈鳞状细胞癌中的变化及意义

[目的]探讨血清鳞状细胞癌抗原水平在宫颈鳞状细胞癌中的变化及其临床意义。[方法]应用微粒子酶免分析（MEIA）对2000年3月～2000年7月在浙江省肿瘤医院收治的宫颈鳞癌（包括5例鳞腺癌）165例患者进行血清鳞状细胞癌抗原水平检测并分析其与临床分期、肿瘤大小、病理分级、淋巴结转移之间关系,其中放射治疗的93例患者进行治疗前后的血清鳞状细胞癌抗原水平的自身比较,以及与近期疗效的关系。[结果]165例宫颈鳞癌患者血清鳞状细胞癌抗原阳性率为64.2％（106/165）。鳞状细胞癌抗原水平与临床分期、肿瘤大小有关（P<0.05）;与病理分级、淋巴结转移之间无统计学差异（P>0.05）;放射治疗前后患者血清鳞状细胞癌抗原水平变化有统计学意义（P<0.05）,且与疗效相关（P<0.05）。[结论]血清鳞状细胞癌抗原是宫颈鳞癌的相关的肿瘤标记物,在监测宫颈鳞癌的发生和评价疗效等方面具有重要价值,对判断宫颈鳞癌的预后具有一定的临床意义。     

101例宫颈小细胞神经内分泌癌患者的临床治疗及预后分析

目的 探讨宫颈小细胞神经内分泌癌（SCNEC）患者的临床治疗及预后影响相关因素。方法 选取江西省妇幼保健院101例SCNEC患者ⅠB1期-ⅡA期手术治疗组72例,ⅡB-Ⅳ期根治性放化疗组29例,对患者的年龄、临床分期、肿瘤大小、治疗及生存率等进行回顾性分析。结果 72例手术患者中,51例生存,生存时间1~139月,五年生存率60.6%。29例根治性放化疗患者中,随访5年以上20例,五年生存率15%。不同分期患者生存率差异有统计学意义（P=0.0025）;淋巴结阴性与阳性患者生存率差异有统计学意义（P=0.0004）。混合型与单纯型患者生存率差异无统计学意义（P=0.0546）。结论 宫颈SCNEC患者临床分期、淋巴结转移情况与预后密切相关,是否混合其他病理类型对生存率无影响。早期手术治疗患者预后明显优于中晚期根治性放化疗患者。     

膀胱小细胞神经内分泌癌与鳞癌混合性癌1例并文献复习

目的:通过对1例膀胱小细胞神经内分泌癌与鳞癌的混合性癌患者病例的分析,探讨该病的临床特点、病理学特点、临床诊断、治疗方法及预后。方法:回顾性分析遵义医学院附属医院泌尿外科2017年10月收治的1例术后病理组织学诊断为膀胱小细胞神经内分泌癌与鳞癌混合性癌患者的临床资料并进行国内外文献复习。结果:49岁男患,因“发现肉眼血尿2月余”入院,全麻下行腹腔镜根治性膀胱全切+回肠新膀胱+扩大淋巴结清扫术,术后经病理组织学确诊为膀胱混合性癌（小细胞神经内分泌癌+角化型鳞癌）。结论:膀胱小细胞癌(包括其与移行细胞癌、腺癌和鳞癌等复合癌)临床表现主要以肉眼血尿为主,呈现高度的恶性生物学行为,具有发现晚、进展快、转移早、恶性程度高、预后差等特点,需尽早完善病理学诊断,明确肿瘤的临床分期以达到早期治疗与有效改善其预后的目的。     

宫颈小细胞癌的研究进展

目的:通过文献复习探讨宫颈小细胞癌(small cell carcinoma of the cervix,SCCC)的临床病理特点、生物学行为、治疗及预后情况。方法:应用检索Meta Med及CHKD期刊全文数据库检索系统,以"宫颈恶性肿瘤、小细胞癌和神经内分泌癌"为关键词,分别或联合检索1998-01-2008-06的相关文献80篇。纳入标准:1)组织发生;2)临床病理特点;3)化疗、放疗和综合治疗疗效;4)预后分析。根据纳入标准,精选59篇文献,最后纳入分析28篇文献。结果:SCCC是一种罕见的宫颈原发恶性肿瘤,与普通的子宫颈癌相比,SCCC具有高度侵袭性,常早期发生远处转移和局部复发,预后差。正确的临床诊断需联合光镜、电镜和免疫组化检查。因发病率低和各中心累积的病例数有限,目前尚无规范的治疗方法。手术是治疗早期SCCC的重要手段,同步放化疗可用于治疗晚期SCCC患者,联合化疗和放疗可能改善预后。临床期别是决定预后的重要因素。结论:SCCC预后差,强调早期诊断和综合治疗,由于SCCC罕见,需长时间才能积累一定数量的患者资料,建议通过多中心协作以探求最佳的治疗方案。     

宫颈小细胞癌12例临床分析

[目的]探讨宫颈小细胞癌(SCCC)确诊方法及治疗、预后.[方法]回顾分析1989年4月～2004年4月收治的12例SCCC患者的临床资料.[结果]12例患者均经病理检查确诊,其中4例通过免疫组化证实.12例SCCC患者中5例放弃治疗.另7例均在术前术后化疗,其中4例死亡,生存期分别为13、17、26、34个月,2例失访,1例仍在随访中(39个月).[结论]主要依赖病理组织形态和免疫组化将宫颈小细胞癌从普通宫颈癌中区分开.基本治疗原则采用术前放、化疗,手术加术后化疗的综合治疗方案.预后差.     

动物肿瘤模型的建立及其标准研讨

白细胞介素2是山T^H细胞在有丝分裂原／抗原及IL-1的双重信号作用下而产生的一种可溶性糖蛋白。其主要功能是维持T细胞持续生长、增殖．表达IL-2受体等。IL-2的产生和／或IL-2R表达异常与多种肿瘤、自身免疫疾病等所致的免疫功能障碍有关。因此，检测T细胞产生IL-2、表达IL-2R和对IL-2的增殖反应水平．可在一定程度上反映机体的免疫应答能力。本文就肿瘤患者PBL对rlL-2增殖反应的水平，与肿瘤术后者及健康者相比较，分析讨论了肿瘤患者免疫调节障碍的具体环节。     

动物肿瘤模型的建立及其标准研讨

动物肿瘤模型，也是人类肿瘤的复制，对肿瘤发生、发展机制的研究及肿瘤预防和治疗等研究具有重要的意义．动物肿瘤模型的建立应注意选择动物的种系和致癌物的类型。动物种系间的差异很大，相同的致癌物对不同种系的动物可诱发不同的肿瘤，因此要诱发出台适的动物肿瘤模型，动物种系的选择极为重要．动物肿瘤模型分为动物自发瘤模型．诱发瘤模型和移植瘤模型．而移植瘤模型为本文讨论的重点。人类肿瘤移植瘤(指移植于免疫缺陷动物)的来源有肿瘤活检组织，手术切除的肿瘤标本和人类肿瘤细胞系。建立移植瘤的基本条件是：肿瘤标本的取材，应在无菌条件下取新鲜、无坏死、无包膜的瘤组织，手术标本的取材应在1—2个小时内完成．移植瘤受体动物(包括免疫缺陷动物)要求在4周龄左右，移植的最常用部位是背侧皮下。移植瘤建成的标准是：传代数应在15—20代(每代传3-4只动物)；最终移植成瘤率为100％；自发消退率减少到虽低限度(不一定完全达到零)；生长速度要稳定；宿主寿命相似(重复性强)；宿主反应性低(已适应受体动物体内生长)；瘤组织的组织学结构仍保持与原发瘤相似．符合以上标准即可称为移植性肿瘤模型。     

循环肿瘤细胞自激注入的研究进展

由于缺乏有效的治疗手段,转移仍是癌症病人死亡的首要原因。肿瘤转移的新理论认为循环肿瘤细胞能够回到肿瘤原发灶,从而滋养肿瘤细胞,并产生更具侵袭力的转移株。本文就该现象加以综述,并对其在人类癌症转移研究中的意义进行探讨。     

Prognostic value of tumor thickness in patients with Merkel cell carcinoma

BACKGROUND AND OBJECTIVES: Merkel cell carcinoma is an aggressive skin malignancy that often presents with tumor metastases. We hypothesized that tumor thickness might correlate with both regional and metastatic tumor spread and could, therefore, be used as an independent prognostic variable. The purpose of this study was to see if depth of tumor invasion would predict prognosis independent of tumor stage. METHODS: Data pertaining to clinical presentation, pathology, treatment, and survival were collected for patients diagnosed with Merkel cell carcinoma from 1972 to 2005. Patients were staged according to AJCC guidelines. Pathologic specimens were evaluated for tumor thickness. The relationship between tumor thickness and disease-free survival or overall survival was analyzed using Kaplan-Meier survival analyses. RESULTS: Sixty patients were identified. Five-year disease-free survivals for Stages 1, 2, and 3 patients were 20%, 33%, and 0%, respectively. Five-year overall survivals for Stages 1, 2, and 3 patients were 33.3%, 60%, and 16.7%, respectively. There was no correlation between tumor thickness and either disease-free survival or overall survival. CONCLUSIONS: This study suggests that tumor thickness is not an independent risk factor for survival. Mean tumor thickness did increase with the AJCC stages, but this most likely represents more advanced stage of disease.     

Bilateral malignant Brenner tumor of the ovary

The clinicopathologic features of a case of malignant Brenner tumor with bilateral ovarian involvement are described. The tumor was apparently confined within the ovaries at initial laparotomy. However, multiple skeletal metastases developed 4 months later and the patient died of the disease 6 months after diagnosis.     

肿瘤基因工程纳米疫苗NL(MH)抗肿瘤复发的实验研究

目的：在小鼠体内观察纳米疫苗NL（MH）抗肿瘤复发作用。方法：以PBS、空白脂质体、MH、MH／NL、NL（MH）免疫C57BL／6小鼠3次后，IFN-γ ELISPOT和LDH杀伤实验检测纳米疫苗激活小鼠特异性细胞免疫反应的情况；以肿瘤攻击实验和肿瘤切除后复发实验来评价纳米疫苗预防肿瘤复发作用。结果：与对照组相比，NL（MH）组小鼠脾淋巴细胞中分泌IFN-γ的T细胞数量明显增多（P〈0．05），CTL对B16-MAGE3细胞具有显著的特异性杀伤作用；在肿瘤攻击实验中，NL（MH）组B16-MAGE3肿瘤成瘤时间长、成瘤率低；肿瘤切除后，NL（MH）组B16-MAGE3肿瘤复发时间延迟，复发率明显降低。结论：NL（MH）能够刺激机体产生强烈的MAGE3特异性的细胞免疫反应，对表达MAGE3的肿瘤细胞具有显著的杀伤作用，能有效预防B16-MAGE3切除后复发。     

循环肿瘤细胞自激注入的研究进展

由于缺乏有效的治疗手段,转移仍是癌症病人死亡的首要原因。肿瘤转移的新理论认为循环肿瘤细胞能够回到肿瘤原发灶,从而滋养肿瘤细胞,并产生更具侵袭力的转移株。本文就该现象加以综述,并对其在人类癌症转移研究中的意义进行探讨。     

Chordoma: natural history and treatment results in 33 cases

Thirty-three chordomas were observed at the Istituto Nazionale Tumori of Milan from 1933 to 1983: 27 sacrococcygeal, 3 spheno-occipital, and 3 vertebral. The male:female ratio was 2.7, and the median age was 63 yr for patients with sacrococcygeal and 35.2 yr for those with nonsacral chordomas. After pathologic reassessment, distinct cytologic patterns were found: physaliphorous, syncytial, and mixed subtypes, with variable degrees of cytologic atypia. However, no evident difference in survival was documented in relation to these cytohistologic features. Four cases had a prior traumatic fracture, and the pathogenetic role of trauma is stressed. Eight cases were operated with adequate surgery and only three recurred, whereas of 11 inadequate operations, 10 developed local relapse. However, follow-up for recent adequate operations is short. Radiation therapy seemed to be effective with adjuvant or palliative aims. No chemotherapeutic regimen achieved any result; one case had a short complete remission after cis-dichlorodiammineplatinum + vinblastine + bleomycin (PVB). This analysis confirms the possibility of achieving radicality with high resection of the sacrum for lesions confined below the second sacral vertebra. Nonsacral chordomas were all unresectable. The best treatment for unresectable lesions seems to be palliative surgery plus radiotherapy.     

肿瘤免疫生物治疗新途径——载药肿瘤囊泡

正常细胞及肿瘤细胞在发生凋亡或受到某些信号刺激时均可释放出直径为0.1~1 μm的膜状囊泡。肿瘤细胞受到信号刺激后骨架改变，导致细胞质膜包裹细胞内容物并向膜外侧起泡形成囊状小体，称为肿瘤囊泡，其不仅影响肿瘤细胞的生物学特性，对肿瘤免疫微环境也产生深刻的影响。除生物学效应外肿瘤囊泡还可作为一种天然的药物载体将治疗药物递送到肿瘤细胞，发挥抗肿瘤作用。研究证实，载药的肿瘤囊泡在天然免疫和获得性免疫反应中均体现良好的抗肿瘤激活效应，目前载药肿瘤囊泡已经进入临床应用阶段，在胆管癌、恶性胸腔积液的治疗中展现了良好的应用前景。     

Plasma thromboxane A2 and prostacyclin concentrations in squamous cell carcinoma of the head and neck

Circulating prostaglandins, including thromboxane A2 and prostacyclin, have been implicated as possible facilitative agents in the growth and dissemination of squamous cell carcinomas of the head and neck. The purpose of this study was to evaluate the relationship of plasma concentrations of these compounds to tumor stage and the effect of surgical resection on plasma prostaglandin levels. Blood samples were obtained from 40 patients with head and neck cancer. Ten treated patients were clinically disease-free (NED), and 30 patients with active disease were previously untreated at the time of this study. Plasma concentrations of thromboxane A2 and prostacyclin were measured by radioimmunoassay of their stable metabolites thromboxane B2 (TxB) and prostaglandin 6-keto-F1 (PGI). Platelet aggregation was performed with normal donor platelets (PRP) and normal control or patient plasma (PPP). TxB and TxB/PGI ratios were increased in T1N0M0 patients, compared with NED and with T4N0M0 primary lesions versus all other groups. With lymphatic and hematogenous metastases, TxB and TxB/PGI ratios fell to NED levels. ADP-induced platelet aggregation was significantly increased in head and neck cancer patients, compared with normal controls, and with T4N0M0 lesions, compared with NED. There were no significant differences in PGI levels. TxB, PGI, TxB/PGI, and platelet aggregometry did not change significantly with curative surgery. TxB and TxB/PGI interactions are involved in head and neck cancer. Changes in TxB and TxB/PGI may be related to increased platelet aggregation.