肺癌脑转移252例综合治疗临床分析

目的 探讨肺癌脑转移综合治疗的疗效及预后影响因素。方法 回顾性分析了２５２例脑转移患者不同治疗方法的生存期生存率。结果 转移灶手术切除及Ｘ－刀治疗辐以放疗、化疗的中位生存期及１、２年生存率明显高于单纯放疗与化疗组（Ｐ〈０．００１及Ｐ〈０．０５）,转移灶数目、部位及有无其它颅外转移均显著影响预后,结论 转移灶的手术切除及Ｘ－刀治疗加放疗和化疗是首选治疗方法。     

~(131)I抗AFP抗体-MMC双弹头导向治疗肝癌31例

目的观察化疗兼内照射的新型双弹头免疫导向治疗肝癌的疗效．方法以马抗人ＡＦＰ多克隆抗体（抗ＡＦＰＡｂ）和大鼠抗人ＡＦＰ单克隆抗体（抗ＡＦＰＭｃＡｂ）为载体，核素１３１Ｉ和丝裂霉素（ＭＭＣ）为双弹头，采用改良氯胺Ｔ法制备１３１Ｉ抗ＡＦＰＭｃＡｂＭＭＣ（双弹头１）和１３１Ｉ抗ＡＦＰＡｂＭＭＣ（双弹头２），静脉滴注，每月１次，治疗不能切除中晚肝癌３１例（治疗组）．治疗１，２，３次分别占４，１７和１０例，放射剂量（ＭＢｑ／例）均值依次为１９３５１±３７７４，６５１９±２３２４和９９２０±２３０５．结果治后肿瘤缩小率、血清ＡＦＰ下降率和１，２年生存率分别高于同期经动脉插管灌注（ＴＡＩ）或化疗栓塞（ＴＡＣＥ）的对照组（５００％，１５／３０比３００％，９／３０Ｐ＜００５；６６７％，１８／２７比２８０％，７／２５Ｐ＜００１和５００％比３３０％，３４０％比３３％Ｐ＜００１），治疗组病例的进展率（１００％）明显低于对照组（４００％，Ｐ＜００１）．结论双弹头疗效提高，由于抗体、核素１３１Ｉ和抗癌药的协同作用而增强了对癌细胞的杀伤力所致．     

血脂康和辛伐他汀对高胆固醇血症调脂作用的比较

目的研究血脂康对高胆固醇血症患者的调脂作用并与辛伐他汀比较。方法２８例高胆固醇血症患者随机分为两组，服药前及服药后４、８周测定血脂。结果（１）服药后４周ＴＣ分别降低了２０７％和２２５％（Ｐ值均＜０００１）；血脂康降低血清低密度脂蛋白胆固醇（ＬＤＬＣ）作用与辛伐他汀相似，ＬＤＬＣ水平分别降低了２８２％和３３％（Ｐ值均＜００１）；（２）血脂康明显降低１７４％的血清ＴＧ水平（Ｐ＜００５）；（３）服血脂康和辛伐他汀４周后，载脂蛋白（Ａｐｏ）Ａ１却分别增加了１２７％和１３６％（Ｐ值均＜００１）；ＡｐｏＢ水平均下降了８％左右（Ｐ＜００５）；分别使脂蛋白（ａ）［Ｌｐ（ａ）］水平降低了３１３％（Ｐ＜００１）和２７８％（Ｐ＜００５）；（４）除了治疗８周后Ｌｐ（ａ）水平进一步下降外，两种药物治疗８周后的调脂作用与４周比较无明显差异。结论血脂康能显著降低Ⅱａ和Ⅱｂ型高胆固醇血症患者血清ＴＣ和ＬＤＬＣ，其作用与辛伐他汀相等；血脂康降低ＴＧ作用优于辛伐他汀     

白细胞介素6与癌胚抗原联检对老年人结核性及癌性胸液的诊断价值

目的　探讨白细胞介素 ６（ Ｉ Ｌ６）及癌胚抗原（ Ｃ Ｅ Ａ ）对老年人结核性及肺癌胸膜转移所致胸腔积液的诊断价值。方法　用酶联免疫吸附试验（ Ｅ Ｌ Ｉ Ｓ Ａ ）及放射免疫分析法（ Ｒ Ｉ Ａ ）检测了老年人结核性渗出性胸膜炎 ３８ 例及肺癌胸膜转移 ４０ 例胸液及血清 Ｉ Ｌ６、 Ｃ Ｅ Ａ 水平。结果　结核组胸液 Ｉ Ｌ６ 水平及 Ｉ Ｌ６ 胸液／血清比值显著高于肺癌组（ Ｐ＜ ００１, Ｐ＜ ００５）,而肺癌组胸液及血清 Ｃ Ｅ Ａ 水平显著高于结核组（ Ｐ＜ ０００１, Ｐ＜ ００１）。结论　联合检测胸液及血清 Ｉ Ｌ６、 Ｃ Ｅ Ａ 水平对结核及肺癌胸膜转移所致胸腔积液有重要的鉴别诊断价值。     

大肠癌患者外周血CD44表达的变化

目的探讨大肠癌患者外周血ＣＤ４４表达变化的意义．方法以流式细胞仪对２６例大肠癌患者外周血ＣＤ４４表达进行免疫荧光检测，通过自身对照分析术前、术后变化，并与正常人（ｎ＝２０）及大肠良性肿瘤患者（ｎ＝１７）进行对比研究，ｔ检验处理数据．结果大肠癌患者外周血ＣＤ４４细胞（２０５％±４５％）明显高于正常人（１８％±１１％）及大肠良性肿瘤患者（２４％±１４％，Ｐ＜００１），后二者差别不明显（Ｐ＞００５），已发生转移的大肠癌患者外周血ＣＤ４４含量（２２９％±４８％）较无转移者（１６１％±３３％）明显增高（Ｐ＜００１），无转移组根治手术后外周血ＣＤ４４含量迅速下降（２９％±１８％）至正常人水平，已有转移者变化不明显（Ｐ＞００５）．结论ＣＤ４４水平可作为大肠恶性肿瘤负荷及转移的指标．     

老年吸烟者肺癌H-ras基因突变的研究

目的探讨老年吸烟者肺癌Ｈｒａｓ基因变化的意义。方法对３３例吸烟肺癌和２２例不吸烟肺癌患者采用纤维支气管镜毛刷刷取支气管脱落细胞,应用ＰＣＲＲＦＬＰ方法进行Ｈｒａｓ基因突变检测。结果肺癌中Ｈｒａｓ基因总突变率为５２７％（２９／５５）,其中吸烟组肺癌Ｈｒａｓ基因突变率为６６７％,不吸烟组肺癌为３１８％,二者差异有显著性（Ｐ＜００５）,吸烟组肺鳞癌患者Ｈｒａｓ基因突变率为７００％,明显高于不吸烟组肺鳞癌患者的１６７％（Ｐ＜００５）。结论提示Ｈｒａｓ基因可能是被烟草激活的一个特殊位点,吸烟是导致Ｈｒａｓ基因突变的重要因素。     

nm23-H1蛋白在胃癌中的表达

目的ｎｍ２３Ｈ１基因被认为是肿瘤转移抑制基因．本研究旨在探讨此基因的蛋白表达与胃癌转移之间的关系．方法使用抗人ｎｍ２３Ｈ１单克隆抗体，采用抗生蛋白链菌素—生物素标记的免疫组织化学染色方法，检测ｎｍ２３Ｈ１蛋白在５２例手术切除的胃癌及其淋巴结转移癌中的表达．结果ｎｍ２３Ｈ１蛋白表达与性别、年龄及胃癌的组织学类型无关．原发癌中ｎｍ２３Ｈ１表达阳性率（３６５％）明显高于转移癌（１２５％，Ｐ＜００１）．无淋巴结转移者及浆膜累及者，ｎｍ２３Ｈ１表达的阳性率（６６７％，６００％）明显高于有淋巴结转移者及浆膜累及者（２７５％，２７０％，Ｐ＜００５）．结论本研究结果表明ｎｍ２３Ｈ１蛋白在抑制胃癌浸润及淋巴结转移中发挥重要作用．     

老年糖尿病临床与脑CT,MRI检查对比分析

目的探讨脑ＭＲＩ、ＣＴ在老年糖尿病并发脑血管病早期诊断中的价值。方法本文对５２例老年２型糖尿病患者同时进行脑ＭＲＩ与ＣＴ的对比检查。结果（１）老年糖尿病患者的脑ＭＲＩ阳性检出者为４５例（８６５％），而脑ＣＴ阳性检出者为２９例（５５８％）（Ｐ＜００１）；（２）糖尿病病程在１０年以内患者中脑ＭＲＩ阳性率（８０８％）明显高于ＣＴ阳性率（３４６％）（Ｐ＜００１），但当糖尿病病程在１０年和１０年以上患者中脑ＭＲＩ阳性率（９２３％）与ＣＴ阳性率（７６９％）相比（Ｐ＞００５），无统计学显著差异；（３）糖尿病脑ＭＲＩ阳性组并发高血压和高脂血症者均高于糖尿病ＭＲＩ阴性组（Ｐ＜００５～００１）。结论脑ＭＲＩ是老年糖尿病脑血管病的一种早期敏感的诊断方法。     

中晚期肝细胞癌个体化综合序贯治疗：———127例分析

目的评价中晚期肝细胞癌的个体化综合序贯治疗疗效和优越性。方法甲组７４例采用个体化综合序贯治疗;乙组５３例为对照组,单用ＴＡＣＥ治疗。结果甲、乙两组的Ⅱ、Ⅲ期ＨＣＣ患者缓解率分别为７２．４％与３６．０％（Ｐ＜０．０５）和４８．９％与１４．３％（Ｐ＜０．０５）,中位生存期分别为２１．９个月与１３．９个月（Ｐ＜０．０１）和１０．１个月与４．１个月（Ｐ＜０．０１）, Ⅱ期 ＨＣＣ２年生存率、Ⅲ期１年生存率分别为４８．３％与１６．０％（Ｐ＜０．０５）和４０．０％与１０．７％（Ｐ＜０．０５）,１年内肝外转移发生率分别为２５．９％和５４．８％（Ｐ＜０．０５）。结论　个体化综合序贯治疗中晚期肝癌是目前最合理和有效的治疗方案。     

大肠癌组织nm23-HI p53 PCNA的表达

目的研究大肠癌组织ｎｍ２３ＨＩ，ｐ５３，ＰＣＮＡ的表达意义及其与肿瘤浸润转移的关系．方法１９９１年３月～１９９６年５月采用免疫组织化学方法检测７４例（男３９例，女３５例，平均年龄５３２岁，术前未做化疗及放疗）大肠癌组织（石蜡切片，厚４μｍ）中ｎｍ２３Ｈ１，ｐ５３，ＰＣＮＡ以及Ⅳ型胶原的表达情况．结果大肠癌ｎｍ２３Ｈ１，ｐ５３，ＰＣＮＡ的阳性率分别为７１６％、５２７％和８１１％．ｎｍ２３Ｈ１低表达与淋巴结转移有关（Ｐ＜００５），在Ⅳ型胶原表达不同的肠癌中ｎｍ２３－Ｈ１的表达无明显差异；ｐ５３和ＰＣＮＡ过表达与浸润程度和淋巴结转移有关（Ｐ＜００５）．结论ｎｍ２３ＨＩ低表达可作为预测大肠癌转移的较好指标．ｐ５３过表达在浸润转移过程及细胞增殖中均起重要作用．     

血管内皮生长因子表达与肺癌预后的相关性研究

目的　研究血管内皮生长因子（ 以下简称 Ｖ Ｅ Ｇ Ｆ） 表达与肺癌的预后相关性。方法　应用 Ｓ Ｐ 免疫组化方法研究 Ｖ Ｅ Ｇ Ｆ 在６０ 例肺癌患者组织中的表达。结果　 Ｖ Ｅ Ｇ Ｆ 阳性表达率为６０ ％ , Ｖ Ｅ Ｇ Ｆ阳性表达主要出现在肺癌组织中癌细胞胞浆内, Ｖ Ｅ Ｇ Ｆ 表达与肺癌的淋巴结转移、复发有关：其中 Ｎ１ 、 Ｎ２（ ＋ ） 组 Ｖ Ｅ Ｇ Ｆ 阳性率分别为５３ ％ 、８０ ％ ,高于 Ｎ０ 组（２３ ％ , Ｐ＜ ００１） , Ｖ Ｅ Ｇ Ｆ 阳性表达率在肺癌复发组（８０ ％ ） 高于无复发组（５３ ％ , Ｐ＜ ００５） ;３ 、５ 年生存率 Ｖ Ｅ Ｇ Ｆ（ ＋ ） 与 Ｖ Ｅ Ｇ Ｆ（ － ） 组分别为３１ ％ 、１１ ％ 和８８ ％ 、５０ ％ ;术后生存时间 Ｖ Ｅ Ｇ Ｆ 表达（ ＋ ） 组远低于 Ｖ Ｅ Ｇ Ｆ 表达（ － ） 组（ 分别为３１ ±７ 月,６４ ±７月, Ｐ＜ ００５） 。结论　 Ｖ Ｅ Ｇ Ｆ是促进肺癌组织血管生成的关键因素,是预测肺癌患者预后的重要指标。     

非小细胞肺癌脑转移的预后因素分析

目的探讨影响非小细胞肺癌脑转移治疗效果的预后因素。方法收集2006年3月-2009年3月在我科接受全脑放射治疗的57例非小细胞肺癌脑转移患者的临床资料,分析影响生存预后的各种因素。结果平均生存期可达到(9.7±2.8)个月。脑转移放疗后复发再次放疗组生存期(11.5月)优于复发后未放疗组(8.7月),无肺、骨转移组生存期(10.1月)优于有肺、骨转移组(8.5月),有显著统计学差异(P0.05)。多因素分析结果显示:脑转移放疗后复发再次放疗,同步放化疗和无肺、骨转移是肺癌脑转移患者的独立预后因素(P0.05)。结论影响非小细胞肺癌脑转移患者预后的主要因素是有无肺内、骨转移、是否采用同步放化疗,脑转移复发后是否再次放疗,选择同步放化疗以及对于脑转移放疗后复发的患者选择再次放疗的治疗方式,可以延长生存。     

Prognostic significance of hemostatic parameters in patients with lung cancer

There is a subclinical activation of coagulation and fibrinolysis system in lung cancer. Alterations in hemostatic system are seen frequently in lung cancer correlated with the prognosis of disease. In this prospective study, our purpose was to investigate the prognostic significance of hemostatic markers in patients with lung cancer. The study comprised 58 patients (22 squamous cell carcinoma, 16 adenocarcinoma, 20 small cell carcinoma). There were 55 men (95%)and 3 women (5%) with a mean age of 61 years range (36-74). Plasma level of platelets (PLT), prothrombin time (PT), active partial thromboplastin time (aPTT), antithrombin III (AT III), fibrinogen (F) and D-dimer level were measured before the initiation of any therapy. Patients were followed up for 17 (12-20) months. The median survival was determined as 6.4 months. Three histopathologic groups; squamous cell carcinoma, adenocarcinoma and small cell carcinoma were compared for the hemostatic parameters. There were no statistically significant differences among the histopathologic types for any of the parameters (P > 0.05). Patients were divided into two groups as patients without distant metastasis (stages I,II,III) and with distant metastasis (stage IV). The group with distant metastasis had higher level of D-dimer than the other group (P < 0.05). However, there were no statistically significant differences for D-dimer level between stages IIIB and IV (P > 0.05). Patients having high D-dimer and low AT III level had poor survival in our study. Thus, high level of D-dimer and low AT III level were determined as correlated with short survival (P < 0.05). These results suggest that elevated plasma level of D-dimer and low AT III level might be a sign of poor prognosis in patients with lung cancer.     

Factors affecting the prognosis in patients with primary lung cancer and brain metastases

Brain metastases are frequent features during the course of patients with lung carcinoma. The aim of this study was to investigate prognostic factors for patients with brain metastasis from lung cancer. Eighty-eight patients with brain metastasis from lung cancer were enrolled in the study. Eighty-two of cases were male, six were female and the mean age was 57.5 +/- 10.4 years. The most common symptoms were headache (32.9%) and dizziness (32.9%). Fifty-two (59.1%) patients had solitary brain metastasis and the most frequent metastasing site was parietal lobe (34.1%). The median survival times were 3 months after diagnosis of lung carcinoma and 1.5 months after diagnosis of brain metastasis. Although the absence of brain metastasis at the moment of diagnosis, metachronous metastasis, central localization of the tumour, chemotherapy administration and surgical treatment of brain metastasis are good prognostic factors affecting survival after the diagnosis of lung carcinoma, the positive factors affecting survival after brain metastasis are central localization of tumour, chemotherapy administration and surgical treatment of brain metastasis. In conclusion, performing the combination of cranial radiotherapy, chemotherapy, surgical therapy and supporting therapy should be evaluated in all appropriate patients with brain metastasis from lung cancer.     

Surgical management of non-small cell lung cancer with synchronous brain metastases

OBJECTIVES: Published series on the synchronous combined resection of brain metastases and primary non-small cell lung cancer are small and scarce. We therefore undertook a multicenter retrospective study to determine long-term survival and identify potential prognostic factors. DESIGN: Our series includes 103 patients who were operated on between 1985 and 1998 for the following tumors: adenocarcinomas (74); squamous cell carcinomas (20); and large cell carcinomas (9). Three patients had two brain metastases, and one patient had three metastases; the remaining patients had a single metastasis. Ninety-three patients presented with neurologic signs that regressed completely after resection in 60 patients and partially, in 26 patients. Neurosurgical resection was incomplete in six patients. Seventy-five patients received postoperative brain radiotherapy. The time interval between the brain operation and the lung resection was < 4 months. Pulmonary resection was incomplete in eight patients. RESULTS: The survival calculated from the date of the first operation was 56% at 1 year, 28% at 2 years, and 11% at 5 years. Univariate analysis showed a better prognosis for adenocarcinomas (p = 0.019) and a trend toward a better prognosis for patients with small pulmonary tumors (T1 vs T3, p = 0.068), N0 stage disease (N0 vs N+, p = 0.069), and complete pulmonary resection (p = 0.057). In a multivariate analysis, adenocarcinoma histology also affected the survival rate (p = 0.03). CONCLUSIONS: It seems legitimate to proceed with lung resection after complete resection of a single brain metastasis, at least in patients with an adenocarcinoma and a small lung tumor and without abnormal mediastinal lymph nodes seen on the CT scan or during mediastinoscopy.     

非小细胞肺癌脑转移预后影响因素

目的探讨非小细胞肺癌脑转移的生存情况及预后影响因素。方法选取我院2014年6月至2018年12月确诊139例非小细胞肺癌脑转移患者,收集临床资料并随访生存时间。运用Kaplan-Meier法对每个临床因素的不同水平进行生存分析,Log-rank法进行生存曲线的比较。采用单因素、多因素分析方法来筛选非小细胞肺癌脑转移的预后影响因素。结果本研究139例患者中位生存时间为11.2个月,对症支持组、全脑放疗组、靶向治疗组、全脑放疗+靶向治疗组、全脑放疗+化疗+靶向治疗组分别为8.1个月、10.1个月、14.6个月、16.7个月、23.4个月。单因素分析显示病理类型、发生脑转移的时间、EGFR突变的状态、RPA分级以及治疗方式对非小细胞肺癌脑转移的发生有显著影响作用。多因素分析表明KPS评分、RPA分级、治疗方法、发生脑转移的时间及EGFR突变状态是影响生存期的独立预后因素。结论经积极治疗(化疗+全脑放疗+靶向治疗)脑转移瘤患者可以获得更长生存期,高KPS评分、RPA I级、异时性脑转移及EGFR敏感突变型是非小细胞肺癌脑转移的预后良好因素。     

伽玛刀联合吉非替尼治疗非小细胞肺癌脑转移瘤的疗效分析

目的：探讨伽玛刀联合吉非替尼治疗非小细胞肺癌脑转移瘤的疗效分析。方法将71例非小细胞肺癌脑转移瘤患者分为2组。观察组采用伽玛刀联合吉非替尼治疗,对照组采用全脑放射疗法联合吉非替尼治疗。对比2组患者的疗效、生存质量、生存率、不良反应。结果观察组和对照组总有效率(91.67% vs 82.86%)与控制率(97.22% vs 94.29%)比较差异均无统计学意义(χ2值分别为1.244、0.378,P 值均>0.05);观察组 Karofsky 得分有效率(72.22%)显著高于对照组(45.71%)(χ2=5.161,P<0.05);2组6个月、12个月的生存率比较差异均无统计学意义(χ2值分别为0.132、0.342,P值均>0.05);观察组脱发、头痛、肝功能损害的发生率显著低于对照组(χ2值分别为27.070、17.154、6.693,P值均<0.05)。结论伽玛刀联合吉非替尼治疗非小细胞肺癌脑转移瘤的疗效确切,能较好地控制肿瘤进展,提高生存率,且不良反应小,能有效改善患者生存质量。     

Risk and patterns of brain metastases in colorectal cancer

PURPOSE: In patients with colorectal cancer, brain metastasis is infrequent. This study aims to elucidate the risk, pattern of occurrence, and survival time after different treatment modalities. METHODS: A retrospective review of all patients with colorectal cancer admitted to the Veterans General Hospital-Taipei between 1970 and 1996 from our hospital was performed. Univariate analysis for survival determination was performed. RESULTS: Brain metastases developed subsequent to surgery for colorectal cancer in 53 well-documented patients, at a median of 36 months after surgery. Brain metastases were more commonly seen in rectal cancer and often occurred concurrently with lung metastases. Forty of these patients received active intervention in terms of surgery, chemotherapy, or radiotherapy, with surgical intervention achieving a significantly increased mean survival time (+/- standard deviation) compared with chemotherapy or radiotherapy or both of 86.6 +/-17.35 vs. 2.9 +/- 0.59 months (P < 0.05). CONCLUSION: Increased awareness of the possibility of brain metastases, early diagnosis, and aggressive therapy can provide increased survival time for patients with colorectal cancer with brain metastases.     

Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients

OBJECTIVES: Currently, little is known about the prognostic significance of achieving successful ablation with the first dosage of I-131 in patients with differentiated thyroid cancer. This study aimed to assess the following: (i) whether successful or unsuccessful ablation at post-ablation follow-up has prognostic consequences; (ii) possible factors predicting success of ablation in a patient. METHODS: In order to do this, we retrospectively studied 180 patients with a median follow-up of 55 months. Ablation was considered to be successful if 1 year after the initial dosage of I-131 patients fulfilled all of the following criteria: not dead from thyroid cancer, no additional therapy needed for any kind for thyroid cancer within the first year, undetectable thyroglobulin (Tg) levels under TSH stimulation, and negative I-131 scintigraphy. Tg levels at the time of ablation (P < 0.001), lymph node metastasis (P = 0.04) and distant metastasis (P < 0.001) have a significant influence on the success of ablation. P values were calculated by Mann-Whitney U test and Chi-square test, respectively. RESULTS: Patients with successful ablation had a better prognosis than those with unsuccessful ablation: disease-free survival was 87% versus 49% after 10 years; additionally, thyroid-cancer related survival was 93% versus 78%. CONCLUSION: We conclude that the extent of the remaining normal or neoplastic thyroid tissue influences the outcome of ablation, and that successful ablation leads to a better prognosis. It seems that it is very important to achieve complete ablation as soon as possible in order to ensure the best possible prognosis for a patient.     

60例肺癌脑转移瘤患者生存与预后分析

目的探讨非小细胞肺癌脑转移不同治疗方案的疗效。方法分析60例肺癌脑转移患者的临床特点。结果单因素分析结果提示原发病治疗方法、脑部放疗方式、T分期、颅外转移数目对患者生存期有影响(P<0.05)。全脑放疗联合全身化疗优于单纯放化疗。Cox模型多因素分析显示脑转移瘤不同治疗方案为独立预后因素(P=0.0001)。结论脑转移瘤不同治疗方案是影响预后的独立预后因素,积极的多学科综合治疗疗效优于单纯全脑放疗。