Objective. To clarify the relationship between preoperative platelet count/(lymphocyte count × prealbumin count) ratio (PLPR) and the prognosis of patients with gastric cancer undergoing a radical operation, combined with Tumor Node Metastasis (TNM) staging, a scoring system was established to guide clinical application. Methods. The clinical data of 238 patients receiving radical operations for gastric cancer were retrospectively analyzed. According to the area under the Receiver operating characteristic curve, the predictive value of the preoperative PLPR for the 5-year overall survival (OS) of gastric cancer was determined, and the best cut-off value of the ratio was corresponding to the maximum value of Yoden index. Chi-squared test was applied to analyze the correlation between the ratio and clinicopathological features. Kaplan–Meier curve was applied to analyze the influence of this ratio on 5-year OS. The Cox regression model was applied to analyze the hazards affecting the long-term survival of patients. The nomogram model was used to predict the long-term survival rate. Results. The optimal cut-off point of preoperative PLPR ratio was 7.46, and the patients were segmented into two sets: one set of ratio <7.46 and another set of ratio ≥7.46. The ratio was correlated with the size of the tumor, T stage, N stage, total stage, vascular cancer thrombus, and nerve invasion. In stage I–III patients, the prognosis was better in the low-ratio set than in the high-ratio set ( P < 0.001 ), subgroup analysis indicated the prognosis was obviously better in the low-ratio set than in the high-ratio set in stage II and III patients ( P < 0.05 and P < 0.001 ), but there was no difference in stage I patients ( P > 0.05 ). Age, T stage, N stage, total TNM stage, tumor size, vascular tumor thrombus, nerve invasion, preoperative neutrophil count/lymphocyte count (NLR; reference value 3.68), preoperative PLPR (reference value 7.46), preoperative platelet count/lymphocyte count (PLR; reference value 159.56), and preoperative platelet count × NLR (SII; reference value 915.48) were related to patient prognosis ( P < 0.05 ); meanwhile age, total TNM stage, preoperative PLPR (reference value 7.46), preoperative PLR (reference value 159.56), and preoperative SII (reference value 915.48) were independent hazards for prognosis ( P < 0.05 ). Five independent risk factors were analyzed by nomogram model to predict the 5-year OS of patients who underwent a radical operation for carcinoma of the stomach. Conclusion. Preoperative PLPR ratio (reference value 7.46) is an independent risk factor for long-term prognosis in patients undergoing a radical operation for gastric cancer. The nomogram scoring system established by postoperative TNM staging combined with this ratio and age, PLR, and SII can better forecast the survival of patients who underwent radical operation for carcinoma of the stomach.

目的:分析食管鳞癌患者调强适形放疗(intensity modulated radiotherapy,IMRT)治疗后发生食管瘘的相关危险因素.方法:回顾性分析接受IMRT治疗的 102 例食管鳞癌患者临床资料,采用χ2 检验和多因素Logistic回归模型分析影响食管瘘发生的危险因素.结果:102 例食管鳞癌患者放疗后有 16 例(15.69%)发生食管瘘.单因素分析显示,T4 期、溃疡型肿瘤、治疗前食管龛影、肿瘤靶区(GTV)最大横径＞2.45 cm、GTV体积＞50 cm3、二次放疗、体质量指数＜20 kg/m2 与放疗后食管瘘发生有关(P＜0.05).多因素分析显示,治疗前食管龛影、GTV最大横径＞2.45 cm、二次放疗为放疗后食管瘘发生的独立危险因素(P＜0.05).结论:治疗前食管造影有龛影、GTV最大横径＞2.45 cm、二次放疗是食管鳞癌患者IMRT后食管瘘发生的高危因素,对这类患者应高度重视,及时采取应对措施,降低食管瘘的发生率.

目的 探讨治疗前谷草转氨酶(AST)与谷丙转氨酶(ALT)的比值(DRR)与食管鳞癌患者预后的关系.方法 回顾性分析接受放化疗的食管鳞癌患者280 例,根据受试者操作特征曲线(ROC)确立DRR对总生存率(OS)的最佳截断值(cutoff值);分析DRR水平与食管癌患者临床病理特征的关系;通过绘制Kaplan-Meier生存曲线分析不同水平的DRR比值对患者预后的影响;采用COX回归模型对影响患者预后的危险因素进行分析.结果 ROC曲线确立了DRR的最佳截断值为1.29.DRR水平与肿瘤T分期、N分期、TNM分期、肿瘤分化程度显著相关.Kaplan-Meier生存曲线分析显示,高DRR患者的预后较低DRR患者差.单因素及多因素COX回归分析显示,T分期、N分期、TNM分期、肿瘤分化程度和DRR水平是食管癌患者的独立影响因素.结论 谷草转氨酶与谷丙转氨酶比值是食管癌放化疗患者预后的独立影响因素.

BACKGROUND:Radiosensitivity of rectal cancer is related to the radiotherapy efficacy and prognosis of patients with rectal cancer, and the genes and molecular mechanisms related to radiosensitivity of rectal cancer have not been clarified. We explored the radiosensitivity related genes of rectal cancer at a multi omics level.METHODS:mRNA expression data and rectum adenocarcinoma (READ) data were obtained from the Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus Database (GEO) (GSE150082, GSE60331, GSE46862, GSE46862). Differentially expressed genes between radiotherapy sensitive group and radiotherapy insensitive group were screened. GO analysis and KEGG pathway analysis were performed for differentially expressed genes. Among the differentially expressed genes, five core genes associated with rectal cancer prognosis were selected using random survival forest analysis. For these five core genes, drug sensitivity analysis, immune cell infiltration analysis, TISIDB database immune gene correlation analysis, GSEA enrichment analysis, construction of Nomogram prediction model, transcriptional regulatory network analysis, and qRT-PCR validation was performed on human rectal adenocarcinoma tissue.RESULTS:We found that 600 up-regulated genes and 553 down-regulated genes were significantly different between radiotherapy sensitive group and radiotherapy insensitive group in rectal cancer. Five key genes, TOP2A, MATR3, APOL6, JOSD1, and HOXC6, were finally screened by random survival forest analysis. These five key genes were associated with different immune cell infiltration, immune-related genes, and chemosensitivity. A comprehensive transcriptional regulatory network was constructed based on these five core genes. qRT-PCR revealed that MATR3 expression was different in rectal cancer tissues and adjacent non-cancerous tissues, while APOL6, HOXC6, JOSD1, and TOP2A expression was not different.CONCLUSION:Five radiosensitivity-related genes related to the prognosis of rectal cancer: TOP2A, MATR3, APOL6, JOSD1, HOXC6, are involved in multiple processes such as immune cell infiltration, immune-related genes, chemosensitivity, signaling pathways and transcriptional regulatory networks and may be potential biomarkers for radiotherapy of rectal cancer.

目的:探究同步放化疗对转移性食管癌患者近远期疗效的影响.方法:选取南通市肿瘤医院2013年6月—2016年6月收治的转移性食管鳞癌患者60例为研究对象,使用随机数字表法将其分为两组,各30例,分别予序贯放化疗(序贯组)和同步放化疗(同步组),比较两组近期疗效,半年、1年、2年生存率,不良反应发生率,治疗前后肿瘤标志物水平及肿瘤侵袭转移相关指标.结果:治疗前,两组患者细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen21-1,CYFRA21-1)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)、微血管密度(micro vascular density,MVD)水平,血管内皮生长因子(vascular endothelial growth factor,VEGF)阳性率及基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)阳性率比较差异均无统计学意义(均P>0.05).治疗后,两组半年生存期差异无统计学意义(P>0.05);同步组治疗有效率及1、2年生存率显著高于序贯组(P<0.05);同步组CYFRA21-1、SCC-Ag、MVD水平,VEGF阳性率及MMP-2阳性率均显著低于序贯组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05).结论:相较序贯放化疗,同步放化疗能有效提高转移性食管癌患者近期疗效,提高2年内存活率,抑制患者肿瘤侵袭能力且不增加不良反应,具有较好安全性,值得临床推广.

目的 探讨不同剂量放疗联合同期顺铂化疗根治性治疗晚期食管癌疗效.方法 选取2015年1月至2017年12月间江苏省南通市肿瘤医院收治的68例食管鳞癌患者为研究对象.根据放疗剂量不同进行分组,每组34例.所有患者均采用放疗联合同期顺铂化疗.其中,放疗剂量为60Gy治疗的34例患者纳入对照组,放疗剂量为50Gy治疗的34例患者纳入研究组.观察两组患者治疗前后血清学和免疫功能变化并比较,观察两组患者治疗后的治疗效果、并发症、生存期和肿块控制率变化情况.结果 治疗前,两组患者各血清学指标比较,差异无统计学意义(P＞0.05).治疗后,研究组白细胞计数较治疗前均显著升高,D-二聚体、血小板平均体积、纤维蛋白原和丙氨酸转氨酶较治疗前显著下降,且研究组上述指标显著优于对照组,差异均有统计学意义(均P ＜0.05).治疗前,两组患者各指标比较,差异无统计学意义(P＞0.05).治疗完成后,研究组免疫球蛋白A(IgA)、IgG、IgM、CD4+和CD4+/CD8+较治疗前均显著升高,CD8+较治疗前显著下降,且研究组显著优于对照组差异均有统计学意义(均P＜0.05).两组患者治疗总有效率比较,差异无统计学意义(P＞0.05).研究组患者的胃肠道反应、白细胞减少、放射性食管炎和急性放射性肺炎各等级发生率均低于对照组患者,差异均有统计学意义(均P＜0.05).研究组1年局部区域控制率和1年无远处转移生存率均高于对照组,差异均有统计学意义(均P＜0.05).结论 低剂量放疗联合同期顺铂化疗根治性治疗晚期食管癌疗效可靠,能降低并发症,同时能提高生存期和免疫功能.

目的 通过观察三维适形放疗和三维调强放疗对乳腺癌根治术后患者心肺受量的比较,为临床选择放疗方案提供参考依据.方法 乳腺癌改良根治术后患者68例,随机分为对照组及观察组各34例,对照组进行三维适形放疗,观察组进行三维调强放疗,对比两组靶区剂量学指标、心肺受量和放疗不良反应.结果 观察组患者PTV剂量V95％略高于对照组,但无统计学差异(P＞0.05).观察组V105％、V110％、V115％和均匀性指数HI显著低于对照组(P＜0.05).观察组适形性指数CI较对照组显著增高(P＜0.05).观察组患侧肺脏指数V5、V10、V20、V30、V40、V50、心脏指数V30、V40、V50和对侧乳腺平均剂量均显著低于对照组(P＜0.05).观察组放疗不良反应发生率低于对照组(P＜0.05).结论 与三维适形放疗相比,三维调强放疗对乳腺癌改良根治术后患者的靶区剂量分布更均匀,心肺受量更少,三维调强放疗的不良反应发生率更低,提示三维调强放疗有效性和安全性均优于三维适形放疗.

Objective To compare the influence of two different position fixation techniques on the setup error of radiotherapy towards breast cancer patients after modified radical mastectomy.Methods Fifty breast cancer patients,who had taken modified radical mastectomy and were receiving adjuvant radiotherapy,were included in the study.Patients were randomly divided into two groups:25 cases in the wing plate and vacuum cushion fixed position group,and 25 cases in the head and neck shoulder thermoplastic membrane fixed position group.In the course of treatment,5 setup errors were measured by cone beam CT (CBCT) for each patient and 250 sets of CT data were obtained.CBCT scan images and planning CT images were automatically bone marked by X-ray volume image (XVI) software,and the setup error values in the threedimensional translation direction (X,Y,Z) and rotational direction (ROLL,PITCH,YAW) were compared.Results For the wing plate and vacuum cushion fixed position group,the setup errors in the center of the X-axis (left-right),Y-axis (cranial-caudal) and Z-axis (anterior-posterior) directions were (2.20 ± 1.65) mm,(2.95 ± 2.10) mm and (2.37 ± 2.14)mm,respectively.The set up errors in ROLL,PITCH and YAW directions were(1.25 ± 0.96)°,(0.45 ± 0.53) ° and(0.61 ± 0.52) °,respectively.For the head and neck shoulder thermoplastic membrane fixed position group,the setup error in the center of the X-axis (left-right),Y-axis (cranial-caudal) and Z-axis (anterior-posterior) directions were (2.29±1.89)mm,(2.49±l.79)mm and (1.67 + 0.95)mm,respectively.The set up errors in ROLL,PITCH and YAW directions were (0.81 ± 0.92) °,(0.43 ± 0.51) ° and (0.53 ± 0.64) °,respectively.Statistically significant differences were found for the setup errors of the two groups in both the Z-axis and ROLL direction (P ＜ 0.05).Conclusion For breast cancer patients after modified radical mastectomy,position fixation with head and neck shoulder thermoplastic membrane can improve the setup repeatability,reduce the setup error,and enhance the setup accuracy during radiotherapy.

Objective To investigate clinical features,MRI findings,radiation volume and dose,and prognosis of irradiated temporal lobe injury in local advanced nasopharyngeal carcinoma infilatrating cavernous sinus after intensity modulated radiation therapy (IMRT).Methods From Aug 2006 to Sep 2011,ten patients with cavernous sinus invasion in locally advanced nasopharyngeal carcinoma receiving radical IMRT were retrospectively analyzed.The total volume,dose volume D1 ml,Dmax and D of irradiated ipsilateral temporal lobe in radiotherapy planning were examined.Clinical features,MRI findings and prognosis of these patients after treatment were investigated.Results The irradiated ipsilateral temporal lobe total volume and dose volume of IMRT of the 10 ten patients were as follows.The total volume was (104.31 ± 13.091)ml,D1 ml was (78.657±2.918)Gy,D was (78.298± 3.498)Gy and D was (29.488±8.891) Gy.The radiation induced temporal lobe injury presented 2-4 years after radiation in the 10 followed-up patients.MRI findings showed T1 WI with high signal reinforced nodular lesions or sheet strengthening and T2WI with varying degrees of edema.Till August 2016,2 patients died;2 patients were with heavy symptoms and the symptoms were not improved obviously after treatment,and meanwhile,MRI showed enhancement and edema;2 patients were significantly improved in clinical symptoms and MRI findings after symptomatic treatment;4 patients with stable disease and MRI of 2 patients showed small recovery cystic foci formation.Conclusion The incidence of irradiated temporal lobe injury in cavernous sinus of locally advanced nasopharyngeal carcinoma after IMRT were associated with the area of tumor invasion,the scope of target delineation and the irradiated volume and dose.

Objective To investigate the value of PET?CT image fusion to delineate the target of intensity modulated radiation therapy( IMRT) in locally advanced non?small cell lung cancer( NSCLC) , and the impact on target volume and dose of normal lung tis?sue. Methods Thirty NSCLC patients of clinical stageⅢA andⅢB were randomly selected. Target and organ at risk were delineated on the same fixed position according to enhanced CT images and fusion images of PET/CT and CT, respectively. Then the volume of gross tumor volume( GTV) and planning target volume( PTV) under these two status were compared. Moreover, the percent of the total lung volume exceeding 5 Gy( V5 ) , percent of the total lung volume exceeding 20 Gy( V20 ) , mean dose of lung irradiated( MLD) in two different conformal IMRT plans were observed when the dosage of PTV was up to 60 Gy/30 f. Results The GTV volume on fusion im?ages of PET?CT/CT was (248?39±94?80)cm3, less than (311?22±99?16)cm3 on the enhanced CT images in 30 cases. The difference was statistically significant(P<0?05). PTV, extended from GTV, in fusion images of PET?CT/CT was (356?68±92?73) cm3, while in the enhanced CT images were (433?58±107?89 cm3) with significant difference(P<0?01). The V5, V20 and MLD of whole lung in the two plans were compared. In fusion images of PET?CT/CT program, V5, V20 and MLD was (51?26±10?50)%, (25?71±5?17)% and (1595?27±148?24) cGy, remarkly less than (56?41±9?55)%, (29?09±4?10)% and (1693?59±100?60) cGy in the enhanced CT program with significant difference( P<0?05) . Conclusion Application of PET?CT/CT fusion image to delin?eate the targets of IMRT can improve the accuracy of target delineation volume and reduce the dose of normal lung tissues.

Objective: To determine the protective efficacy of vitamin B12 combined with far-infrared radiation on radiation-induced skin damage in the treatment of acute and chronic pelvic tumours. Methods: One hundred patients requiring radiation therapy were randomly assigned to one of two groups: 50 patients were assigned to the control group and received usual care; the 50 patients assigned to the experimental group were, in addition to usual care, given vitamin B12 (0.25 mg/mL) injections to radiation-sensitive perineal skin and subsequently treated with far-infrared radiation beginning the first day of radiotherapy. Far-infrared radiation treatment was performed at a light distance of 40 cm at a temperature of 28°C to 32°C for 25 min twice per day. Results: The incidence of acute skin reactions in the two groups was statistically different (P<0.05). The incidences of grades I, II, III and IV radiation-induced skin damage in the experimental group were 60.0%, 30.0%, 10.0% and 0%, respectively; in contrast, the incidences in the control group were 26.0%, 54.0%, 18.0% and 2.0%, respectively. Grades II to IV skin reactions in the experimental group were remarkably less severe than those of the control group. When a radiation treatment dose of <40 Gy was used, the incidences of acute radiation-induced dermatitis in the control and experimental groups were 66% and 34%, respectively (P<0.05). Conclusion: Vitamin B12 combined with far-infrared radiation had a markedly protective effect on acute radiation-induced skin damage in the treament of pelvic cancers. Moreover, the treatment improved patient quality of life and was clinically valuable.

目的:应用三维治疗计划系统评价食管癌采用常规放疗(CRT)与三维适形放疗(3D-CRT)技术照射时肺体积-剂量关系,比较两种放疗技术所致放射性肺炎的发生率,以明确食管癌采用三维适形放疗的优势。方法:60例食管中段鳞癌患者,普通放疗组30例,适形放疗组30例,两组均予处方剂量66-68GY/33-34F,2GY/F,5F/W,用剂量体积直方图(DVH)比较两种技术照射下肺V20、V30、Dmean及放射性肺炎的发生率。结果:60例患者均顺利完成治疗,常规放疗下肺V20、V30、Dmean、NTCP较3D-CRT的百分比高。结论:食管中段癌如采用适形放疗,正常肺组织受到照射的体积、剂量相对较低,3D-CRT可更好的保护正常肺组织,减少放射性肺炎的发生。