目的:回顾性比较索拉非尼单独或联合经动脉化疗栓塞和射频消融治疗复发性肝细胞癌的疗效.方法:选取2014年6月至2019年5月吉林省肿瘤医院收治的298例晚期复发性肝细胞癌患者的临床资料.根据治疗方法不同分为联合组(索拉非尼联合经动脉化疗栓塞和射频消融治疗)152例和对照组(索拉非尼单药治疗)146例.比较两组患者的临床疗效、总生存期(OS)与疾病进展时间(TTP),采用单变量和多变量Cox比例风险模型评价影响患者OS与TTP的相关因素,分析两组患者用药不良反应情况.结果:联合组患者的疾病控制率明显高于对照组[83.6％(127/152)vs.48.0％(70/146)],差异有统计学意义(P<0.001).联合组患者的OS和TTP明显长于对照组,差异均有统计学意义(P<0.001).肝内肿瘤数量(HR=2.065,95％CI=1.366～3.099,P=0.001)和联合治疗(HR=1.605,95％CI=1.072～2.402,P=0.023)是OS的独立相关因素,联合治疗(HR=1.462,95％CI=1.019～2.498,P=0.041)是TTP的独立相关因素.两组患者服用索拉非尼引起的手足皮肤反应、腹泻及恶心呕吐等不良反应发生率的差异均无统计学意义(P>0.05).结论:索拉非尼联合经动脉化疗栓塞和射频消融治疗肝切除术后晚期复发性肝细胞癌的疗效优于单纯索拉非尼治疗,患者耐受性好,且安全性高.

目的 探讨不同一线化疗方案对于青年女性晚期胃癌的临床效果及其与降钙素原水平的相关性.方法 选取本院2016年3月至2017年2月收治的青年女性晚期胃癌患者86例为研究对象,采用随机数表法将其分为观察组(氟尿嘧啶+顺铂+紫杉醇治疗)和对照组(氟尿嘧啶+顺铂治疗),每组各43例.比较两组患者的临床疗效、不良反应发生情况、治疗前后降钙素原水平变化情况,并采用皮尔逊相关系数明确降钙素原水平与患者的疾病进展和死亡的相关性.结果 两组患者治疗有效率比较无统计学意义(P>0.05),观察组患者无进展生存时间显著长于对照组(P<0.05).两组患者不良反应发生率比较差异均无统计学意义(均P>0.05).观察组患者化疗结束时的血清降钙素原水平显著低于对照组(P<0.05).皮尔逊相关系数显示,患者降钙素原水平与疾病进展存在相关性(r=0.789,P<0.001).偏相关分析显示,患者降钙素原水平与疾病进展存在相关性(r=0.342,P=0.001).结论 青年女性晚期胃癌患者应用氟尿嘧啶+顺铂+紫杉醇联合化疗能够延长其无进展生存期,且患者能够耐受,联合化疗能够降低患者治疗期间的降钙素原水平,但应常规监测患者化疗后的降钙素原水平.

目的:本文回顾性分析奥沙利铂治疗晚期左右半结肠癌疗效,观察原发不同部位晚期结肠癌对奥沙利铂敏感性差异,探讨是否可以根据部位为患者选择更有效的化疗方案,争取更好的疗效.方法:选择我科2016年1月至2017年12月就诊的晚期结肠癌患者44例,左半结肠癌28例,其中结肠脾曲癌8例,乙状结肠癌6例,直肠癌14例;右半结肠癌16例,其中升结肠癌6例,结肠肝曲癌8例,盲肠癌2例.均应用含奥沙利铂方案一线化疗,其中XELOX方案25例,OLF方案6例,奥沙利铂130mg/m2,第1天,静点,每3周为一周期;mFOLFOX6方案13例,奥沙利铂85mg/m2,第1天静点2小时,每2周为一周期.完成2周期化疗后分析疗效.结果:左半结肠癌CR 0例,PR 9例,SD 6例,PD 29例,CR+PR 9例,有效率32.1％;CR+PR+SD 15例,疾病控制率53.6％.右半结肠癌CR 0例,PR3例,SD 4例,PD 9例,CR+PR 3例,有效率18.8％;CR+PR+SD7例,疾病控制率43.8％.应用SPSS 13.0统计软件对数据进行统计学处理,采用x2检验,两者之间均无显著性差异,P＞0.05,无统计学意义.结论:应用含奥沙利铂方案治疗晚期左右半结肠癌未见疗效差异,尚无充分证据支持在晚期结肠癌治疗中根据原发部位来选择奥沙利铂治疗.

我国是胃癌高发国家,占世界胃癌总发病人数的40%左右,近年来,女性胃癌发病率呈逐渐增高趋势,且具有独特的临床特征,即确诊时多为晚期,化疗敏感性差,预后较差。目前研究表明,合理治疗对分期较晚的胃癌患者非常重要,通过分子标志物

Objective To observe the efficacy and safety of docetaxel combined with fluorouracil in the treatment of ad-vanced gastric cancer. Methods A total of 168 patients with advanced gastric cancer admitted to this hospital from January 2012 to January 2015 were randomly divided into treatment group and control group with 84 in each one. The treatment group underwent chemotherapy using docetaxel combined with fluorouracil and the control group was treated with chemotherapy using docetaxel combined with S-1 for more than two courses with 3 weeks as one course. The improvement of people's physical ability, short-term curative effect and adverse reactions to chemotherapy of the two groups were ob-served after treatment. Results No statistically significant difference can be found in the short-term effective rate of chemotherapy between the two groups, P>0.05. The improvement rate of people's physical ability (83.34% vs 45.24%) was obviously higher in the treatment group than in the control group, and the difference was statistically significant, P<0.05). Conclusion Docetaxel combined with fluorouracil in the treatment of advanced gastric cancer is worthy clinical application because it can bring less negative impact on patients' physical ability on the basis of keeping a good efficacy.

目的:观察胃肠道间质瘤(GIST)免疫表型的表达,分析其在诊断上的临床意义,探讨其与危险度分级的关系.方法:吉林大学第一医院病理科2010年12月至2012年8月检测的GIST术后标本65例,采用免疫组化SP法检测CD117、CD34、DOG1、SMA、S-100、Ki-67和Desmin的表达,应用SPSS 17.0对数据进行分析,探讨相关免疫表型与临床病理相关因素的关系.结果:65例GIST中DOG1、CD117、CD34的阳性率分别为100.0％、96.9％、89.2％.CD34在胃GIST的阳性表达高于小肠GIST(P ＜0.05),SMA在小肠GIST的阳性表达高于胃GIST(P ＜0.05),Ki-67的表达与肿瘤大小、核分裂相、危险度分级相关.结论:CD117联合CD34、DOG1检测可以提高GIST的诊断率;SMA在小肠GIST中表达率明显高于胃GIST的表达,CD34在胃GIST中表达率高于小肠GIST的表达;Ki-67可以作为一个判定GIST预后的指标.

Objective We examined the expression of mTOR protein in Her-2 negative breast cancer.Discussits clin-ical significance and looks for new therapeutic target for Her-2 negative breast cancer.Methods mTOR were deter-mined immunohistochemically in 65 cases of Her-2 negative breast cancer,tumor-adjacent tissues and normal tissues. Results Positive mTOR expression was noted in Her-2 negative breast cancer apparently higher than tumor-adjacent tissues and normal tissues(P <0.05).it was also obviously higher in group with axillary lymphnode metastasis than in group with out lymphnode metastasis(P <0.05).Conclusion Expression of mTOR?significantly increased in Her-2 negative breast cancer.The detection of mTOR play an important role in tumorigenesi,it has significant correlation with axillary lymphnode metastasiss,and provide a new road for trentment of Her-2 negative breast cancer.

伊立替康是临床广为应用的化疗药物，在多种恶性肿瘤的化疗中占有重要地位。我们在应用伊立替康（商品名：艾力）治疗晚期大肠癌中，出现1例血小板急剧减少的患者，现报告如下。

Objective To evaluate the efficacy,drug safety and tolerability of Edostar combined with vinorelbine and cisplatin on terminal breast cancer.Methods 36 cases stage Ⅳ breast cancer patients proved by pathology,admitted in our hospital from February,2009 to August,2012 were selected.16 cases were treated with Edostar combined with vinorelbine and cisplatin and 20 cases were treated with vinorelbine and cisplatin.Edostar(15 mg in 500 ml saline) was injected intravenously for three hours in the first 14 days.Vinorelbine(25 mg/m2) was injected intravenously for the first ang eighth days.Cisplatin(25 mg/m2) was injected intravenously for the second to fourth days.Three weeks repeated.Then evaluated the effect by RECIST 1.1,adverse reactions by NCI.CTC3.0.The efficacies and adverse reactions were evaluated after two courses of treatment.Results Edostar combined with NP:CR 3 cases,PR 6 cases,SD 5 cases,PD 2 cases.RR 56.3%,DCR 87.5%.The stage G 3/4 adverse reactions were: The decreasing levels of neutrophil 4 cases(25%),the decreasing levels of platelet 1 case(6.25%),nausea and vomit was took place in 1 case(6.25%).NP:CR 2 cases,PR 6 cases,SD 6 cases,PD 6 cases.RR 40%,DCR 70%。 The stage G 3/4 adverse reactions were: The decreasing levels of neutrophil 5 cases(25%),the decreasing levels of platelet 2 cases(10%),nausea and vomit was took place in 2 cases(10%).There were statistically significant differences in ORR and DCR between the two groups(P<0.05).Conclusion The Edostar combined with NP has better therapeutic effects on terminal breast cancer than NP with good safety and less adverse reactions,and it can improve the life quality of the patients,which is deserved to be utilized widely in clinic.

目的 观察吉非替尼联合化疗治疗老年中晚期肺腺癌的疗效及安全性.方法 27例患者化疗同时均口服吉非替尼250 mg,直到疾病缓解时停药,同时选择性配合营养支持疗法、降低颅内压、抗骨转移治疗和止痛等治疗.观察症状变化、近期疗效、肿瘤进展时间、生存期及不良反应.结果 治疗后27例患者CR 3例(11.11%),PR 16例(59.26%),SD 5例(18.52%),PD 3例(11.11%).有效率(RR)为70.4%,疾病控制率(DCR)88.9%.中位肿瘤进展时间(TTP)11.3个月.疗效以不吸烟者为好(P＜0.05);性别间疗效差异无统计学意义(P＞0.05).3例生存时间＞24个月,5例＞12个月,1年生存率29.6%,8例＞8个月,8例＞3个月.毒副作用主要为腹泻Ⅱ～Ⅲ度、胸面部丘疹、色素沉着等.结论 中晚期肺腺癌应用吉非替尼联合化疗疗效较好且安全,患者的耐受性及顺从性好.

目的探讨非小细胞肺癌（NSCLC）组织中趋化因子受体（CXCR4）的表达与肺癌生物学行为以及血管形成之间的关系,着重分析CXCR4的表达以及新生血管形成在肺癌侵袭、转移及预后中的生物学意义。方法应用免疫组织化学方法 （SP法）检测62例非小细胞肺癌组织、12例癌旁正常组织中CXCR4的表达及微血管密度（MVD）的值,并分析CXCR4的表达及MVD与组织类型、肿瘤大小、TNM分期、分化程度、淋巴结转移的相关性。结果 CXCR4在肺癌组织中的阳性表达率为58.1%,在正常组织中的阳性表达率为16.7%,两者比较差异有显著性（P＜0.05）。非小细胞肺癌组织中CXCR4表达明显升高,以及MVD明显高于正常组织,与肿瘤的分化程度、临床分期、淋巴结转移均有相关性（P＜0.05）,与肿瘤的大小、病理分型无关（P＞0.05）。CXCR4在NSCLC中的表达以及肿瘤MVD二者呈显著正相关。结论同时检测非小细胞肺癌组织的CXCR4的表达及MVD对判断肿瘤的恶性程度和估计预后有一定的意义。

目的探讨非小细胞肺癌(NSCLC)组织中表皮生长因子受体(EGFR)、趋化因子受体4(CXCR4)的表达与肺癌生物学行为以及血管形成之间的关系。方法应用免疫组织化学方法(SP法)检测62例NSCLC癌组织、12例癌旁正常组织中EGFR、CXCR4的表达及微血管密度(MVD),并分析EGFR、CXCR4的表达及MVD与组织类型、肿瘤大小、TNM分期、分化程度、淋巴结转移的相关性。结果 CXCR4在肺癌组织中的阳性表达率为58.1%,在正常组织中的阳性表达率为16.7%,两者比较有显著性差异(P<0.05)。NSCLC癌组织中,EGFR、CXCR4表达明显升高,MVD也明显高于正常组织,与肿瘤的分化程度、临床分期、淋巴结转移均有相关性(均P<0.05),与肿瘤的大小、病理分型无关(均P>0.05)。EG-FR、CXCR4在NSCLC中的表达与肿瘤MVD呈显著正相关。结论同时检测NSCLC癌组织的EGFR、CXCR4的表达及MVD对判断肿瘤的恶性程度和估计预后有一定的意义。

Objective To investigate correlations between expression of MMP2 and clinicalbiological characteristics,to analyze the relationship with invasion,metastasis and prognosis in non-small cell lung cancer.Methods High sensitive S-P immunohistochemical method was used to detect the expressions of MMP-2 and MVD in 62 cases of NSCLC and 12 cases of para-cancerous normal lung tissues.To study the relationships between their expressions and histological types of NSCLC,Tumor size,TNM stages,differentiations,lymph node metastasis and their correlations each other.Results The positive rates of MMP-2 expression was 62.9% in NSCLC,which was dramatically higher than that in a normal tissues(16.7%)(P0.05).The expressions of MMP-2 and MVD was significantly correlated in NSCLC to TNM stage,differentiations and lymph node metastasis(P0.05).It was no relationship with the histological types and tumor size of NSCLC(P0.05).MMP-2 play important roles in non-small cell lung cancer procession,especially in tumor metastasis.MMP-2 have intimate relationship with MVD.Conclusion MMP-2 and MVD may be good preditors of metastasis and prognostic evaluation for NSCLC patients.

The objective of this study was to summarize gemcitabine in combination with cisplatin therapty for advanced esophageal cancer about the efficacy and the prognosis.Fifty-six patients with advanced esophageal cancer.All the patients were treated with gemcitabine in combination with cisplatin.The image change,the status from head to foot and bite and sup were observed to decide the operation or the radiotherapy.After the chemotherapy 18 case were operated on,in which 2 cases of neck anastomose,6 cases of oesophagus-stomach anastomose up the bow,9 cases of oesophagus-stomach anastomose under the bow.One cases of opening exploration died after 6 months without synthesis therapy;1 case of the neck anastomosed died after 14 months without the sequence chemotherapy.Thirty-eight patients who could not be operated on were treated gemcitabine in combination with cisplatin therapty,and their average survival time was 13 months.In conclusion,gemcitabine plus cisplatin therapy was well tolerated and has a significant activity in patients with advanced esophageal cancer.

在恶性肿瘤的化疗中我们发现随着治疗周期的延长有越来越多的患者出现空腹血糖增高,其中部分病人诊断为糖尿病.为进一步探讨化疗药物能否诱发糖尿病,我们对我科近2年收治的735例恶性肿瘤患者化疗后血糖水平及相关资料进行分析,现报道如下.

目的:分析淋巴瘤合并结核病患者的临床特征及发病情况,探讨结核感染与淋巴瘤的关系。结论:结核病和淋巴瘤可发生在同一患者,临床症状相似,易导致误诊及漏诊,应引起临床医生注意并及时获取病理学诊断,有利于早期诊断及治疗。

[目的]观察FOLFOX4方案治疗晚期胃肠道恶性肿瘤临床疗效及其毒副作用。[方法]56例晚期胃肠道恶性肿瘤患者采用FOLFOX4方案化疗,每2周为1个周期,治疗4～6个周期后按WHO实体瘤疗效判定标准评价疗效及毒副反应。[结果]56例均可评价疗效,结直肠癌37例,CR1例、PR12例,有效率35.14%;胃癌19例,CR1例、PR9例,有效率52.63%;总有效率为41.07%。毒副反应主要为胃肠道反应、末鞘神经毒性、骨髓抑制及静脉炎等,未见因毒副反应而终止治疗者,无治疗相关性死亡。[结论]FOLFOX4方案治疗晚期胃肠道恶性肿瘤耐受性较好,疗效较满意,有临床应用价值。

目的观察草酸铂(OXA)联合低剂量氟尿嘧啶(5-FU)治疗老年晚期胃癌的疗效和毒副反应。方法36例老年晚期胃癌患者中贲门癌13例,胃体癌23例。采用草酸铂65 mg/m2,第1、8天;5-FU 250 mg/m2,采用深静脉持续静注,持续2周。每3~4周重复,每例进行2~4周期化疗后评价疗效及毒副作用。结果全组36例均可评价,获得CR 2例、PR 17例、SD 11例、PD 6例,总有效率(CR+PR)为52.8%,肿瘤控制率(CR+PR+SD)为83.3%;中位缓解期为7个月,中位生存期为10个月。主要不良反应为、度白细胞血小板下降和消化道反应及少数患者的度周围神经毒性。结论草酸铂联合低剂量氟尿嘧啶治疗老年晚期胃癌患者疗效较好,不良反应可以耐受,是一种安全有效的化疗方案。

目的:观察吉西他滨(商品名泽菲)加奥沙利铂(商品名艾恒)联合化疗治疗老年晚期非小细胞肺癌(NSCLC)的疗效和不良反应。方法:56例老年晚期NSCLC接受治疗,方案为吉西他滨1.0 g/m2静滴30 min,第1、8天;奥沙利铂130 mg/m2静滴2 h,第1天,3周为1个周期,每个病例至少化疗2周期。结果:全组56例均可评价疗效,总有效率为46.4%,其中CR3.6%,PR 42.9%。不良反应主要为骨髓抑制,消化道反应和肢端感觉异常反应轻。结论:吉西他滨加奥沙利铂联合化疗治疗老年晚期NSCLC有效率高,毒性可以耐受,值得临床推广。

原发性肝癌是我国常见的恶性肿瘤之一,恶性程度高,起病隐匿,复发率高,能够接受手术切除治疗的肝癌患者仅占20%左右[1].故临床上大多数肝癌仍需采用非手术疗法.肝癌主要治疗手段有手术、放疗、化疗、介入治疗等.对于病变范围小、孤立、数目少的可以手术或放疗;对于病变大又有包膜的可以介入栓塞治疗.但原发性肝癌往往当发现时,已是晚期,病变较大或弥散,手术、介入栓塞难以起作用.晚期肝癌多数伴有不同程度的肝硬化及肝功失代偿,化疗效果不佳.不断探索和研究新的治疗方法,显得十分重要.随着高热治疗癌的进展,大量的临床实践及生物实验表明热疗联合化疗有明显的互补与增敏效果.我科自2003年11月～2004年11月采用局部热疗联合化疗治疗63例晚期原发性肝癌患者,取得满意疗效,现报告如下: