目的 探讨原发性食管小细胞癌的诊断、治疗和预后特点.方法 回顾性分析2011年5月至2017年9月郑州大学附属肿瘤医院确诊的82例原发性食管小细胞癌患者的临床资料和随访资料,采用Kaplan-Meier方法绘制生存曲线,组间生存率比较采用Log-Rank检验,预后因素采用Cox多因素分析.结果 本研究患者1、3、5年生存率分别为63.41％、12.20％、2.44％,中位总生存期为15.50个月,其中局限期为27个月,广泛期为9个月,行综合治疗患者预后优于行单一治疗患者,Ki-67指数＜90％患者预后优于Ki-67指数≥90％的患者,广泛期无顽固性低钠血症患者预后优于有顽固性低钠血症患者.Cox多因素分析提示:不论是局限期还是广泛期原发性食管小细胞癌,Ki-67指数、治疗模式均为其独立预后因素,广泛期患者有无顽固性低钠血症也是可评价预后的指标.结论 原发性食管小细胞癌转移早,预后差,恶性程度较高,综合治疗可显著改善患者预后.

早诊早治是胃癌诊疗的关键.肿瘤标志物检测具有简便、快捷等优点,是目前临床常用的筛查和诊断胃癌的手段.随着胃癌分子研究不断深入,更多的胃癌相关肿瘤标志物被发现.全文对近年来胃癌相关肿瘤标志物研究进行概述,总结了一部分新型肿瘤标志物的研究进展,为胃癌的临床筛查、早期诊断提供参考.

目的 研究青年胃癌(≤40岁)患者的临床病理特征及预后.方法 回顾性分析2011年1月至2012年12月在郑州大学附属肿瘤医院行手术治疗的胃癌患者,其中青年胃癌组(年龄≤40岁)110例,老年胃癌组(年龄≥60岁)720例,比较两组的临床病理特点及预后.结果 与老年胃癌患者相比,青年胃癌患者以女性常见,肿瘤大部分位于胃中下区,多见低分化腺癌、弥漫性胃癌,青年胃癌组有胃癌家族史的患者比例更高,而腹痛、呕血黑便等症状的比例低(P<0.05).两组在肿瘤大小、浸润深度、淋巴结转移、TNM分期及手术方式等方面比较,差异无统计学意义(P>0.05).单因素分析结果显示,肿瘤浸润深度、淋巴结转移、手术方式、TNM分期与术后生存时间有关(P<0.05).多因素分析提示,TNM分期及手术方式是影响青年胃癌患者预后的独立危险因素(HR=3.669,95％CI:1.590～8.468;HR=8.153,95％CI:3.657～18.180).结论 青年胃癌患者以女性为主,有其独特的临床病理特征,TNM分期及手术方式是其预后不良的独立危险因素.

目的 探究不同环氧合酶-2(COX-2)表达水平对胃癌细胞SGC-7901迁移能力及其上皮钙粘素(E-cadherin)表达的影响.方法 采用不同浓度的COX-2特异性抑制剂塞来昔布(10、20、30、40、50 μmol/L)干预胃癌细胞SGC-7901作为实验组,另设对照组(不加塞来昔布干预),构建不同COX-2表达水平的胃癌细胞SGC-7901,采用Transwell小室法检测胃癌细胞SGC-7901迁移情况.以终浓度为30 μmol/L的塞来昔布干预胃癌细胞SGC-7901,通过作用不同时间(24、36、48小时)构建不同COX-2表达水平的胃癌细胞SGC-7901,采用免疫荧光标记法检测胃癌细胞 SGC-7901 E-cadherin表达情况;采用实时荧光定量反转录PCR检测胃癌细胞SGC-7901 COX-2及E-cadherin mRNA表达情况.结果 对照组及实验组(10、20、30、40、50 μmol/L)COX-2 mRNA表达量分别为(1.00±0.00)及(0.82±0.15)、(0.70±0.29)、(0.62±0.25)、(0.49± 0.21)、(0.33±0.15);E-cadherin mRNA分别为(1.00±0.00)及(0.73±0.16)、(1.38±0.22)、(2.43±0.21)、(2.66±0.34)、(2.87±0.28).与对照组比较,实验组胃癌细胞SGC-7901 COX-2 mRNA表达量均显著降低, E-cadherin mRNA表达量显著升高,且均呈剂量依赖性(P<0.01).Transwell小室实验结果显示,与对照组比较,实验组胃癌细胞SGC-7901迁移数量均显著降低(P<0.01),实验组随COX-2表达水平的降低呈逐渐降低趋势(P<0.01),迁移抑制率呈逐渐升高趋势(P<0.01).以终浓度为30μmol/L塞来昔布处理胃癌细胞SGC-790124、36、48小时后COX-2 mRNA表达量分别为(0.69 ±0.23)、(0.55 ±0.17)、(0.42 ±0.11);E-cad-herin mRNA表达量分别为(2.46±0.23)、(4.03±0.31)、(5.11±0.28);SGC-7901 E-cadherin平均荧光强度分别为(21.25±4.32)、(27.67±5.01)、(46.38±4.92);随着塞来昔布作用时间的延长,胃癌细胞 SGC-7901 COX-2 mRNA表达量逐渐降低,而E-cadherin mRNA表达量及平均荧光强度均逐渐升高(P<0.05).结论通过COX-2特异性抑制剂塞来西布抑制胃癌细胞SGC-7901 COX-2表达,可显著上调其E-cadherin mRNA,进而抑制胃癌细胞SGC-7901迁移能力.

目的 探讨肿瘤标志物癌胚抗原(carcinoembryonic antigen,CEA)、糖链抗原(carbohydrate antigen,CA)19-9、CA72-4、CA125及甲胎蛋白(alpha-fetoprotein,AFP)联合检测在胃癌个体化诊疗中的临床应用价值.方法 分别对2013年9月至2014年12月于本院接受治疗的118例胃癌患者(胃癌组)、60例胃良性疾病患者(胃良性疾病组)及51例健康体检者(健康体检组)进行血清肿瘤标志物检测,并回顾性分析118例胃癌患者的血清肿瘤标志物、临床病理特征及预后资料.结果 118例胃癌患者CEA、CA19-9、CA72-4、CA125、AFP联合检测的初诊阳性率均明显高于胃良性疾病组和健康体检组;CEA、CA19-9、CA72-4、CA125、AFP联合检测阳性率高于CEA、CA19-9、CA72-4联合检测.CA125阳性与性别和腹膜转移有关(P均<0.05);AFP阳性与肝转移有关(P=0.002).多因素生存分析提示,CA72-4(P=0.022)、AFP(P=0.002)、肿瘤TNM分期(P=0.002)及腹膜转移(P=0.025)是胃癌的独立预后因素,其中,CA72-4阳性和AFP阳性患者死亡危险系数分别是阴性患者的1.732倍和3.086倍.结论 CEA、CA19-9、CA72-4、CA125及AFP联合检测可提高胃癌初诊阳性率,减少漏诊误诊的发生,对胃癌患者的个体化诊疗具有重要价值,其中CA72-4、AFP可以作为独立预后因子.

Background and purpose: Apatinib is the first oral cancer antiangiogenic drug in the world for advanced gastric cancer. With its wide application in clinics, finding suitable predictors of efficacy and screening for sensitive populations have become important issues. This study aimed to observe the efficacy and safety of apatinib in the treatment of advanced gastric cancer, and explore clinical prediction and prognostic factors. Methods: The clinicopathological features of 105 patients with advanced gastric cancer, who were treated with apatinib from Jan. 2015 to Aug. 2016, were analyzed retrospectively. All patients were given oral administration of apatinib. The indicators were treatment-related adverse reactions, disease control rate (DCR) and progression-free survival (PFS). We analyzed the relationship between clinicopathological features, treatment-related adverse reactions and prognosis. Results: The median PFS (mPFS) was 71 d (95%CI: 50.1-91.9 d), the objective response rate was 5.71%, and DCR was 65.71%. The univariate analysis showed that PFS was significantly prolonged among patients with one of the potential prognostic factors including age of >56 years, ECOG PS 0-1, dose 500 mg, hypertension, hand-foot skin reaction (HFSR) and proteinuria. The DCR was higher among patients with one of the potential prognostic factors including ECOG PS 0-1, dose 500 mg, hypertension, HFSR, proteinuria and diarrhea. Cox and logistic multivariate analysis showed that ECOG PS, dose, hypertension, HFSR were independent prognostic factors of PFS. ECOG PS 0-1, treatment-related HFSR, hypertension were significantly associated with DCR. Conclusion: Apatinib has good efficacy and safety in the patients with advanced gastric cancer. ECOG PS, HFSR, hypertension are the favorable prognostic factors of PFS and DCR, and the drug dose can be used as an independent predictor of PFS.

Objective To assess the value of serum carcinoembryonic antigen (CEA)and carbohydrate antigen 19-9 (CA19-9) levels in the diagnosis of gastric cancer in elderly patients.Methods This prospective study included 104 elderly patients with gastric cancer at our hospital from March 2015 to December 2016 to serve as an experimental group.Moreover,104 elderly patients with benign gastric lesions were enrolled to serve as a control group.Serum CEA and CA19-9 levels were compared between the two groups.The diagnostic specificity,sensitivity,and validity for gastric cancer were calculated by using CEA or CA19-9 alone or the two in combination.Results Serum CEA and CA19-9 levels in the experimental group were significantly higher than in the control group(t =3.001 and 5.110,P =0.039 and 0.016,respectively);The specificity,sensitivity,and validity of CEA and CA19-9 in combination were significantly higher than when each of the measures was used alone(x2 =2.101 and 2.109,P =0.031 and 0.019,respectively).Serum CEA levels showed good predictive power for both lymph node metastasis of gastric cancer(Z =5.109,P =0.002) and liver metastasis of gastric cancer(Z =3.910,P =0.026);Serum CA19-9 levels could predict lymph node metastasis of gastric cancer (Z =4.189,P =0.003) Conclusions Serum CEA and CA19-9 in combination have high sensitivity and validity for gastric cancer detection;Elevated CEA can predict gastric cancer metastasis and elevated CA19-9 may predict lymph node metastasis.

Objective:To analyze the short -term efficacy and toxic and side effects of concurrent chemoradiotherapy of Paclitaxel(PTX)combined with compound Kushen injection treating elderly patients with esophagus cancer.Methods:118 elderly patients with esophagus cancer were randomly divided into the observation group(n=59)and the control group(n=59).The control group was treated with concurrent chemoradiotherapy of PTX;on which basis,the observa-tion group was also treated with compound Kushen injection to the end of chemoradiotherapy.The chemoradiotherapy was three months,and the follow-up was one year.The short -term clinical efficacy was compared between the two groups;immune function changes before and after the treatment,as well as the toxic and side effects during the follow -up were observed.Results:After three-month treatment,DCR was 96.61%in the observation group,which was sig-nificantly higher than 67.80%in the control group(P<0.05);during the follow-up,the survival rate was 86.44%in the observation group,which was also significantly higher than 67.80% in the control group(P<0.05).The blood CD+4ratio and CD +4/CD+8were significantly higher after the treatment than those before the treatment in the theatment group;they were much higher in the observation group compared to those in the control group(P<0.01); the blood CD+8ratio after the treatment in the observation group was significantly lower than that before the treatment and that in the control group(P<0.01).The serum levels of IgG,IgA and IgM were significantly lower in the control group after the treatment than those before the treatment and those in the observation group(P<0.01).During the treatment and follow-up period,the toxic and side effects,such as the incidence rates of grade I ~II appetite,vomiting,white blood cell descent, radiation esophagitis and grade III ~IV vomiting, were remarkably lower in the observation group than those in the control group(P<0.05).Conclusion: Concurrent chemoradiotherapy of PTX combined with compound Kushen injection can effectively control the progress of esophagus cancer in elderly patients, reduce the toxic and side effects,and increase the tolerance and improve survival rate.

In recent years, anti-angiogenic drugs influencing vascular endothelial growth factor receptor (VEGFR) and vascular endothelial growth factor (VEGF) signaling have been widely used in the treatment of malignant tumors. Apatinib is an orally bioavailable small molecule antiangiogenic agent. The CSCO Guide to Gastro-Oncology,published in 2017, lists apatinib as the only targeted drug targeted for third-line treatment of gastric cancer. This review summarizes the recent advances in the structure, mechanisms of action, reversing drug resistance, clinical efficacy, adverse reactions, and biomarkers in various types of malignancies.