超声引导下经直肠前列腺穿刺活组织检查术在前列腺癌诊断中的意义

目的:探讨超声引导下经直肠前列腺穿刺活组织检查术在前列腺癌诊断中的意义。方法:选取2013年2月~2015年2月北京怀柔医院收治的280例患者为研究对象,回顾性分析其临床资料,经直肠前列腺穿刺活组织检查其超声显像结果与病理资料,并分析影响前列腺癌诊断的相关因素。结果:本组280例患者,前列腺癌检出率为39.64%(111/280),根据患者年龄分为4组,组间前列腺癌检出率比较,差异有统计学意义(P0.05);240例检测前列腺特异性抗原(Prostate specific antigen level,PSA)水平患者,前列腺癌检出率为34.17%(82/240),根据PSA分为5组,组间前列腺癌检出率比较,差异有统计学意义(P0.05);248例经直肠超声检查前列腺体积患者,前列腺癌检出率为37.90%(94/248),根据前列腺体积分为2组,组间前列腺癌检出率比较,差异有统计学意义(P0.05)。结论:在疑似前列腺癌诊断中应用超声引导下经直肠前列腺穿刺活组织检查术,具有积极的意义,临床价值显著。     

超声引导下穿刺置管引流治疗肝脓肿的疗效分析

目的:探讨超声引导下穿刺置管引流治疗肝脓肿的临床疗效。方法:回顾性分析本院2012-2013年56例肝脓肿住院患者超声引导下穿刺置管引流治疗的临床资料。结果:56例患者行超声引导下穿刺置管引流治疗,其中3例多发脓肿行2次穿刺置管治疗,其余均一次穿刺置管成功,未出现出血、胆漏、周围脏器损伤等并发症,本组患者手术前后体温、白细胞数及脓肿面积比较均有统计学意义(P0.01)。24例体温升高患者中,21例术后3天内恢复正常,3例仍有升高;41例白细胞数升高患者中,29例术后3天内恢复正常,12例仍有增高;56例患者术后脓肿面积均明显减小,该组患者腹痛、肝区叩痛等临床症状均明显缓解。结论:超声引导下穿刺抽吸及置管引流治疗肝脓肿是一种简单方便、安全可靠、创伤小、明显有效的局部治疗方法,操作者需要充分作好术前准备,严格把握适应症,严谨操作步骤并结合全身抗生素治疗可以明显改善患者发热症状,有效降低患者白细胞及中性粒细胞,明显缩短治疗周期,提高治愈率。     

影像引导下前列腺定向穿刺活检术的研究进展

确诊前列腺癌的金标准无疑是病理组织学检查,影像引导下的前列腺定向穿刺活检又是这当中最有效、最便捷的方式。而基于前列腺特异抗原(prostate specific antigen,PSA)筛查以及6分活检结果的前列腺癌诊断,已经由于其对低度肿瘤的过度诊断和对临床上有意义前列腺癌(格林森评分≥7)的诊断不足遭到批评。所以纵观国内外,影像引导已经增加到先用多参数MRI(multi-parametric magnetic resonance imaging,mpMRI)扫描检出病变组织再进行前列腺定向穿刺活检,包括,in-bornMRI引导,认知融合引导,以及MRI/TRUS融合引导下的活检。本文就一些影像引导下前列腺定向穿刺活检术的研究进展进行综述。     

超声引导下经皮穿刺引流对重症急性胰腺炎的精准治疗

目的:评价超声引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)的安全性及临床疗效。方法:回顾性分析2011年1月-2015年12月在超声引导下经皮穿刺置管引流的273例SAP患者的临床资料,比较患者引流前后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平的变化。结果:273例患者中,131例患者仅经过PCD术后治愈出院;103例患者行超声引导下PCD术后全身症状得到明显改善,后期再采用经腹膜后内镜下清创术治愈出院,39例患者无好转,中转为开腹手术,PCD术的成功率为100%。103例经内镜下清创的患者中2例死亡,39例无好转的开腹手术患者中13例死亡。患者引流后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均较引流前显著降低,差异有统计学意义(P0.05)。结论:采用超声引导下的经皮穿刺置管引流治疗SAP具有定位准确、创伤小的有点,可使部分患者免于手术,或者为后续治疗创造有利条件,临床疗效显著。     

超声内镜引导下细针穿刺活检联合基因检测对胰腺癌的诊断价值

目的:研究超声内镜引导下细针穿刺活检(EUS-FNA)联合K-ras基因检测对胰腺癌的诊断价值,为临床诊疗提供依据。方法:选取2013年11月到2015年11月我院收治的胰腺占位病变患者90例,患者入院次日行EUS-FNA,检测患者血清及活检物中K-ras基因阳性率,比较EUS-FNA单独与EUS-FNA联合K-ras基因检测对胰腺癌诊断的准确率与敏感性。结果:90例胰腺占位病变者中,经病理证实胰腺癌56例,EUS-FNA单独与EUS-FNA联合K-ras基因分别检出胰腺癌50例、53例,准确率分别为89.29%、94.64%,敏感性分别为92.59%、98.15%,两组比较差异均有统计学意义(P0.05)。胰腺癌患者活检物中K-ras阳性率为83.93%,明显高于血清中的41.07%(P0.05)。结论:EUS-FNA联合K-ras基因检测可提高对胰腺癌诊断的准确率与敏感性。     

86例超声引导下经会阴前列腺穿刺体会

目的分析86例经直肠超声(TRUS)引导下经会阴前列腺穿刺病理,提高前列腺癌活检阳性率。方法86例(年龄71-89岁,PSA.>10 ng/ml,PSAD>0.3),直肠超声(TRUS)引导下经会阴前列腺穿刺,6+X法。结果前列腺癌39例,前列腺增生46例,前列腺炎1例。前列腺癌阳性中:有可疑病灶32例,无可疑病灶7例,前列腺癌敏感性82%(32/39),其中第二次穿刺病例8例,阳性4例,第三次穿刺2例,阳性2例。结论对70岁以上高老人的前列腺穿刺活检病人,因个性化对待,重点对可疑病灶点和外周带的穿刺。     

超声引导下经皮肾穿刺活检术的护理

超声引导下经皮肾穿刺活体组织检查(简称“肾穿刺”),具有定位准确、操作简便、成功率高、并发症少等优点,是目前国内外普及的肾活检方法。此术对原发性疾病、继发或遗传性肾脏疾病的诊断具有重要意义,而肾穿刺术的护理对提高穿刺成功率、减少术后并发症起着关键的作用。现将护理体会报告如下。1临床资料我院于2006年1~12月对42例患者在超声引导下行肾穿刺活检术,均取得了良好的诊疗效果,无1例发生严重并发症。其中男24例,女18例;年龄16~65岁,平均27岁。临床诊断为急性及慢性肾炎共17例,原发性肾病综合征5例,糖尿病肾病1例,紫癜性肾炎1例,可…     

超声引导下经阴道细针穿刺注射5-FU治疗宫外孕的疗效观察

目的：探讨超声引导下经阴道应用细针穿刺注射5-FU介入治疗异位妊娠的临床疗效。方法：超声引导下经阴道用18G及22GPTC针对42例未破裂型异位妊娠病灶进行穿刺抽吸囊液后,注射5．氟尿嘧啶（5-FU）及氨甲喋呤（MTX）治疗,进行疗效观察。结果：应用22G细针穿刺,一次性穿刺成功病例21例,成功率100％;穿刺出血病例3例,穿刺后出血发生率14．2％。对照组18G粗针穿刺,分别为15例、71．4％;9例、42．8％;差异具有显著性（P〈0．05）。注射5-FU术1周病人血HCG测量值及异位妊娠病灶缩小或消失率达到90．4％、治疗方法有效率为95．2％,对照组注射MTX分别为71．4％、80．9％;差异具有显著性（P〈0．05）。结论：超声引导下经阴道22G细针穿刺注射5．Fu治疗未破裂型宫外孕较18G粗针及注射MIX疗效显著,成功率高、副反应少,为临床保守治疗未破裂型异位妊娠穿刺针型号及用药种类的选择提供了一种新的方法,有一定的临床应用价值。     

超声引导改良外周静脉导入中心静脉置管术临床应用经验

目的:探讨超声引导下改良的外周静脉导入中心静脉置管术(Peripherally Inserted Central Catheter,PICC)的临床应用。方法:对42例有恶性肿瘤病史需行PICC置管、浅静脉直视下不明显或触摸不到、不适合盲穿患者42例进行超声引导下改良的PICC术。改良方法包括穿刺支架超声引导以及用一次性使用麻醉用针替代Seldinger包内的穿刺针进行,并与23例标准PICC法对比分析穿刺成功率及穿刺并发症发生率。结果:两种方法穿刺成功率均为100%,其中改良PICC患者41例穿刺一次成功,一次成功率为97.6%;标准PICC患者21例穿刺一次成功,一次成功率为91.3%。两种方法一次成功率差异无统计学意义(P0.05)。42例改良患者中发生2例并发症,包括局部水肿1例及导管异位1例;23例标准PICC患者中发生6例并发症,包括局部水肿2例,导管异位1例,静脉炎1例及局部感染2例。两种方法并发症发生率差异有统计学意义(P=0.019)。结论:超声引导下改良的PICC术一次成功率高,并发症少,值得临床推广。     

Influence of adjuvant radiotherapy on circulating epithelial tumor cells and circulating cancer stem cells in primary non-metastatic breast cancer

Background: There is an unmet need to identify biomarkers that directly reflect response to adjuvant radiotherapy (RT). Circulating epithelial tumor cells (CETCs) represent the liquid component of solid tumors and are responsible for metastatic relapse. CETC subsets with cancer stem cell characteristics, circulating cancer stem cells (cCSCs), play a pivotal role in the metastatic cascade. Monitoring the most aggressive subpopulation of CETCs could reflect the aggressiveness of the remaining tumor burden. There is limited data on the detection and monitoring changes in CETC and cCSC numbers during RT in early breast cancer.Methods: CETC numbers were analyzed prior to, at midterm and at the end of RT in 52 primary non-metastatic breast cancer patients. Hormone receptor status was determined in CETCs prior to and at the end of RT. For the identification of cCSCs cell suspensions from the peripheral blood of patients were cultured in vitro under conditions favoring growth of tumorspheres.Results: Hormone receptor status in CETCs before RT was comparable to that in primary tumor tissue. Prior to RT numbers of CETCs correlated with aggressiveness of primary tumors. cCSCs could be successfully identified and monitored during RT. Prior to RT patients treated with neoadjuvant chemotherapy had significantly higher numbers of CETCs and tumorspheres compared to patients after adjuvant chemotherapy. During RT, the number of CETCs decreased continuously in patients after neoadjuvant chemotherapy but not after adjuvant chemotherapy.Conclusion: Monitoring the number of CETCs and the CETC subset with cancer stem cell properties during RT may provide additional clinically useful prognostic information.     

Multiple MAGE-A genes as surveillance marker for the detection of circulating tumor cells in patients with ovarian cancer

Abstract

Ovarian cancer is a leading cause of death among gynecologic malignancies. In this study, we reported the expression of melanoma-associated antigens A (MAGE-A) genes in peripheral blood from 80 patients with ovarian cancer and 30 healthy donors. MAGE-As expression was associated with the factors indicating poor prognosis. The expressions of MAGE-As and each individual MAGE-A genes were also associated with low overall survival of patients with ovarian cancer. Our results suggested MAGE-A genes may have the potential to be surveillance markers for the detection of circulating tumor cells and represent a poor prognosis for patients with ovarian cancer.     

Vaccination of prostatectomized prostate cancer patients in biochemical relapse,with autologous dendritic cells pulsed with recombinant human PSA

This study was conducted in prostate cancer patients in biochemical relapse after radical prostatectomy, to assess the feasibility, safety, and immunogenicity of therapeutic vaccination with autologous dendritic cells (DCs) pulsed with human recombinant prostate-specific antigen (PSA) (Dendritophage-rPSA). Twenty-four patients with histologically proven prostate carcinoma and an isolated postoperative rise of serum PSA (>1 ng/ml to 10 ng/ml) after radical prostatectomy were included. The patients received nine administrations of PSA-loaded DCs by combined intravenous, subcutaneous, and intradermal routes over 21 weeks. Postbaseline blood tests were performed at months 1, 3, 6, 9, and 12 (PSA levels), at months 6 and 12 (circulating prostate cancer cells), at month 6 (anti-PSA IgG and IgM antibodies), and at up to eight time points before, during, and after immunization (PSA-specific T cells). Circulating prostate cancer cells detected in six patients at baseline were undetectable at 6 months and remained undetectable at 12 months. Eleven patients had a postbaseline transient PSA decrease on one to three occasions, predominantly occurring at month 1 (7 patients) or month 3 (2 patients). Maximum PSA decrease ranged from 6% to 39%. PSA decrease on at least one occasion was more frequent in patients with low Gleason score (p=0.016) at prostatectomy and with positive skin tests at study baseline (p=0.04). PSA-specific T cells were detected ex vivo by ELISpot for IFN- in 7 patients before vaccination and in 11 patients after vaccination. Of the latter 11 patients, 5 had detectable T cells both before and during the vaccination period, 4 only during the vaccination period, while 2 patients could for technical reasons not be assessed prevaccination. No induction of anti-PSA IgG or IgM antibodies was detected. There were no serious adverse events or otherwise severe toxicities observed during the trial. Immunization with Dendritophage-rPSA was feasible and safe in this cohort of patients. An immune response specific for PSA could be detected in some patients. A notable effect was the disappearance of circulating prostate cells in all patients who were RT-PCR positive before vaccination.Scientific correspondence should be addressed to B. Barrou; editorial correspondence to M.L. Ericson.     

肿瘤干细胞对恶性肿瘤辅助治疗的影响

放化疗是目前恶性肿瘤治疗的重要手段,但是迄今为止,除了手术以外,几乎没有能单独根治恶性肿瘤的治疗方法,甚至一些恶性肿瘤在手术、化疗或放疗后会出现再生和侵袭能力增强,被称为恶性肿瘤治疗后再增殖,这可能是恶性肿瘤治疗失败的主要原因,其主要机制可能是肿瘤干细胞(cancer stem cells,CSCs)对放化疗的耐受,以及放化疗导致肿瘤细胞的上皮细胞间质化,继而提高了肿瘤侵袭性。该文将从CSCs的角度重新探讨放化疗等辅助治疗对恶性肿瘤的影响。     

Inhibitory effect of roburic acid in combination with docetaxel on human prostate cancer cells

Roburic acid (ROB) is a naturally occurred tetracyclic triterpenoid, and the anticancer activity of this compound has not been reported. Docetaxel (DOC) is the first-line chemotherapeutic agent for advanced stage prostate cancer but toxic side effects and drug resistance limit its clinical success. In this study, the potential synergistic anticancer effect and the underlying mechanisms of ROB in combination with DOC on prostate cancer were investigated. The results showed that ROB and DOC in combination synergistically inhibited the growth of prostate cancer cells. The combination also strongly induced apoptosis, and suppressed cell migration, invasion and sphere formation. Mechanistic study showed that the combined effects of ROB and DOC on prostate cancer cells were associated with inhibition of NF-κB activation, down regulation of Bcl-2 and up regulation of Bax. Knockdown of NF-κB by small interfering RNA (siRNA) significantly decreased the combined effect of ROB and DOC. Moreover, we found that esomeprazole (ESOM), a proton pump inhibitor (PPI), strongly enhanced the effectiveness of ROB and DOC on prostate cancer cells in acidic culture medium. Since acidic micro environment is known to impair the efficacy of current anticancer therapies, ESOM combined with ROB and DOC may be an effective approach for improving the treatment of prostate cancer patients.     

Detection of oncogenic mutations in paired circulating tumor DNA and circulating tumor cells in patients with hepatocellular carcinoma

Background and aimsCirculating tumor cells (CTCs) or circulating tumor DNA (ctDNA) may be used for diagnostic or prognostic purposes in patients with hepatocellular carcinoma (HCC). We aim to determine whether CTCs or ctDNA are suitable to determine oncogenic mutations in HCC patients.MethodsTwenty-six mostly advanced HCC patients were enrolled. 30 mL peripheral blood from each patient was obtained. CellSearch system was used for CTC detection. A sequencing panel covering 14 cancer-relevant genes was used to identify oncogenic mutations. TERT promoter C228T and C250T mutations were determined by droplet digital PCR.ResultsCTCs were detected in 27% (7/26) of subjects but at low numbers (median: 2 cells, range: 1–15 cells) and ctDNA in 77% (20/26) of patients. Mutations in ctDNA were identified in several genes: TERT promoter C228T (77%, 20/26), TP53 (23%, 6/26), CTNNB1 (12%, 3/26), PIK3CA (12%, 3/26) and NRAS (4%, 1/26). The TERT C228T mutation was present in all patients with one or more ctDNA mutations, or detectable CTCs. The TERT C228T and TP53 mutations detected in ctDNA were present at higher levels in matched primary HCC tumor tissue. The maximal variant allele frequency (VAF) of ctDNA was linearly correlated with largest tumor size and AFP level (Log10). CtDNA (or TERT C228T) positivity was associated with macrovascular invasion, and positivity of ctDNA (or TERT C228T) or CTCs (≥ 2) correlated with poor patient survival.ConclusionsOncogenic mutations could be detected in ctDNA from advanced HCC patients. CtDNA analysis may serve as a promising liquid biopsy to identify druggable mutations.     

Prognostic impact of circulating tumor cells in patients with ampullary cancer

Circulating tumor cells (CTCs) are an important topic of investigation for both basic and clinical cancer research. In this prospective study, we evaluated the clinical role of CTCs in ampullary cancer. We analyzed blood samples from 62 consecutively diagnosed patients with ampullary adenocarcinoma and 24 healthy controls for their CTC content. Combined data from immunostaining of CD45, 4′,6‐diamidino‐2‐phenylindole (DAPI), and fluorescence in situ hybridization with a chromosome 8 centromere (CEP8) probe were used to identify CTCs; cells that were CD45‐/DAPI+/CEP8>2 were considered CTCs. The Cox proportional hazards model was used to assess the relationship between CTCs, clinical characteristics, and patient outcomes. We detected ≥2 CTCs/3.2 ml whole blood in 43 of 62 patients (69.4%), as well as ≥5 CTCs/3.2 ml in 16 of these patients (25.8%). A CTC cutoff value of 2 cells/3.2 ml achieved 69.4% sensitivity and 95.8% specificity as a diagnostic tool; CTCs were associated with tumor burden. CTC levels ≥3/3.2 ml (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: (1.2–5.2), p = 0.014) and ≥5/3.2 ml (HR: 3.5, 95% CI: 1.7–7.3, p < 0.001) were both associated with shorter disease‐free survival. Moreover, ≥3 CTCs/3.2 ml (HR: 2.7, 95% CI: 1.2–6.3, p = 0.019) and ≥5 CTCs/3.2 ml (HR: 3.8, 95% CI: 1.8–8.5, p < 0.001) were predictive of shorter overall survival. CTC assessment may help identify patients with ampullary cancer who are at high risk of an unfavorable outcome.     

Dynamics of prostate cancer stem cells with diffusion and organism response

We develop a systems based model for prostate cancer, as a sub-system of the organism. We accomplish this in two stages. We first start with a general ODE that includes organism response terms. Then, to account for normally observed spatial diffusion of cell populations, the ODE is extended to a PDE that includes spatial terms. Numerical solutions of the full PDE are provided, and are indicative of traveling wave fronts. This motivates the use of a well known transformation to derive a canonically related (non-linear) system of ODEs for traveling wave solutions. For biological feasibility, we show that the non-negative cone for the traveling wave system is time invariant. We also prove that the traveling waves have a unique global attractor. Biologically, the global attractor would be the limit for the avascular tumor growth. We conclude with comments on clinical implications of the model.     

循环肿瘤细胞在胃癌化疗预后评估中的临床意义

目的:探讨检测循环肿瘤细胞对评估胃癌患者化疗敏感性和预后的临床价值。方法:选取行根治术的胃癌患者112例,术前留取血液标本进行循环肿瘤细胞检测。选取病理分期为Ⅲ期的36位患者进行术后6周期Xelox化疗,在化疗前和化疗结束后检测循环肿瘤细胞。分析循环肿瘤细胞检测值和肿瘤分期、化疗预后的关系。结果:在胃癌患者中,循环肿瘤细胞阳性率(2)为39.29%(44/112),并且和肿瘤分期与淋巴结转移明显相关(P0.05)。在术后行辅助化疗的胃癌患者中,循环肿瘤细胞阳性率和化疗敏感性明显相关,循环肿瘤细胞检测值动态增高的患者比降低的患者预后差(P0.05)。结论:循环肿瘤细胞的动态监测有助于预测胃癌患者的化疗预后。     

A nonlinear model with competition between prostate tumor cells and its application to intermittent androgen suppression therapy of prostate cancer

The recurrence of a tumor is a crucial problem in hormonal therapy of prostate cancer. Recent studies suggest that intermittent androgen suppression administration may prolong or hopefully prevent the progression to the recurrence. It was shown that a simple mathematical model is useful to understand how and why intermittent administration can be effective and to seek a better medication scheme. In this paper, we propose a new model for the intermittent androgen suppression therapy. What is central in the new model is that the competitive effect between androgen-dependent and independent cancer cells is assumed to be essential for the decrease of androgen-independent cells under a normal androgen level. In the newly proposed model, the separatrix in the phase space for a normal androgen level plays an important role. There is crucial difference between the previous model and the new one in the phase diagram of success and failure of the permanent tumor control by intermittent androgen suppression administration. That means that the suggestions from the models for clinical problems can be different. We also consider the combined model of the previous and newly proposed models, which can smoothly bridge two models.