Objective To investigate the clinical application and early results of combined epiphyseal preservation and autograft bone transfer for limb salvage in children with osteosarcoma. Methods Between March 2010 and March 2011, 3 children with osteosarcoma were treated with epiphyseal preservation and autograft bone transfer. There were 1 boy and 2 girls with the age of 10-14 years. The disease duration was 2 weeks to 3 months. The tumors were rated as type II according to San-Julian radiological classification and as type IIB according to Enneking surgical classification. The locations were the distal femur in 1 case and the proximal tibia in 2 cases. The surgical technique included preoperative neoadjuvant chemotherapy, excision of part of the epiphysis, preservation of subarticular epiphysis, external fixation with Ilizarov apparatus and transport osteogenesis treatment. Safe excision border was confirmed by histological examination. Postoperative observation included the wound healing, local recurrence or distant metastasis, length, speed, alignment, and regeneration of transplanted bone, the length and function of the affected limb. Results The postoperative histological examination proved the safe surgical margin in all 3 patients. The incision healing by first intention was obtained at distal femur in 1 case and by second intention at proximal tibia in 2 cases at 4 weeks after changes of dressing. Three patients were followed up 12, 18, and 24 months, respectively. There was no local recurrence or distant metastasis during follow-up. Two cases had pin-tract infection at 10 months after external fixation and were cured after changes of dressing and antibiotics administration. The length of transplanted osteogenisis was 18.0, 9.5, and 16.0 cm, respectively. The speed of lengthening was 2.57, 2.07, and 1.20 cm/month, respectively. One patient had alignment deviation during lengthening, which was adjusted under anaesthesia. Bony healing was achieved at 8 months after lengthening end in 2 cases and external fixation was removed; 1 patient had poor bone growth and was given retraction for promoting bone growth. At last follow-up, the length of the affected limbs was 1.0-1.5 cm shorter than that of normal limbs, but no abnormalities was observed at donor sites. The affected knee flexion reached 90° and 120° in 2 patients and poor knee function was observed in 1 patient for external fixation. Conclusion The combined epiphyseal preservation and transport osteogenesis technique can be used for bone defect repair by lengthening the residual bone. It is a promising limb salvage treatment for children with osteosarcoma.
Objective To discuss influence of spinal surgery on quality of life (QOL) of patients with late-period spinal metastatic tumor and to explore if spinal surgery could influence on survival time of patients or not. Methods From July 2007 to March 2009, we identified patients who were eligible for the observational study hospitalized in Changzheng Hospital, the Second Military Medical University in Shanghai, China. All eligible patients were divided into two groups depending on whether they would receive spinal surgery or not. Then, all eligible patients completed five QOL assessments using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire when they were diagnosed as late-period spinal metastatic tumor, after 1-month treatment, after 3-month treatment, after 6-month treatment, and after 9-month treatment. Survival time of each patient was also recorded. Results We identified 312 patients who were eligible for the study (surgery group, 147 cases; and non-surgery group, 165 cases). There was no significant difference in survival time between the two groups (χ2=3.167, P=0.075). Within 9 months, the surgery group had significantly higher physical well-being scores, emotional well-being scores, functional well-being scores and total QOL scores than the non-surgery group. Conclusion The results of this study suggest that spinal surgery can significantly improve the QOL of patients with late-period spinal metastatic tumor, but cannot prolong the survival time.
Objective To systematically evaluate the clinical effectiveness and safety of capecitabine plus docetaxel in the treatment of patients with metastatic breast cancer where anthracycline has failed as a treatment. Methods We electronically searched PubMed, EMBASE, the Cochrane Library (2008, issue 4), and CBM to Sept. 2008. Randomized controlled trials (RCTs) and quasi-RCTs about capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with metastatic breast cancer were identified. Study selection and analyses were undertaken according to the Cochrane Handbook, and RevMan 5.0 was applied for statistical analyses. The following was studied: total survival time, the development time of disease, reaction rate, the mid-survival time, adverse events and quality of life. Results Three RCTs involving 672 patients with metastatic breast cancer were included. The results of meta-analyses showed that the overall survival (MD=3.00, 95%CI 1.64 to 4.36), disease time to progression (MD=1.85, 95%CI 1.15 to 2.55), and the response rate (RR=1.29, 95%CI 1.09 to 1.52) were superior in the combination arm to the docetaxel alone arm. Conclusion The current evidence available shows that the combination of capecitabine and docetaxel may significantly improve the short-term efficacy comparing with docetaxel alone. However, adverse events and long-term efficacy are not clear; more high-quality RCTs should be conducted.
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
目的 检测血管内皮生长因子（VEGF）、白细胞分化抗原34（CD34）及CXC趋化因子受体4（CXCR4）在转移性鼻咽癌患者鼻咽部肿瘤组织中的表达，探讨它们与鼻咽癌各种临床病理因素的关系以及它们之间的相互联系。 方法 采用免疫组织化学链霉素抗生物素蛋白-过氧化物酶连结法检测2003年3月－2009年5月35例转移性鼻咽癌患者VEGF、CD34及CXCR4在鼻咽部肿瘤组织中的表达情况，结合患者临床病理特征进行分析。 结果 转移性鼻咽癌患者鼻咽部肿瘤组织中的VEGF及CXCR4阳性表达率分别为62.9%（22∕35）和42.9%（15∕35），CD34计数为11～92，平均43.2 ± 20.5。无肺转移较有肺转移的患者VEGF的阳性表达率高（78.9%、43.8%，P=0.043），多器官转移较单器官转移的患者CXCR4的表达强度高（62.5%、26.3%，P=0.044）。 结论 VEGF表达阳性的患者易发生肺转移；CXCR4强表达的患者易发生多器官转移。
【摘要】 目的 探讨超声在诊断颈部转移性与淋巴瘤性淋巴结中的应用价值。 方法 2007年1月-2008年12月对经病理证实的102例患者120个颈部淋巴结，应用二维超声、能量多普勒显像（PDI）分为两组:转移性淋巴结68个，淋巴瘤性淋巴结52个。对淋巴结长短比（L/S）、结构及血流分布状态进行分析。 结果 两组淋巴结门消失、局部液化灶、中央血流率比较差异有统计学意义（Plt;0.05），两组出现淋巴结形态不规则、皮质回声减低、淋巴门型血流、周围型血流率比较差异有统计学意义（Plt;0.05）。两组的L/S≤2淋巴结无统计学差异（Pgt;0.05）。 结论 超声检查对颈部转移性淋巴结与淋巴瘤性淋巴结的鉴别诊断有较高价值。【Abstract】 Objective To explore the application value of the ultrasound in diagnosis of metastatic and lymphoma lymph nodes of the neck. Methods From January 2007 to December 2008, 120 neck lymph nodes of 102 patients confirmed by pathology were divided into two groups, including 68 metastatic lymph nodes and 52 lymphoma lymph nodes. The reports of two groups were performed using two-dimensional ultrasonography and power Doppler imaging (PDI). The long-short axis ratio (L/S), structure, blood flow pattern of lymph nodes were studied. Results The rate of the lymph door disappearance, inner liquefacient position and central blood stream in two groups had statistical difference (Plt;0.05). The rate of irregular form, diminution of cortical resonance, blood stream of lymph door and peripheral flow in two groups had statistical difference (Plt;0.05), but the difference of their L/S≤2 had no statistical significance (Pgt;0.05). Conclusion The ultrasonography is a valuable method for diagnosing between neck metastatic nodes and lymphoma lymph nodes.
ObjectiveTo explore the expressions of survivin, p53, and Ki67 in recurrence or metastasis breast cancer tissue, and explore their correlations and clinical significance. MethodsEighty-six patients with the chest wall local recurrence, axillary or supraclavicular lymph node metastases get treated in this hospital between January 2005 and January 2010 were excised and the expressions of survivin, p53, and Ki67 were detected by immunohistochemistry test, then compared them between the recurrence and metastasis breast cancer tissues and the primary breast cancer tissues. ResultsThe positive expression rate of survivin, p53, and Ki67 in the recurrence and metastasis breast cancer tissues were significantly higher than those in the primary breast cancer tissues, survivin: 90.70% (78/86) versus 61.63% (53/86), χ2=20.014 895, Plt;0.001; p53: 68.60% (59/86) versus 52.33% (45/86), χ2=4.766 968, Plt;0.05; Ki67: 62.79% (54/86) versus 46.51% (40/86), χ2=4.597 927，Plt;0.05. The positive expression rates of survivin in the recurrence and metastasis patients with p53, Ki67 negative expression were significantly higher than those of the primary breast cancer tissue (70.37% versus 24.39%, χ2=14.071 113, Plt;0.05; 75.00% versus 39.13%, χ2=6.540 373, Plt;0.05). The correlation coefficient of survivin with p53 and Ki67 positive expressions in the recurrence and metastasis breast cancer tissue and the primary breast cancer tissue were 0.876 214, 0.773 643 and 0.725 164, 0.698 112, respectively, Plt;0.05. ConclusionThe positive expression rates of survivin, p53, and Ki67 which increase in recurrence and metastasis breast cancer tissue indicate bad prognosis.