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中华肿瘤杂志
中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院
中华肿瘤杂志

中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院

赵平

月刊

0253-3766

chinjoncol@yahoo.com.cn

010-87788229

100021

北京市朝阳区潘家园南里17号

中华肿瘤杂志/Journal Chinese Journal of OncologyCSCD北大核心CSTPCD
查看更多>>1979年创刊，中国科学技术协会主管，中华医学会主办。本刊是肿瘤专业学术期刊，始终坚持基础与临床相结合的方针，以我国肿瘤防治研究工作的主要成就、进展及新动向为报道重点，记载了我国防癌、抗癌事业的发展历程，展现了我国防癌、抗癌事业所取得的辉煌成就。《中华肿瘤杂志》已被Medline等14个数据库和25个文摘期刊收录。1999年获第一届国家期刊奖提名奖。1992—2002年连续三次获得中国科协优秀学术期刊奖。2001—2010年连续九次获“百种中国杰出学术期刊”称号。被中国自然科学核心期刊研究课题组评为中国自然科学核心期刊，被中国国家新闻出版总署定为中国期刊方阵双奖期刊。
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    转录因子En1通过调控Hedgehog信号通路促进食管鳞状细胞癌细胞增殖和迁移

    赵宁巩彤阳魏子超从计...
    99-107页
    查看更多>>摘要：目的 探讨转录因子En1在食管鳞状细胞癌（ESCC）细胞中的功能及机制。 方法 利用癌症基因组图谱数据库（TCGA）中9 397例泛癌患者的En1表达和总生存资料、4 349例泛癌患者的En1表达和无进展生存资料，分析泛癌中En1表达水平与患者预后的关系。利用基因表达综合数据库（GEO）的53对和国家基因组科学数据中心-组学原始数据归档库（NGDC-GSA）的155对ESCC组织和配对癌旁组织的基因表达资料分析ESCC组织中En1的表达水平。以慢病毒系统介导ESCC细胞KYSE180和KYSE450中En1基因敲降，采用细胞计数试剂盒8法和克隆形成实验检测细胞的增殖能力，Transwell实验检测细胞的迁移能力，采用裸鼠皮下移植瘤实验检测En1对ESCC细胞体内肿瘤生长的影响。采用实时荧光定量聚合酶链反应（RT-qPCR）检测细胞中En1及Hedgehog通路主要调控因子胶质瘤相关癌基因家族锌指1（GLI1）、GLI2和平滑蛋白（SMO）的表达。 结果 来自TCGA数据库的泛癌样本资料显示，En1低表达患者的总生存时间和无进展生存时间均比En1高表达患者更长（均P＜0.001）。来自GEO和NGDC-GSA数据库的资料显示，ESCC组织中En1的表达水平高于配对癌旁组织（均P＜0.001）。功能研究显示，与shNC组相比，敲降En1能显著抑制KYSE180和KYSE450细胞的增殖（均P＜0.001）、抑制克隆形成［KYSE180细胞：shEn1#1组和shEn1#2组的克隆形成数分别为（138.33±23.07）个和（127.00±19.70）个，均低于shNC组的（340.67±12.06）个（均P＜0.001）；KYSE450细胞：shEn1#1组和shEn1#2组的克隆形成数分别为（65.33±2.52）个和（9.00±3.00）个，均低于shNC组的（139.00±13.00）个（均P＜0.001）］、抑制迁移［KYSE180细胞：shEn1#1组和shEn1#2组的迁移细胞数分别为（66.67±12.66）和（71.33±11.02）个，均低于shNC组的（334.67±16.56）个（均P＜0.001）；KYSE450细胞：shEn1#1组和shEn1#2组的迁移细胞数分别为（112.33±14.57）和（54.33±5.51）个，均低于shNC组的（253.33±21.03）个（均P＜0.001）］。裸鼠皮下移植瘤实验显示，敲降En1肿瘤的生长速度减慢，shEn1#1组和shEn1#2组小鼠的移植瘤重量分别为（0.046±0.026）g和（0.047±0.025）g，均低于shNC组［（0.130±0.038）g，均P＜0.001］。RT-qPCR检测结果显示，shEn1#1组和shEn1#2组KYSE180细胞中GLI1 mRNA表达量分别为0.326±0.162和0.322±0.133，shEn1#1组和shEn1#2组KYSE450细胞中GLI1 mRNA表达量分别为0.131±0.006和0.352±0.050，均低于shNC组（均P＜0.01）。在敲降En1的KYSE450细胞中过表达GLI1，能减弱敲降En1对细胞增殖（P＜0.001）、克隆形成［shEn1#1-GLI1组的克隆形成数为（151.00±9.54）个，高于shEn1#1-vector组的（102.33±10.02）个（P=0.004）］和迁移［shEn1#1-GLI1组的迁移细胞数为（193.67±10.07）个，高于shEn1#1-vector组的（109.33±11.50）个（P＜0.001）］的抑制作用。ESCC组织中GLI1、GLI2、GLI3、音猬因子、SMO和补缀同源物1的表达水平均高于配对癌旁组织，Hedgehog通路被激活。 结论 En1在ESCC组织中高表达，其通过调节Hedgehog信号通路在促进ESCC细胞增殖和迁移中发挥重要作用。 Objective To explore the function and mechanism of transcription factor En1 in esophageal squamous cell carcinoma (ESCC). Methods The correlations of En1 with prognosis were analyzed using the overall survival data of 9 397 pan-cancer patients and progression-free survival data of 4 349 pan-cancer patients from The Cancer Genome Atlas (TCGA) database. The En1 expression data in 53 and 155 cases of ESCC and their paired adjacent tissues were from Gene Expression Omnibus (GEO) database and National Genomics Data Center-Genome Sequence Archive(NGDC-GSA)database. Lentivirus was used to generate En1 stable knockout cell lines KYSE180 and KYSE450. The proliferation ability of the cells was detected by cell counting kit 8 and clone formation assay. The migration ability of the cells was detected by Transwell assay. The effect of En1 on the proliferation of ESCC was detected by xenograft experiment in BALB/c-nu/nu mice. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was used to detect the expressions of En1, glioma-associated oncogene family zinc finger 1 (GLI1), glioma-associated oncogene family zinc finger 2 (GLI2) and smoothened (SMO). Results Pan-cancer data from TCGA showed that patients with low En1 expression had longer overall survival and progression-free survival than patients with high En1 expression (P< 0.001). Data from GEO and GSA databases also showed a high expression level of En1 in ESCC tissues compared with paired tissues (P＜0.001). Proliferation was inhibited after knockout of En1 in KYSE180 and KYSE450 cells (P＜0.001). The colony formation numbers decreased. The colony formation numbers of KYSE180 cells in the shEn1#1 group and the shEn1#2 group were 138.33±23.07 and 127.00±19.70, respectively, significantly lower than that of the shNC group 340.67±12.06 (P<0.001). The colony formation numbers of KYSE450 cells in the shEn1#1 group and the shEn1#2 group were 65.33±2.52 and 9.00±3.00, respectively, significantly lower than that of the shNC group 139.00±13.00 (P<0.001). The migration numbers was inhibited after knockout of En1 [the Transwell numbers of KYSE180 cells in the shEn1#1 group and the shEn1#2 group were 66.67±12.66 and 71.33±11.02, respectively, significantly lower than that of the shNC group 334.67±16.56 (P<0.001). The Transwell numbers of KYSE450 cells in the shEn1#1 group and the shEn1#2 group were 112.33±14.57 and 54.33±5.51, respectively, significantly lower than that of the shNC group 253.33±21.03 (P<0.001)]. Xenograft model showed a slower growth rate of shEn1#1 and shEn1#2 cell lines (P＜0.001). The tumor weights of KYSE450 cells in the shEn1#1 group and the shEn1#2 group were (0.046±0.026)g and (0.047±0.025)g, respectively, significantly lower than that of the shNC group (0.130±0.038)g (P＜0.001). After knockdown of En1, the relative expression levels of GLI1 in KYSE180 cells of the shEn1#1 group and the shEn1#2 group were 0.326±0.162 and 0.322±0.133, and the relative expression levels of GLI1 in KYSE450 cells of the shEn1#1 and shEn1#2 groups were 0.131±0.006 and 0.352±0.050, respectively, which were all lower than that in the shNC group (P＜0.01). After knockdown of En1, overexpression of GLI1 attenuated the inhibitory effect of knockdown of En1 on cell proliferation (P＜0.001), colony formation[the colony formation numbers of the shEn1#1-GLI1 group were 151.00±9.54, higher than 102.33±10.02 (P=0.004) of the shEn1#1-vector group] and migration [the migration numbers of the shEn1#1-GLI1 group were 193.67±10.07, higher than 109.33±11.50 (P<0.001) in the shEn1#1-vector group]. In clinical samples of ESCC, major regulatory factors of the Hedgehog pathway were up-regulated and the pathway was activated. Conclusion En1 promotes the proliferation and migration of ESCC cells by regulating the Hedgehog pathway and can be used as a new potential target for targeted therapy of ESCC.

    食管鳞状细胞癌En1Hedgehog通路细胞增殖细胞迁移

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    敲降Ras相关结合蛋白23表达对食管鳞状细胞癌细胞侵袭和迁移的影响及机制

    马刚梁寒张汝鹏孙意...
    108-117页
    查看更多>>摘要：目的 探讨Ras相关结合蛋白23（RAB23）在食管鳞状细胞癌（简称食管鳞癌）细胞侵袭和迁移中的作用和机制。 方法 采用实时荧光定量聚合酶链反应检测16例配对食管鳞癌及癌旁正常组织中RAB23 mRNA的表达。比较基因表达综合（GEO）数据库的GSE20347数据集中食管鳞癌和配对癌旁正常组织RAB23 mRNA的表达水平。免疫组织化学检测106例配对食管鳞癌和癌旁正常组织、33例淋巴结阳性与10例淋巴结阴性患者原发灶与淋巴结组织中RAB23蛋白含量。在食管鳞癌KYSE30和KYSE150细胞中瞬时敲降RAB23表达（转染si-RAB23-1和si-RAB23-9）或者稳定敲降RAB23表达（转染sh-RAB23），采用Western blot法验证RAB23敲降效率，采用细胞计数试剂盒8法和裸鼠皮下成瘤实验检测食管鳞癌细胞的增殖能力，采用Transwell实验和裸鼠尾静脉-肺转移实验检测食管鳞癌细胞的侵袭和迁移能力，采用细胞黏附实验检测食管鳞癌细胞的黏附能力，采用转录组测序技术分析RAB23敲降后对细胞转录谱的影响，并通过Western blot检测验证相关信号通路。 结果 16例食管鳞癌组织中RAB23 mRNA表达水平为0.009 7±0.008 9，高于癌旁正常组织［0.003 2±0.003 7，P=0.006］。对GEO数据库GSE20347数据集中食管鳞癌和配对癌旁正常组织表达谱的生信分析显示，食管鳞癌组织中RAB23 mRNA表达水平为4.30±0.25，高于癌旁正常组织（4.10±0.17，P=0.037）。106例食管鳞癌组织中，51例RAB23低表达，55例RAB23高表达；而配对癌旁正常组织中，82例RAB23低表达，24例RAB23高表达，食管鳞癌组织中RAB23表达水平高于配对癌旁正常组织（P＜0.001）。33例淋巴结阳性食管鳞癌组织中，1例RAB23低表达，32例RAB23高表达；10例淋巴结阴性的食管鳞癌组织中，3例RAB23低表达，7例RAB23高表达。淋巴结阳性食管鳞癌组织中RAB23表达水平高于淋巴结阴性食管鳞癌组织（P=0.024）。33例阳性淋巴结组织中，1例RAB23低表达，32例RAB23高表达，而10例阴性淋巴结组织中均为RAB23低表达。阳性淋巴结组织中RAB23表达水平高于阴性淋巴结组织（P＜0.001）。瞬时或稳定敲降RAB23后，KYSE30细胞体外和体内的增殖能力无明显变化，KYSE30细胞的细胞侵袭和迁移能力下降，而KYSE150细胞仅侵袭能力下降，迁移能力无明显变化。sh-RAB23组KYSE30细胞黏附细胞的数量为（313.75±89.34）个，少于sh-NC组［（1 030.75±134.29）个，P＜0.001］。sh-RAB23组KYSE150细胞的黏附细胞数为（710.5±31.74）个，也少于sh-NC组［（1 005.75±61.09）个，P＜0.001］。转录组测序分析显示，敲降RAB23后，si-RAB23-1组和si-RAB23-9组KYSE30细胞中黏着斑相关信号通路均被削弱，sh-RAB23组KYSE30和KYSE150细胞中p-FAK和p-paxillin表达水平降低。 结论 RAB23在食管鳞癌组织中高表达，与淋巴结转移有关。敲低RAB23表达后能够削弱黏着斑相关信号通路，进而抑制食管鳞癌细胞的侵袭、迁移和黏附。 Objective To investigate the role and the mechanism of Ras-associated binding protein23 (RAB23) in the migration and invasion of esophageal squamous cell carcinoma (ESCC) cells. Methods RAB23 mRNA levels were measured in 16 pairs of ESCC and adjacent normal tissues via real-time polymerase chain reactions. RAB23 mRNA levels in the ESCC and adjacent normal tissues of dataset GSE20347 deposited in the Gene Expression Omnibus (GEO) database were also analyzed. Immunohistochemistry (IHC) was used to detect the RAB23 protein expressions in 106 pairs of ESCC and adjacent normal tissues, as well as in the lymph glands and primary tumor tissues of 33 patients with positive lymph nodes and 10 patients with negative lymph nodes. Endogenous RAB23 expression was transiently depleted using siRNAs (si-NC, si-RAB23-1, and si-RAB23-9) or stably reduced using shRNAs (sh-NC and sh-RAB23) in ESCC KYSE30 and KYSE150 cells, and the knockdown efficiency was tested using Western blot assays. Cell counting kit-8 assays and mouse xenograft models were used to test the proliferation of ESCC cells. Transwell assays and tail vein-pulmonary metastasis models in immunocompromised mice were used to examine the migration and invasion of ESCC cells. Cell adhesion assays were used to test the adhesion of ESCC cells. RNA-seq assays were used to analyze how RAB23 knockdown influenced the expression profile of ESCC cells and the implicated signal pathways were confirmed using Western blot assays. Results The RAB23 mRNA expression in 16 cases of ESCC tissues was 0.009 7±0.008 9, which was markedly higher than that in adjacent normal tissues (0.003 2±0.003 7, P=0.006). GEO analysis on RAB23 expressions in ESCC and adjacent normal tissues showed that the RAB23 mRNA level in ESCC tissues (4.30±0.25) was remarkably increased compared with their normal counterparts (4.10±0.17, P=0.037). Among the 106 pairs of ESCC and tumor-adjacent normal tissues, 51 cases exhibited low expression of RAB23 and 55 cases showed high expression of RAB23, whereas in the paired tumor-adjacent normal tissues 82 cases were stained weakly and 24 strongly for RAB23 protein. These results indicated that RAB23 expression was markedly increased in ESCC tissues (P<0.001). Additionally, only 1 out of 33 primary ESCC tissues with positive lymph nodes showed low RAB23 protein expression. On the other hand, 7 samples of primary ESCC tissues with negative lymph nodes were stained strongly for RAB23 while its level in the other 3 samples was weak. These results showed that RAB23 expression was remarkably increased in primary ESCC tissues with positive lymph nodes compared with those with negative lymph nodes (P=0.024). Further tests showed that 32 out of 33 positive lymph nodes were stained strongly for RAB23, whereas no negative lymph nodes (n=10) exhibited high expression of RAB23 (P<0.001). Both transient and stable knockdown of endogenous RAB23 expression failed to cause detectable changes in the proliferation of KYSE30 cellsin vitro and in vivo, but attenuated the migration and invasion of KYSE30 cells as well as the invasion of KYSE150 cells. RAB23 knockdown was found to significantly decrease the number of adhesive KYSE30 cells in the sh-RAB23 group (313.75±89.34) compared with control cells in the sh-NC group (1 030.75±134.29, P<0.001). RAB23 knockdown was also found to significantly decrease the number of adhesive KYSE150 cells in the sh-RAB23 group (710.5±31.74) compared with the number of control cells in the sh-NC group (1 005.75±61.09,P<0.001). RNA-seq assays demonstrated that RAB23 knockdown using two siRNAs targeting RAB23 mRNA markedly impaired focal adhesion-related signal pathways, and decreased the levels of phosphorylated FAK (p-FAK) and phosphorylated paxillin (p-paxillin) in KYSE30 and KYSE150 cells. Conclusions Significantly increased RAB23 in ESCC tissues positively correlates with lymph node metastasis. Depleted RAB23 expression attenuates focal adhesion-related signal pathways, thus impairing the invasion, metastasis, and adhesion of ESCC cells.

    食管鳞状细胞癌Ras相关结合蛋白23黏着斑侵袭迁移

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    血浆热休克蛋白90α预测肝细胞肝癌介入治疗预后的临床价值

    孙伟李肖王书亚
    118-126页
    查看更多>>摘要：目的 探讨血浆热休克蛋白90α（HSP90α）与肝细胞肝癌（HCC）患者经动脉化疗栓塞（TACE）治疗反应及长期预后的关系。 方法 收集2017年8月至2018年12月在中国医学科学院肿瘤医院介入治疗科进行TACE治疗的96例HCC患者的病历资料，采用χ2检验分析TACE治疗前血浆HSP90α水平与临床病理特征的关系，TACE治疗应答的影响因素分析采用单因素和多因素logistic回归分析，TACE治疗后患者无进展生存时间（PFS）的影响因素分析采用单因素和多因素Cox回归分析。 结果 96例患者TACE治疗前的血浆HSP90α水平为（99.70±66.61）ng/ml。高HSP90α组（30例）比低HSP90α组（66例）肿瘤更大、甲胎蛋白更高、血管侵犯阳性者更多、巴塞罗那临床肝癌（BCLC）分期更晚（均P＜0.05）。TACE治疗4周后评估，应答组41例，无应答组55例。应答组与无应答组患者TACE治疗前后HSP90α水平差值分别为（-32.20±22.79）ng/ml和（7.20±51.94）ng/ml，差异有统计学意义（P＜0.001）。多因素logistic回归分析显示，Child-Pugh分级（OR=0.186，P=0.046）、血管侵犯（OR=0.132，P=0.025）、TACE治疗后血浆HSP90α降低百分比（25%～50%：OR=5.061，P=0.013；＞50%：OR=86.831，P＜0.001）是HCC TACE治疗应答的独立影响因素。96例患者的中位PFS为8.7个月。多因素Cox回归分析显示，BCLC分期（B期：HR=2.804，P=0.008；C期：HR=4.628，P＜0.001）和TACE治疗后血浆HSP90α降低百分比（25%～50%：HR=0.569，P=0.051；＞50%：HR=0.198，P＜0.001）是TACE治疗后HCC患者PFS的独立影响因素。 结论 血浆HSP90α作为一种新的生物标志物，可用于预测HCC患者TACE治疗的疗效和预后。 Objective To evaluate the relationship between plasma heat shock protein 90α (HSP90α) levels and treatment response after four weeks and long-term prognosis after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Methods The clinical data of HCC patients who underwent TACE in the Department of Interventional Radiology, Cancer Hospital of Chinese Academy of Medical Sciences from August 2017 to December 2018 were retrospectively collected. Chi-square tests were used to analyze the relationship between plasma HSP90α level and clinicopathological features before TACE treatment. Univariate and multivariate logistic regression analysis was used to analyze the influencing factors of TACE treatment response. Univariate and multivariate Cox regression analysis was used to analyze the influencing factors of progression-free survival (PFS) after TACE treatment. Results The expression level of plasma HSP90α in 96 patients before TACE treatment was (99.70 ± 66.61) ng/ml. Compared with the low HSP90α group (n=66), the high HSP90α group (n=30) had larger tumors, higher alpha-fetoprotein enrichment, more positive vascular invasions, and more advanced Barcelona Clinic Liver Cancer (BCLC) stages (all P<0.05). After four weeks of TACE treatment, 41 patients in the response group and 55 patients in the non-response group were evaluated. The difference of HSP90α expression levels between the response group and the non-response group before and after TACE treatment was (-32.20±22.79) ng/ml and (7.20±51.94) ng/ml, respectively, and the difference was statistically significant (P<0.001). Multivariate logistic regression analysis showed that Child-Pugh classification (OR=0.186, P=0.046), vascular invasion (OR=0.132, P=0.025), and the percentage reduction of plasma HSP90α after TACE treatment (percentage reduction 25%-50%: OR=5.061, P=0.013 percentage reduction >50%: OR= 86.831, P<0.001) were independent influencing factors for the response to TACE treatment in HCC. The median PFS of the 96 patients was 8.7 months. Multivariate Cox regression analysis showed that BCLC stage (stage B:HR=2.804, P=0.008 stage C: HR=4.628, P<0.001) and the percentage reduction of plasma HSP90α after TACE treatment (percentage reduction 25%-50%:HR=0.569, P=0.051 percentage reduction >50%: HR=0.198, P<0.001) were independent influence factors for the PFS in these HCC patients after TACE treatment. Conclusion Plasma HSP90α may represent a novel biomarker for predicting efficacy of TACE and PFS of patients with HCC.

    肝细胞肝癌经动脉化疗栓塞热休克蛋白90α治疗应答预后

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    甲状腺乳头状癌杨氏模量平均值与组织病理特征的相关性研究

    苏莉莉康晓妍李雪婷李雅琴...
    127-132页
    查看更多>>摘要：目的 探讨影响甲状腺乳头状癌（PTC）病灶硬度的组织病理因素。 方法 选取2019年1月至2020年12月在山西白求恩医院经手术病理证实的PTC患者96例，结节101个。术前行二维超声和实时剪切波弹性成像（SWE）检查，并测量PTC结节的杨氏模量平均值（Emean）。术后对PTC结节进行组织病理检测，包括病灶大小、数量、钙化类型、有无被膜及被膜外侵犯、纤维化程度、微血管密度、肿瘤细胞数量。分析病灶大小、纤维化程度、微血管密度、肿瘤细胞数量与Emean的相关性，比较不同病灶数量、有无被膜及被膜外侵犯、不同病理钙化类型间PTC结节的Emean，采用多元线性回归分析评估影响Emean的组织病理因素。 结果 101个PTC结节病灶大小为（1.29±0.95）cm，纤维化程度为（30.64±18.37）%，微血管密度为（101.64±30.7）条/高倍视野，PTC肿瘤细胞数量为（373.52±149.87）个/高倍视野，Emean为（36.47±19.62）kPa。相关分析显示，PTC病灶大小、纤维化程度与Emean呈正相关（r=0.660，P＜0.001；r=0.789，P＜0.001），PTC微血管密度与Emean呈负相关（r=-0.198，P=0.047）。有被膜及被膜外侵犯组Emean高于无被膜及被膜外侵犯组（P=0.014），不同病理钙化类型的Emean差异有统计学意义（P=0.001）。多元线性回归分析显示，病灶大小（β=0.325，P＜0.001）、纤维化程度（β=0.563，P＜0.001）、砂砾体（β=0.177，P=0.001）、基质钙化（β=0.164，P=0.003）、砂砾体基质混合钙化（β=0.163，P=0.003）对Emean的影响有统计学意义，其中纤维化程度影响最大。 结论 PTC病灶的Emean与组织病理特征有关，病灶大小、纤维化程度及钙化均对Emean有明显影响，其中纤维化程度影响最大。 Objective To explore the histopathological factors affecting the stiffness of papillary thyroid carcinoma (PTC). Methods Ninety-six patients with PTC confirmed by surgery and pathology in Shanxi Bethune Hospital from January 2019 to December 2020 were selected, including 101 nodules. Two-dimensional ultrasound and shear-wave elastography (SWE) were performed before surgery and the average Young's modulus (Emean) of PTC nodules were measured. Histopathological examinations on the nodules were conducted after surgery to decide the lesion size, number of lesions, calcification type, presence or absence of capsular and extracapsular invasion, degree of fibrosis, microvessel density, and number of tumor cells. The correlations between the lesion size, degree of fibrosis, microvessel density, and number of tumor cells and the Emean were analyzed. The Emeans of nodules with different numbers of lesions, presence or absence of capsular and extracapsular invasion, and different pathological calcification types were compared. The multiple linear regression analysis was used to evaluate the histopathological factors influencing the Emean. Results The ranges of the lesion sizes, degrees of fibrosis, microvascular density, numbers of tumor cells, and the Emeans of the 101 investigated PTC nodules were (1.29±0.95) cm, (30.64±18.37)%, (101.64±30.7) vessels per high power field, (373.52±149.87) cells per high power field, and (36.47±19.62) kPa, respectively. Correlation analysis showed that the lesion size of PTC and the degree of fibrosis were positively correlated with the Emean (r=0.660, P＜0.001 r=0.789, P＜0.001), while the microvessel density was negatively correlated with the Emean (r=-0.198, P=0.047). The Emean of the group with capsular and extracapsular invasion was higher than that of the group without (P=0.014). There were statistical differences in the Emeans among different types of pathological calcification (P＜0.001). The multiple linear regression analysis showed that the lesion size (β=0.325, P＜0.001), degree of fibrosis (β=0.563, P＜0.001), psammoma bodies (β=0.177, P=0.001), stromal calcification (β=0.164, P=0.003), and mixed calcification of both psammoma bodies and stroma (β=0.163, P=0.003) were independent influencing factors for the Emean. The degree of fibrosis had the greatest impact on the Emean. Conclusions The Emean of PTC lesions was correlated with the histopathological characteristics of PTC. The lesion size, degree of fibrosis, and calcification had significant impact on the Emean, among which the degree of fibrosis had the greatest impact.

    甲状腺乳头状癌剪切波弹性成像杨氏模量平均值组织病理特征

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    不同大小甲状腺髓样癌与甲状腺乳头状癌的超声特征比较

    张岱杨凡王莹穆佳丽...
    133-139页
    查看更多>>摘要：目的 探讨不同大小甲状腺髓样癌（MTC）的超声特征，为不同大小MTC和甲状腺乳头状癌（PTC）的鉴别诊断提供有效信息。 方法 2018年6月至2022年3月在天津医科大学肿瘤医院超声检查发现并经病理证实的MTC患者87例，PTC患者220例。以甲状腺结节最大径1 cm为界值，将患者分为小结节组（最大径≤1 cm）和大结节组（最大径＞1 cm）。小结节组97例，其中MTC 28例，PTC 69例。大结节组210例，其中MTC 59例，PTC 151例。按甲状腺结节分层后，比较MTC与PTC患者甲状腺结节和转移性淋巴结的超声声像图特征、术前血清降钙素（CT）和癌胚抗原（CEA）水平。 结果 在小结节组中，MTC表现为低回声、边缘光滑、有血流信号的比例高于PTC，差异有统计学意义（均P＜0.05）。在大结节组中，MTC表现为囊实性、低回声、边缘光滑、有血流、血管分布为Ⅳ型的比例高于PTC，并且MTC与PTC的钙化类型差异也有统计学意义（均P＜0.05）。而无论结节大小，MTC与PTC的病灶数量、纵横比差异均无统计学意义（均P＞0.05）。在小结节组中，分别有6例甲状腺髓样癌转移性淋巴结（LNM-MTC）和11例甲状腺乳头状癌转移性淋巴结（LNM-PTC）被超声正确诊断，超声对二者的诊断符合率分别为78.6%（22/28）和78.3%（54/69），差异无统计学意义（P=0.973）。大结节组中，分别有28例LNM-MTC和83例LNM-PTC被超声正确诊断，超声对二者的诊断符合率分别为88.1%（52/59）和73.5%（111/151），差异有统计学意义（P=0.022），其中82.1%的LNM-MTC和56.6%的LNM-PTC表现为血流信号异常，二者比较差异有统计学意义（P=0.016）。小结节组和大结节组MTC患者术前血清CT、CEA水平差异均有统计学意义（均P＜0.05）。 结论 不同大小的MTC超声特征不同，淋巴结内异常血流信号对LNM-MTC的诊断具有重要意义。在缺乏超声特征的情况下，结合术前血清CT检测有助于MTC的诊断。 Objective To investigate the ultrasonographic features of medullary thyroid carcinomas (MTCs) of different sizes and supply valid information for separating MTCs from papillary thyroid carcinomas (PTCs). Methods There were 87 patients with MTC and 220 patients with PTC detected by ultrasonography and confirmed by pathology at Tianjin Medical University Cancer Institute and Hospital from June 2018 to March 2022. Nodules were divided into the large nodule group (the maximum diameter of the tumor was＞1 cm) and the small nodule group (the maximum diameter of the tumor was ≤1 cm). There were 97 cases in the small nodule group, including 28 cases of MTC and 69 cases of PTC. There were 210 cases in the large nodule group, including 59 cases of MTC and 151 cases of PTC. After stratification by thyroid nodules, ultrasonographic features of thyroid nodules and metastatic lymph nodes, preoperative serum calcitonin (CT) and carcinoembryonic antigen (CEA) levels were compared between MTC and PTC patients. Results In the small nodule group, the proportion of MTCs exhibiting hypoecho, smooth margins, and having blood flow signals was higher than that of PTCs, with statistically significant differences (all P＜0.05). In the large nodule group, the proportion of MTCs showing cystic solidity, hypoecho, smooth margins, blood flow, and the type Ⅳvascular distribution was higher than PTCs, and the difference of calcification type between them was also statistically significant (allP＜0.05). In contrast, the differences in the number of lesions and aspect ratio between MTCs and PTCs were not statistically significant regardless of nodule size (all P＞0.05). In the small nodule group,6 metastatic lymph nodes of medullary thyroid carcinoma (LNM-MTC) and 11 metastatic lymph nodes of papillary thyroid carcinoma (LNM-PTC) were correctly diagnosed by ultrasound, respectively. The diagnostic compliance rate of ultrasound was 78.6% (22/28) and 78.3% (54/69), respectively, with no statistically significant difference (P=0.973). In the large nodule group, 28 LNM-MTC and 11 LNM-PTC were correctly diagnosed by ultrasound, respectively. The diagnostic compliance of ultrasound was 88.1% (52/59) and 73.5% (111/151), respectively, which was statistically significant (P=0.022). Among them, 82.1% of LNM-MTC and 56.6% of LNM-PTC showed abnormal blood flow signals, with a statistically significant difference (P=0.016). There were significant differences in preoperative serum CT and CEA levels of different sizes of MTCs (all P＜0.05). Conclusions Different sizes of MTCs require diverse demonstrative criteria. Abnormal blood flow signal is of great significance in the diagnosis of LNM-MTC. Within the absence of ultrasonic characteristics, preoperative serum CT test can provide confidence for the diagnosis of MTC.

    甲状腺髓样癌甲状腺乳头状癌超声降钙素

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    吲哚菁绿荧光导航的侧方前哨淋巴结活检在腹腔镜直肠癌侧方淋巴结清扫中的临床意义

    苏昊徐正包满都拉罗寿...
    140-145页
    查看更多>>摘要：目的 探讨应用吲哚菁绿（ICG）荧光导航技术的直肠癌侧方前哨淋巴结活检（SLNB）在腹腔镜直肠癌侧方淋巴结清扫（LLND）中的临床意义，评估该技术预测侧方淋巴结（LPLN）状态的准确性和可行性。 方法 回顾性分析2017年4月至2022年10月中国医学科学院肿瘤医院结直肠外科在腹腔镜直肠癌LLND术中行ICG荧光导航的侧方SLNB的16例直肠癌患者的临床病理资料。入组患者未行术前新辅助放疗且LPLN可见但未明确转移（在高分辨率MRI图像中，LPLN最大短径为5.0～9.9 mm）。随访观察患者的术后并发症。 结果 16例患者均在腹腔镜直肠癌LLND术中成功完成ICG荧光导航的侧方SLNB。3例患者行双侧LLND，13例患者行单侧LLND。14例患者侧方前哨淋巴结（SLN）可见明显荧光显像，SLN检出率为87.5%。其中2例患者侧方SLN术中冰冻病理发现肿瘤转移，12例患者侧方SLN术中冰冻病理阴性。在14例侧方SLN荧光显像的患者中，侧方清扫的非前哨淋巴结（NSLB）均为阴性。2例无侧方SLN荧光显像的患者，所有切除的LPLN均为阴性。SLNB的特异度为85.7%，灵敏度、阴性预测值和准确性均为100%。术后1例患者出现切口感染，1例患者出现造口周围皮炎。 结论 ICG荧光导航的侧方SLNB在预测LPLN状态方面安全可行，并具有良好的准确性，该技术有望替代局部晚期直肠癌的预防性LLND。 Objectives This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

    直肠肿瘤侧方淋巴结清扫前哨淋巴结吲哚菁绿荧光导航

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    合并患侧腋窝癌结节乳腺癌患者的临床病理特征及预后影响因素

    肖晶晶黄美玲延常姣凌瑞...
    146-154页
    查看更多>>摘要：目的 探讨合并患侧腋窝癌结节乳腺癌患者的临床病理特点及预后影响因素。 方法 分析2008年1月至2018年9月在西京医院甲状腺乳腺血管外科初次确诊乳腺癌且合并患侧腋窝癌结节的155例乳腺癌患者的临床及随访资料，采用Kaplan-Meier法进行生存分析，预后影响因素的单因素分析采用Log rank检验，多因素分析采用Cox回归分析。 结果 155例患者患者的中位无病生存时间（DFS）为52.0个月，中位无远处转移生存时间（DMFS）为66.6个月，中位总生存时间（OS）为102.2个月。5年和10年无复发转移生存率分别为45.7%和23.1%，5年和10年无远处转移生存率分别为56.9%和28.9%，5年和10年总生存率分别为79.3%和46.0%。多因素Cox回归分析显示，家族肿瘤病史（HR=0.362，95% CI：0.140～0.937）、临床T分期（T3期：HR=3.508，95% CI：1.380～8.918；T4期：HR=2.220，95% CI：1.076～4.580）、雌/孕激素受体状态（HR=0.476，95% CI：0.261～0.866）、癌结节数量（HR=1.965，95% CI：1.104～3.500）以及是否新辅助化疗（HR=1.961，95% CI：1.032～3.725）是患者DFS的独立影响因素，分子分型［表皮生长因子受体2（HER-2）阳性激素受体阴性：HR=7.862，95% CI：3.189～19.379］、癌结节数量（HR=2.155，95% CI：1.103～4.212）、是否新辅助化疗（HR=5.002，95% CI：2.300～10.880）以及放疗（HR=2.316，95% CI：1.005～5.341）是患者DMFS的独立影响因素，组织学分级（HR=4.362，95% CI：1.932～9.849）、雌/孕激素受体表达（HR=0.399，95% CI：0.168～0.945）、HER-2表达（HR=2.535，95% CI：1.114～5.768）以及是否新辅助化疗（HR=4.080，95% CI：1.679～9.913）是患者OS的独立影响因素。 结论 癌结节的存在削弱了腋窝淋巴结状态和是否有远处转移对乳腺癌患者预后的影响，应制定将癌结节考虑在内的乳腺癌临床病理分期系统。癌结节数量影响乳腺癌患者的复发转移风险，建议在乳腺癌术后病理报告中详细报告检出的癌结节数量。 Objective To investigate the clinicopathologic features and prognostic factors of breast cancer patients with tumor deposits in the ipsilateral axillary region. Methods We retrospectively analyzed the clinicopathologic data and follow-up results of 155 patients with breast cancer diagnosed for the first time and complicated with tumor deposits in the ipsilateral axillary region in the Department of Thyroid-Breast-Vascular Surgery of Xijing Hospital from January 2008 to September 2018. Kaplan-Meier method was used for survival analysis. Log rank test was used for the univariate analysis of prognostic factors, and Cox regression was used for multivariate analysis. Results The median disease free survival (DFS), median distant metastasis free survival (DMFS), and median overall survival (OS) of the 155 patients were 52.0 months, 66.6 months, and 102.2 months, respectively. The 5-year and 10-year DFS rates were 45.7% and 23.1%, the 5-year and 10-year DMFS rates were 56.9% and 28.9%, and the 5-year and 10-year OS rates were 79.3% and 46.0%, respectively. Multivariate Cox regression analysis showed that family tumor history (HR=0.362, 95% CI: 0.140-0.937), clinical T stage (T3: HR=3.508, 95% CI: 1.380-8.918 T4: HR=2.220, 95% CI: 1.076-4.580), estrogen/progesterone receptor status (HR=0.476, 95% CI: 0.261-0.866), number of tumor deposits (HR=1.965, 95% CI:1.104-3.500) and neoadjuvant chemotherapy (HR=1.961, 95% CI: 1.032-3.725) were independent influencing factors for DFS. Molecular subtype [human epidermal growth factor receptor-2(HER-2) positive and hormone receptor negative: HR=7.862, 95% CI: 3.189-19.379], number of tumor deposits (HR=2.155, 95% CI: 1.103-4.212), neoadjuvant chemotherapy (HR=5.002, 95% CI: 2.300-10.880) and radiotherapy (HR=2.316, 95% CI: 1.005-5.341) were independent influencing factors of DMFS. Histological grade (HR=4.362, 95% CI: 1.932-9.849), estrogen/progesterone receptor expression (HR=0.399, 95% CI: 0.168-0.945), HER-2 expression (HR=2.535, 95% CI: 1.114-5.768) and neoadjuvant chemotherapy (HR=4.080, 95% CI: 1.679-9.913) were independent influencing factors of OS. Conclusions The presence of tumor deposits weakens the influence of axillary lymph node status and distant metastases on the prognosis of breast cancer patients. Therefore, a clinicopathological staging system taking into account tumor deposits should be developed. Since the number of tumor deposits affects the risk of recurrence and metastasis of breast cancer patients, we recommend that the number of tumor deposits should be reported in detail in the pathological report after breast cancer surgery.

    乳腺肿瘤癌结节临床特征预后

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    人工腹水及人工软组织水肿辅助超声引导经皮热消融治疗特殊部位肝脏肿瘤

    冯莉王勇牛丽娟王书亚...
    155-160页
    查看更多>>摘要：目的 探讨人工腹水和（或）人工软组织水肿辅助超声引导经皮热消融治疗邻近膈肌、心脏、胃肠、胆囊及肾脏等特殊部位肝脏恶性肿瘤的应用价值及操作技巧。 方法 回顾分析132例特殊部位肝脏恶性肿瘤患者的临床资料。患者均在超声引导下建立人工腹水和（或）人工软组织水肿后实施热消融。评价建立人工腹水和（或）人工软组织水肿的完成情况、肿瘤完全消融情况及并发症发生情况。 结果 132例患者中，81例成功建立单纯人工腹水，人工腹水量（1 301±685）ml；19例成功建立单纯人工软组织水肿，人工软组织水肿量（534±258）ml；30例成功联合建立人工腹水及人工软组织水肿。水隔离技术总成功率为98.5%（130/132）。74例（108个病灶）行射频消融，58例（82个病灶）微波消融。共129例患者（186个病灶）顺利完成超声引导经皮热消融治疗，首次完全消融率为92.5%（172/186）。患者术后平均住院3 d，未出现肝表面肿瘤破裂、胃肠道穿孔、膈肌穿孔等严重并发症及治疗相关死亡。 结论 对于邻近膈肌、心脏、胃肠、胆囊及肾脏等特殊部位的肝脏恶性肿瘤，适时建立人工腹水和（或）人工软组织水肿辅助进行超声引导经皮热消融治疗，可提高肿瘤治疗的安全性，减少相邻重要脏器损伤，降低肝表面肿瘤破裂及膈肌穿孔的发生率，是一种安全有效的技术方法。 Objective To explore the application value and operation skills of ultrasound-guided percutaneous thermal ablation assisted by artificial ascites or/and soft tissue edema in the treatment of special hepatic tumors located nearby the diaphragm, heart, stomach, gastrointestinal tract, gall bladder, kidney, and other organs. Methods The clinical data of 132 patients with special-region hepatic tumors treated with ultrasound-guided percutaneous thermal ablation aided by artificial ascites and/or artificial soft tissue edema were retrospectively analyzed. Intraoperative contrast-enhanced ultrasound was used to guide ablation when necessary. During the operation, the ablation needle was lifted or pressed down, or the direction of the needle handle was changed to protect vital organs. The technical success rate of artificial ascites and/or soft tissue edema formation, the complete in activation rate of the tumor, and the complications were observed. Results There were 74 patients (108 lesions) treated with radiofrequency ablation and 58 patients (82 lesions) treated with microwave ablation. Among them, 81 cases was successfully injected artificial abdominal ascites, with a water volume of (1 301±685) ml artificial soft tissue edema was successfully formed for 19 patients, with a water volume of (534±258) ml. Both artificial ascites and artificial soft tissue edema were built for 30 patients. The success rate of this hydro-isolation technique was 98.5% (130/132). 129 patients successfully completed the treatment, and the complete inactivation rate of the tumor was 92.5% (172/186). The average postoperative hospital stay was three days. No patient had serious complications, such as surface tumor rupture, gastrointestinal injury, or diaphragm perforation. Conclusions For hepatic tumors located adjacent to other organs such as the diaphragm, heart, gastrointestinal tract, gallbladder, and kidney, the application of artificial ascites and/or artificial soft tissue edema can reduce the damage to these organs, as well as reduce the possibility of tumor rupture and diaphragm perforation. These methods are safe and effective in ultrasound-guided percutaneous thermal ablation.

    肝肿瘤特殊部位射频消融术微波消融术人工腹水人工软组织水肿

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    维奈克拉联合化疗治疗遗传学中高风险急性髓系白血病的疗效及对抗凋亡家族蛋白差异化表达的影响

    黄彬涛赵卫红王志玲向彩霞...
    161-167页
    查看更多>>摘要：目的 评价维奈克拉（VEN）联合化疗治疗具有不良遗传学特征的初治成年急性髓系白血病（AML）患者的疗效及对凋亡蛋白表达的影响。 方法 2019年4月至2022年5月内蒙古医科大学附属医院收治的38例AML患者，11例为遗传学中风险，27例为遗传学高风险。采用随机数字法将患者分为化疗组（18例）和VEN+化疗组（20例）。化疗组患者接受2个周期的诱导化疗［伊达吡星（或柔红霉素）+阿糖胞苷］和6个周期的强化化疗（阿糖胞苷）。VEN+化疗组患者在化疗组治疗方案的基础上口服VEN。采用Western blot方法检测患者初诊及强化化疗后骨髓血抗凋亡家族蛋白骨髓细胞白血病蛋白1（MCL-1）和B细胞淋巴瘤2（BCL-2）的表达。 结果 VEN+化疗组患者的客观缓解率（ORR）为90.0%，高于化疗组（55.6%，P=0.012）。化疗组患者的平均PFS为17.9个月，平均OS为21.3个月，VEN+化疗组患者的平均PFS为27.1个月，平均OS为32.2个月，均优于化疗组（P值分别为0.038和0.004）。在遗传学中风险患者中，化疗组ORR为80.0%（4/5），平均PFS为27.9个月，VEN+化疗组ORR为100%（6/6），平均PFS为32.0个月，两组差异均无统计学意义（P值分别为0.251和0.582）。在遗传学高风险患者中，化疗组ORR为46.2%（6/13），平均PFS为11.1个月，VEN+化疗组ORR为85.7%（12/14），平均PFS为23.7个月，均优于化疗组（P值分别为0.029和P=0.002）。在化疗组中，M5型患者（7例）和非M5型患者（11例）的平均PFS分别为20.0和15.45个月，差异无统计学意义（P=0.298），但在VEN+化疗组中，M5型患者（8例）和非M5型患者（12例）平均PFS分别为19.6和30.2个月，差异有统计学意义（P=0.031）。VEN+化疗组患者最常见的3～4级不良反应为白细胞减少、血小板减少、贫血和感染，与化疗组比较，发生率均未明显增加。Western blot检测显示，VEN能够持续抑制不同FAB分型AML患者骨髓有核细胞中BCL-2蛋白的表达，但VEN仅能使M5型患者骨髓有核细胞中MCL-1蛋白的表达水平提高。 结论 VEN联合强化化疗对具有不良遗传学特征的初治AML患者有较好的近远期疗效，且未增加不良反应。MCL-1蛋白的异常表达可能是导致VEN耐药的重要因素。 Objective This was an open-label observational assessment aimed to evaluate whether venetoclax (VEN) plus chemotherapy could enhance the therapeutic benefits for treatment-naive acute myeloid leukemia (AML) patients with adverse cytogenetic profiles. Methods A total of 38 adult patients (including 11 patients with moderate risk stratification and 27 patients with high risk stratification) who were treated at the Affiliated Hospital of Inner Mongolia Medical University from April 2019 to May 2022 were enrolled in this study. Patients were randomized into two cohorts according to the random number method to receive single intensive chemotherapy (18/38) alone or VEN+intensive chemotherapy (20/38), respectively. The chemotherapy cohort received 2 cycles of induction chemotherapy (idarbicin or daunorubicin plus cytarabine), followed by 6 cycles of consolidation chemotherapy (cytarabine), while the treatment for the VEN + chemotherapy cohort consisted of the same chemotherapy as above plus oral VEN. Heparinized bone marrow samples were obtained from patients at enrollment de novo and post chemotherapy. The expressions of MCL-1 and BCL-2 were detected by Western blot analysis. Results Patients with VEN+chemotherapy showed an objective response rate (ORR) of 90.0% (18/20), compared with 55.6% (10/18, P=0.012) of the chemotherapy group. Meanwhile, the VEN + chemotherapy cohort gained more benefits in progression-free survival (PFS) and overall survival (OS) than the chemotherapy cohort (mean PFS: 27.1 months versus 17.9 months, P=0.038 mean OS: 32.2 months versus 21.3 months, P=0.004). For patients with moderate risk stratification, there were no differences in the ORR and PFS between the chemotherapy cohort and the VEN + chemotherapy cohort: the ORR was 80.0% (4/5) versus 100% (6/6, P=0.251), and the PFS was 27.9 months versus 32.0 months (P=0.582). Moreover, the ORR was 85.7% (12/14) for the VEN+chemotherapy cohort and 46.2% (6/13) for the chemotherapy cohort in the high risk profile (P=0.029). The PFS of the VEN+chemotherapy cohort was superior to the chemotherapy cohort in the high risk profile (mean PFS: 23.7 months versus 11.1 months, P=0.002). Meanwhile, in the chemotherapy cohort, there were no difference in the PFS between FAB-M5 patients and non-FAB-M5 patients the mean PFS was 20.0 months versus 15.5 months (P=0.298) for the two groups. Nevertheless, FAB-M5 patients were inferior to non-FAB-M5 patients in PFS in the VEN + chemotherapy arm (mean PFS: 19.6 months versus 30.2 months, P=0.031). The most frequent grade 4 hematological toxicities (therapy related) were leukopenia and thrombopenia. Grade 3/4 hematological adverse events in patients treated with VEN+chemotherapy were not increased compared with those who received chemotherapy. Western blot showed VEN continuously decreased the expression of BCL-2 proteins in both FAB-M5 and non-FAB-M5 patients, but obviously increased the expression of MCL-1 proteins only in FAB-M5 patients. Conclusions VEN combined with intensive chemotherapy have yielded high ORR and survival advantages for de novo AML patients with poor cytogenetics profiles. The high-expression of MCL-1 may drive resistance to VEN.

    急性髓系白血病维奈克拉疗效细胞遗传学骨髓细胞白血病蛋白1

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    上海市长宁区居民胃癌和结直肠癌伤残调整寿命年的统计分析

    吴景张磊姜玉唐丹丹...
    168-176页
    查看更多>>摘要：目的 分析上海市长宁区户籍居民胃癌和结直肠癌伤残调整寿命年（DALY）的现况及其变化趋势，为长宁区胃癌和结直肠癌的防治提供科学依据。 方法 利用2002—2019年上海市长宁区肿瘤登记数据，估算该地居民胃癌和结直肠癌的DALYs、粗DALY率、标化DALY率等指标，采用Joinpoint回归分析计算标化率的年度变化百分比（APC）和年均变化百分比（AAPC），描述其不同阶段的时间变化趋势。 结果 2002—2019年长宁区胃癌和结直肠癌的DALYs分别为55 931人年和65 252人年，粗DALY率分别为512.16/10万和597.51/10万；男性疾病负担高于女性，胃癌粗DALY率峰值分布在75～79岁组，结直肠癌粗DALY率峰值分布在85岁以上组。Joinpoint回归分析显示，2002—2019年长宁区胃癌标化DALY率呈下降趋势（AAPC=-3.86%，P＜0.05），结直肠癌标化DALY率变化趋势无统计学意义（AAPC=-0.08%，P＞0.05），但结直肠癌标化DALY率在男女性中变化趋势不同，男性呈上升趋势（AAPC=1.24%，P＜0.05），女性呈下降趋势（AAPC=-1.67%，P＜0.05）。 结论 上海市长宁区居民的胃癌和结直肠癌DALY整体上有所下降，男性及中老年人群仍是防治重点。 Objectives To analyze the status and temporal changes of disability-adjusted life year (DALY) for stomach and colorectal cancers among registered permanent residents in Changning District of Shanghai Municipality, and provide scientific basis for the prevention and treatment of stomach and colorectal cancers in this district. Methods Using the cancer registration data of stomach and colorectal cancers from 2002 to 2019, we estimated the indices such as the DALYs, the DALY crude rates, the age-standardized DALY rates, etc. Then we used the Joinpoint regression model to calculate the average annual percent change (AAPC) and annual percent change (APC) to explore the temporal variations in different periods. Results The DALYs of stomach and colorectal cancers in Changning District from 2002 to 2019 were 55 931 person years and 65 252 person years, respectively. The crude rates of DALY were 512.16/105 and 597.51/105, respectively. We observed a higher disease burden in men than in women, and the peak rate of DALY in stomach cancer was in the 75-79 years age group, while in colorectal cancer the rate was in the 85-years-or-older age group. Joinpoint regression analysis showed that from 2002 to 2019, the age-standardized DALY rate of stomach cancer showed a downward trend (AAPC=-3.86%, P＜0.05), while the trend of colorectal cancer was not statistically significant(AAPC=-0.08%, P＞0.05). However, the trends in the age-standardized DALY rates of colorectal cancer were different between males and females, with males showing an upward trend (AAPC=1.24%, P＜0.05) and females showing a downward trend (AAPC=-1.67%, P＜0.05). Conclusions The DALY of stomach and colorectal cancers in Changning District of Shanghai showed a decreasing trend. Males and the middle-aged and elderly populations are still the key targets for disease prevention and control in this district.

    胃肿瘤结直肠肿瘤疾病负担伤残调整寿命年趋势变化上海市

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