Objective To assess the effectiveness and safety of nedaplatin combined with 5-fluorouracil (5-Fu) for advanced esophageal cancer. Methods Such databases as PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data were searched from the date of their establishment to May 4th, 2012 to collect the randomized controlled trials (RCTs) about nedaplatin combined with 5-Fu versus cisplatin combined with 5-Fu for advanced esophageal cancer. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. Results A total of 15 RCTs invloving 863 patients were included. The results of meta-analysis suggested that, compared with cisplatin combined with 5-Fu, nedaplatin combined with 5-Fu could improve short-term effects (RR=1.31, 95%CI 1.14 to 1.52, P=0.000 2) and reduce gastrointestinal reaction and renal function impairment, but it was associated with aggravated myelosuppression, increase of thrombocytopenia and leukopenia, and decrease of hemoglobin. There were no significant differences between the two groups in liver function impairment, diarrhea and peripheral neurovirulence. Conclusion Nedaplatin combined with 5-fluorouracil can increase short-term effects and reduce gastrointestinal reaction and renal function impairment. However, nedaplatin is associated with aggravated myelosuppression, so it should be applied in clinic with cautious. Nedaplatin combined with 5-fluorouracil can be used as a replacement chemotherapy regimen for advanced esophageal cancer, but the evidence about long-term effects and safety is still required. For the quality and quantity limitation of the included studies which decreases the level of evidence, so the conclusion of this systematic review only provides some references for clinical practice and research.
ObjectiveTo evaluate the impact of video-assisted thoracoscopic surgery (VATS) esophagectomy and routine operation on the short-term quality of life in patients with esophageal cancer. MethodsFrom January 2012 through January 2014, 157 esophageal cancer patients were classified into a VATS group (n=42) and a routine operation group (n=115) in our hospital. All patients in the two groups completed the Chinese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 at one, six and 12 months after operation separately. ResultsAt the end of 6, 12 months after operation, the evaluation on global health status was higher in the VATS group(68.8±12.3 vs. 62.7±13.7, P<0.05; 76.2±10.4 vs. 68.6±8.8, P<0.05). At the end of 1, 6, 12 months after operation, the scores of symptom pain were less significantly in the VATS group than those in the routine operation group (P<0.05). One month after operation, the score of active ability in the VATS group was higher (P<0.05). At the end of 6, 12 months after operation, the score of emotional function and social role in the VATS group was higher (P<0.05). At the end of 12 months after operation, the score of role function and cognitive function in the VATS group was also higher (P<0.05). ConclusionVATS is of better effect on improving short-term quality of life of esophageal cancer patients compared with routine operation.
Objective To assess the value of vascular endothelial growth factor (VEGF) expression in the prognosis of esophageal cancer. Methods PubMed and EMbase were searched for collecting retrospective cohort studies on the correlation between VEGF expression and prognosis of esophageal cancer, and relevant articles were also retrieved from inception to June, 2012. Two reviewers independently screened the literature, extracted the data, and evaluated the quality. Then the meta-analysis was performed by using RevMan5.0 software, and the publication bias of literature was evaluated by means of Begg’s funnel plot and Egger’s method. Results Finally 10 cohort studies involving 811 patients were included. The meta-analysis showed that, patients with high level of VEGF had poor overall survival (HR=1.55, 95%CI 1.25 to 1.91). The results of subgroup analyses including VEGF subtype, critical value of VEGF and source of patient showed that: a) there was no correlation between patient’s prognosis and high level of VEGF-C; b) The high level of VEGF subtype in cancer tissue indicated a higher risk of death when the critical value was 10%, while it was not related to the prognosis when the critical value was 30%; and c) The high level of VEGF in cancer tissue was more valuable to predict the prognosis of esophageal cancer for Chinese patients rather than non-Chinese patients. Conclusion The level of VEGF’s expression in cancer tissue is valuable to predict the prognosis of esophageal cancer.
Objective To systematically review the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Methods Such databases as PubMed, EMbase, CJFD, CBM, CNKI, VIP and WanFang Data were electronically searched from inception to January 1st, 2013, to collect case-control studies on the correlation between epidermal growth factor (EGF) 61A/G polymorphism and the risk of esophageal carcinoma. Two reviewers independently identified the literature according to inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 and Stata 12.0 software. Results A total of six studies involving 1 448 cases and 1 728 control subjects were included. The results of meta-analysis showed that, there was no significant association between EGF 61A/G polymorphism and the risk of esophageal carcinoma (dominant model: AG+GG vs. AA: OR=1.22, 95%CI 0.91 to 1.65; and recessive model: GG vs. AG+AA: OR=1.35, 95%CI 0.94 to 1.94; AG vs. AA: OR=1.12, 95%CI 0.93 to 1.35; GG vs. AA: OR=1.43, 95%CI 0.83 to 2.47). The results of subgroup analysis grouped by ethnicity showed that, EGF 61A/G polymorphism increased the risk of esophageal carcinoma of the White population (dominant model: AG+GG vs. AA: OR=1.39, 95%CI 1.14 to 1.71; and recessive model: GG vs. AG+AA: OR=1.75, 95%CI 1.37 to 2.25; GG vs. AA: OR=1.93, 95%CI 1.47 to 2.55). However, it had no correlation to the risk of esophageal carcinoma of Asian population. Conclusion Current studies showed that, EGF 61A/G polymorphism is not associated with susceptibility to esophageal carcinoma , but it may increase the risk of esophageal carcinoma in White population. Due to limited quality and quantity of the included studies, the above conclusion needs to be verified by more studies with large sample size.
Objective To investigate the relationship between cyclooxygenase-2 (COX-2) gene polymorphism and genetic susceptibility to esophageal cancer. Methods The PubMed and EMbase databases were searched from the date of their establishment to January 1st, 2011 to collect the case-control studies on COX-2 polymorphism and susceptibility to esophageal cancer. For the population genotype distributions of both esophagus cancer group and control group, their odds ratios (ORs) and 95% confidence intervals (CIs) were taken as the effect indexes, either the fixed or random effect model was applied to conducted Meta-analysis in homozygote comparison, dominant and recessive genetic models, and the publication bias was assessed then. All statistical analyses were conducted with Stata11.0 software. Results A total of five case-control studies were included. The results of meta-analyses showed for the COX-2-765Ggt;C polymorphism, the CC+GC genotype was associated with the risk of esophageal cancer in a dominant genetic model (CC+GC vs. GG: OR=1.806, 95% CI 1.050 to 3.106); for the COX-2-1195Ggt;A polymorphism, the AA genotype was associated with the risk of esophageal cancer in homozygote comparison and recessive genetic models, the AA+GA genotype was associated with the risk of esophageal cancer in a dominant genetic model. Conclusion It is suggested that COX-2 polymorphism may be associated with genetic susceptibility to esophageal cancer.
摘要:目的:探讨晚期食管癌切除、纵隔淋巴结清扫及术中纵隔热灌注化疗对残留于气管、支气管、胸主动脉、奇静脉等器官的癌性肉眼微小病灶治疗效果。方法:选择食管癌病变浸润超过外膜层外侵至气管、支气管、胸主动脉、奇静脉等器官患者112例，随机分为两组:治疗组56例,术中42～43℃无菌蒸馏水2000～2500 mL加入顺铂(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在体外循环下行纵隔热灌注化疗40 min;对照组56例,术中未进行纵隔热灌注化疗。结果:治疗组术后第一年有6例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年有11例纵隔区域肿瘤复发及淋巴结转移;对照组术后第一年有14例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年23例出现纵隔区域肿瘤复发及淋巴结转移。结论:晚期食管癌术中纵隔热灌注化疗可明显减少或延迟纵隔区域肿瘤复发及淋巴转移,提高术后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0.6%（2/316），吻合口狭窄发生率为5.7%（18/316），对照组吻合口瘘发生率为1.6%（3/186），吻合口狭窄发生率为4.3%（8/186），均有显著性差异（P＜0.05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P＞0.05）。行机械吻合手术时间明显缩短，有统计学意义（P＜0.05）。实验组肺部感染发生率0.3%（1/316），无肺不张，对照组肺部感染发生率1.6%（3/186），肺不张0.5%（1/186），其差异有统计学意义（P＜0.05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。
目的:探讨健康教育对食管癌患者及家属的影响。方法:将2007.1～2008.1在我科行食管癌手术患者60例，随机分为两组，对照组按食管癌健康教育计划实施健康指导，实验组除实施对照组措施外，对患者家属同步实施健康教育。于手术前一天和术后第八天，采用问答方式调查两组患者及家属对围术期、康复期相关知识的掌握情况以及护理满意度，并进行比较。结果:两组患者及家属经健康指导后对围术期相关知识及康复期护理知识以及护理满意度具有差异性（P＜0.05）。结论:对患者及家属同步实施健康教育可促进对食管癌相关知识及恢复期保健知识掌握，能提高护理满意度。