影响乳腺癌肝转移患者预后的多因素分析

目的:分析影响乳腺癌肝转移患者的预后因素.方法:回顾分析我院1991年3月～2004年2月收治的26例乳腺癌肝转移患者的临床资料,采用t检验比较多因素对乳腺癌肝转移患者TTP影响的差异.结果:乳腺癌肝转移患者化疗的有效率为53.84%.肝内单一转移灶7人,中位TTP为9.86个月,多个转移灶19人,中位7TP为6.10个月,P＞0.05;不伴有其它远处转移灶10人,中位TTP为5.00个月,伴有其它远处转移灶16人,中位TTP为9.86个月,P＞0.05;肝转移后化疗17人,中位TTP为9.65个月,不化疗9人,中位TTP为2.33个月,P＜0.05.结论:化疗对乳腺癌肝转移患者的预后有明显的影响,肝内转移灶数目和是否伴有其它转移灶对预后影响不明显.     

影响乳腺癌肝转移患者预后的多因素分析

目的:分析影响乳腺癌肝转移患者的预后因素。方法:回顾分析我院1991年3月-2004年2月收治的26例乳腺癌肝转移患者的临床资料,采用t检验比较多因素对乳腺癌肝转移患者TTP影响的差异。结果:乳腺癌肝转移患者化疗的有效率为53．84％。肝内单一转移灶7人,中位TTP为9．86个月,多个转移灶19人,中位 TTP为6．10个月,P>0．05;不伴有其它远处转移灶10人,中位TTP为5．00个月,伴有其它远处转移灶16人,中位 TTP为9．86个月,P>0．05;肝转移后化疗17人,中位TTP为9．65个月,不化疗9人,中位TTP为2．33个月,P< 0．05。结论:化疗对乳腺癌肝转移患者的预后有明显的影响,肝内转移灶数目和是否伴有其它转移灶对预后影响不明显。     

沙利度胺联合含铂方案治疗三阴性乳腺癌肝转移

目的:探讨沙利度胺联合化疗在肝转移三阴性乳腺癌中的临床疗效及安全性.方法:将48例符合入组条件的三阴性肝转移乳腺癌患者随机分为两组,其中实验组24例,至少接受含铂方案治疗2周期联合沙利度胺持续服6周后观察疗效及毒副反应.对照组24例,至少接受含铂方案治疗2周期后观察疗效及毒副反应.结果:实验组有效率优于对照组(P＜0.05);毒副反应,实验组消化道反应发生率较对照组明显下降(P＜0.05),骨髓抑制两组无明显差异.实验组治疗后Karnofsky评分情况优于对照组(P＜0.05).结论:沙利度胺联合化疗对三阴性乳腺癌肝转移的疗效优于单一化疗组,且可明显减轻患者化疗胃肠毒副反应,提高患者生活质量.     

新辅助化疗在结直肠癌肝转移治疗中的作用

目的 探讨新辅助化疗在结直肠癌肝转移治疗中的作用。方法 选取76例接受新辅助化疗的结直肠癌肝转移患者,观察新辅助化疗前后原发灶及肝转移灶大小、血清CEA水平变化情况,分析其根治性手术切除率、化疗不良反应、手术并发症以及根治性手术切除患者及其他治疗方式患者的2年生存情况。结果 新辅助化疗后,大部分患者原发灶、肝转移灶体积明显缩小,血清CEA水平明显下降,与接受新辅助化疗前相比,差异有统计学意义（P＜0.05）。其中肝转移灶获CR 0 例,PR 51 例, SD 24 例, PD 1例, 有效率为66.11%（51/76）;原发灶获CR 0 例,PR 44 例, SD 30例, PD 2例, 有效率为57.89% （44/76）。新辅助化疗不良反应以周围神经炎、消化道反应、骨髓抑制等为主,多为Ⅰ～Ⅱ级,未出现Ⅳ级不良反应。根治性手术切除率为30.26%（23/76）,手术并发症发生率为3.95%（3/23）。Kaplan-Meier生存分析显示,行根治性手术切除的结直肠癌肝转移患者2年生存情况显著优于其他治疗方法的患者（P＜0.05）。结论 新辅助化疗应用于肝转移灶潜在可切除的结直肠癌肝转移患者,使部分患者肝转移灶缩小,提高根治性手术切除率,改善预后,不良反应可耐受,是一种安全、有效的治疗方法。     

恩度联合化疗治疗晚期难治性乳腺癌的疗效与安全性分析

目的 探讨恩度联合化疗治疗晚期难治性乳腺癌的疗效及安全性.方法 回顾性分析34例接受恩度联合化疗治疗的晚期难治性乳腺癌患者的临床资料,评估恩度联合化疗的临床疗效、无进展生存时间(PFS)和不良反应.结果34例晚期难治性乳腺癌患者均可评价疗效,治疗的客观缓解率为17.6%(6/34),疾病控制率为67.6%(23/34),中位PFS为4.04个月(2.59~5.50个月),1年生存率为59.6%,死亡11例.单因素分析及多因素分析结果显示:各临床病理特征亚组间PFS、OS比较,差异均无统计学意义(P﹥0.05).本研究主要不良反应表现为乏力及血液学毒性,经治疗均可缓解.结论 恩度联合化疗对晚期难治性乳腺癌有一定疗效,且不良反应可耐受.     

恩度联合化疗在HER-2阴性乳腺癌肝转移中的临床应用——附5例报告

背景与目的乳腺癌肝转移患者预后差,对化疗敏感性差,生存期短。如何提高乳腺癌肝转移患者的治疗效果,提高生存期,是目前临床研究中亟需解决的问题。抗肿瘤新药重组人血管内皮抑素注射液(恩度,YH216)联合化疗治疗晚期非小细胞肺癌,能够显著提高客观疗效,延长患者的生存时间并改善生活质量。本组在HER-2阴性乳腺癌肝转移患者应用重组人血管内皮抑素联合化疗,观察近期疗效及毒副作用,为晚期乳腺癌肝转移的治疗提供有效的治疗参考。方法经病理组织学确诊的晚期乳腺癌肝转移患者5例(均为ER,PR,HER-2阴性),接受恩度联合化疗的方案治疗。其中恩度15mg,加入生理盐水500ml中缓慢静脉滴注4小时,第1～14天连续给药,间歇7天重复;同时联合既往未使用的或与既往治疗无交叉耐药的化疗药物,每21天为1个周期。结果本组5例患者中,总共完成的周期数为20个周期,平均4个周期1例。获得CR1例,PR2例,SD1例,PD1例,客观有效率(RR)为60%(3/5)。Ⅲ～Ⅳ度的毒性反应主要与化疗药物有关,5例患者在第2个周期结束后均出现不同程度的骨髓抑制,3例出现Ⅱ度白细胞下降(3/5,60%),1例出现血小板下降(1/5,20%)。5例均有不同程度恶心呕吐,1例出现轻度心律失常(未处理)。无其他毒副作用发生。结论恩度与化疗药物联合使用可以提高HER-2阴性乳腺癌肝转移患者的疗效,与化疗药物具有协同作用,其毒性低,安全性好,为乳腺癌肝转移提供新的治疗思路。     

胃肠道癌局限性肝转移的95例治疗分析

目的探讨胃肠道癌局限性肝转移患者的治疗方法.方法对我院1987-2000年收治的原发癌根治术后的95例胃肠道癌局限性肝转移患者进行回顾性研究.结果原发癌加肝转移灶切除的患者1、3、5年生存率分别为76.1%、39.1%、19.4%,而肝转移灶未治疗的患者其分别为26.7%、0、0,1、3年生存率的差异均有显著性(P＜0.05);肝转移灶微波固化和无水酒精注射及肝脏区域化疗的合并组患者1、3、5年生存率分别为73.5%、29.4%、12.0%,其与肝转移灶切除组的差异均无显著性(P＞0.05).与肝转移灶未治疗组的1年生存率差异有显著(P＜0.05).结论胃肠道癌局限性肝转移患者,应尽可能彻底切除原发癌和肝转移灶,肝转移灶微波固化和无水酒精注射及肝脏区域化疗是其治疗的重要的补充.     

哌柏西利治疗激素受体阳性晚期乳腺癌的真实世界研究及疗效预测模型

目的评价真实世界中哌柏西利治疗激素受体(HR)阳性晚期乳腺癌的疗效和安全性。方法回顾性分析南京医科大学第一附属医院2018—2020年接受哌柏西利联合内分泌治疗的66例HR阳性复发转移性乳腺癌患者的临床资料。生存分析采用Kaplan-Meier法和Log rank检验, 多因素分析采用Cox回归模型, 构建预测哌柏西利治疗HR阳性乳腺癌疾病进展风险的列线图模型, 使用一致性指数(C-index)和校准曲线进行内部验证评估模型的预测能力和符合度。结果 66例患者中, 复发转移后未经内分泌治疗、一线内分泌治疗、二线及以上内分泌治疗的患者分别占33.3% (22例)、42.4% (28例)、24.2% (16例);肝转移者占36.4% (24例);内分泌敏感患者占16.7%(11例), 原发内分泌耐药患者占27.3%(18例), 继发性内分泌耐药患者占56.1%(37例)。全组患者客观有效率为14.3%(95%CI:6.7%～25.4%), 临床获益率为58.7%(95%CI:45.6%～71.0%)。非肝转移(P=0.001)、内分泌治疗敏感/继发耐药(P=0.004)、复发转移后未行化疗...     

乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。     

乳腺癌骨转移的综合治疗(附70例临床分析)

目的骨转移为乳腺癌的常见转移部位，其最大危害是骨痛，应采用一系列方法减轻骨痛，努力提高患者的生存质量。方法７０例乳腺癌骨转移患者采用化疗、放疗、内分泌、同位素和综合治疗，分单一方法治疗组和综合方法治疗组，观察治疗后疼痛缓解和功能障碍恢复情况，经ｔ检验得出结论。结果单一方法治疗中，内分泌和同位素治疗有效率高于单纯化疗和放疗；单一方法治疗有效率为５６．４％，综合治疗有效率为９０％，经统计学处理，Ｐ＜０．０１。结论单纯内分泌和同位素治疗优于单纯化疗和放疗，乳腺癌骨转移患者雌孕激素受体多为阳性，更适于内分泌治疗；综合治疗明显优于单一治疗，综合治疗中大剂量化疗加内分泌治疗效果最佳。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.