血清糖类抗原19-9、糖类抗原125和人附睾蛋白4水平检测对老年卵巢癌患者的诊断和鉴别诊断价值

目的分析血清糖类抗原19-9(CA19-9)、糖类抗原125(CA125)和人附睾蛋白4(HE4)水平检测对老年卵巢癌患者的诊断和鉴别诊断价值。方法纳入51例老年卵巢癌患者(卵巢癌组)、33例卵巢良性病变患者(良性病变组)、30例健康体检女性(对照组)。比较3组研究对象血清CA19-9、CA125和HE4水平,并比较不同病理类型的老年卵巢癌患者血清CA19-9、CA125和HE4水平。通过绘制受试者工作特征(ROC)曲线比较单独与联合检测血清CA19-9、CA125和HE4对老年卵巢癌的诊断效能。结果与良性病变组和对照组比较,卵巢癌组血清CA19-9、CA125和HE4水平显著升高(P均<0.05)。黏液性癌患者血清CA19-9水平较透明细胞癌、子宫内膜样癌及浆液性癌患者均显著升高(P均<0.05);浆液性癌患者血清CA125水平较黏液性癌、透明细胞癌及子宫内膜样癌患者均显著升高(P均<0.05),子宫内膜样癌患者血清CA125水平较黏液性癌和透明细胞癌患者均显著升高(P均<0.05);子宫内膜样癌、浆液性癌患者血清HE4水平较黏液性癌和透明细胞癌患者均显著升高(P均<0.05)。CA19-9、CA125和HE4三者联合检测对诊断老年卵巢癌的敏感性、约登指数及ROC曲线下面积最高,HE4单独检测的特异性最高。结论老年卵巢癌患者血清CA19-9、CA125和HE4处于异常高水平,三者联合检测对老年卵巢癌的早期诊断和鉴别诊断具有重要的应用价值。     

卵巢癌患者TPS与CA125测定

[目的]探讨卵巢上皮性癌患者组织多肽特异抗原(tissue polypeptide specificantigen,TPS)与CA125水平测定及其临床意义.[方法]采用ELISA法和EIA法分别检测96例卵巢上皮性癌患者和33例妇科良性疾病患者血清TPS与CA125水平并进行比较分析.[结果]Ⅲ Ⅳ期卵巢上皮性癌患者血清TPS和CA125平均水平及阳性率均高于Ⅰ Ⅱ期(P<0.05),治疗有效组TPS和CA125水平显著低于初诊未治组,而复发转移组TPS水平明显高于初诊未治组.[结论]TPS与CA125水平的联合检测对卵巢癌诊断、疗效及预后有临床应用价值.     

血清CA125检测在卵巢上皮性癌预后评估中的价值

目的探讨卵巢上皮性癌患者术前血清CA125水平对治疗效果的预测、术后血清CA125水平的动态变化对预后的影响及复发的诊断价值。方法356例卵巢上皮性癌患者均行肿瘤细胞减灭术,术前及治疗期间采用电化学发光法定量检测CA125,治疗及随访期间监测血清CA125。结果术前CA125>500ku/L(48.7%)手术不能达到理想肿瘤细胞减灭术的明显高于术前CA125≤500ku/L(20.1%)(P值<0.01)的。术前CA125>500ku/L(73.1%)复发或转移率明显高于术前CA125<500ku/L(59.2%)(P<0.05)。189例患者在发现复发或转移病灶前或同时检测血清CA125异常(>35ku/L)。结论术前CA125以500ku/L为界值可作为术前判断能否实施理想肿瘤细胞减灭术的1项重要指标,术后化疗期间血清CA125动态监测能很好地观察卵巢癌的治疗效果及预后,CA125作为卵巢上皮性癌治疗后的病情监测指标有着非常重要的作用。     

晚期卵巢上皮性癌与血小板计数增高相关性分析

[目的]探讨晚期卵巢上皮性癌与血小板(PLT)计数增高之间的关系及其相关临床意义。[方法]收集1998年1月～2005年1月收治的晚期卵巢上皮性癌43例,并以同期收治的卵巢浆液性囊腺瘤50例为对照。采空腹静脉血测血小板(PLT)计数及CA125。[结果]晚期卵巢上皮性癌与浆液性囊腺瘤病人之间CA125值及PLT计数均有显著性差异。卵巢上皮性癌中PLT计数>300×109/L病人共20例,该部分病人CA125检测结果明显高于PLT正常者(P<0.05)。同时在PLT增高的病人中,完成满意减瘤术的比例低于PLT正常者,两者之间差异也有显著性意义。[结论]PLT增高可能是术前判断晚期卵巢上皮性癌预后不良的参考因素之一。     

血清CA125、CA15-3联合测定对卵巢肿瘤诊断的临床价值

CA125系高分子糖蛋白,与胚胎期体腔上皮中出现的糖蛋白相似,属卵巢癌相关抗原。是非黏液性卵巢上皮癌诊断,观察病程及疗效的指标之一[1,2]。CA15-3为乳腺癌的二株McAb识别的糖类抗原[1],在卵巢浆液性和黏液性囊腺癌组织中也存在一定的阳性表达。我科采用IMMULITE仪检测78例卵巢肿瘤患者血清中CA125、CA15-3水平,以探讨两者联合测定对卵巢肿瘤的诊断价值。1资料与方法1.1病例病例均为我院收治、临床拟诊为卵巢肿瘤的患者。年龄18～62岁,平均40岁。其中卵巢上皮癌51例(浆液性囊腺癌23例,子宫内膜样癌17例,黏液性囊腺癌8例,透明细胞癌3…     

血清CA125检测对卵巢癌诊断的意义

目的 探讨血清CA125与卵巢癌患者临床病理之间的关系,为CA125在卵巢癌临床诊断、治疗、预后判断中提供参考.方法 应用电化学发光法检测68例卵巢癌、36例正常对照者血清CA125浓度.结果 卵巢癌组、正常对照组血清CA125浓度分别为(586.97±1019.28)u/mL、(16.73±5.92)u/mL,两者比较差异具有统计学意义(P＜0.01);卵巢癌组中随着临床分期的增加,血清CA125浓度逐渐增加,Ⅰ、Ⅱ期与Ⅲ、Ⅳ期相比差异具有统计学意义(P＜0.01);血清CA125浓度与卵巢癌病理类型有关,浆液性显著高于非浆液性(P＜0.01).结论 血清CA125的检测对卵巢癌的诊断、分期及预后判断有一定的价值.     

间皮素和CA125在卵巢上皮性肿瘤中的共定位表达及临床意义

目的:研究上皮性卵巢癌OVCAR-3等细胞株和人卵巢肿瘤组织中间皮素(mesothelin,MSLN)和CA125的表达及定位,探讨2者之间的共定位关系及临床意义.方法:利用免疫组织化学法和间接免疫荧光双标记染色法检测人卵巢癌细胞株和卵巢上皮性肿瘤组织中间皮素和CA125的定位及表达.结果:免疫组织化学法和双标记免疫荧光细胞化学染色结果提示,间皮素和CA125在卵巢癌细胞及组织中均主要分布在细胞膜上,二者完全重叠,为共定位表达.卵巢上皮性癌组织中间皮素蛋白表达的荧光值为1 639.20±181.92,显著高于交界性卵巢上皮性肿瘤(590.85±126.95)、卵巢良性上皮性肿瘤(227.69±26.54)和正常卵巢皮质表面上皮(213.00±24.37),差异有统计学意义(P＜0.05);病理分级中G2、G3级的蛋白表达量分别为1 642.63±44.58和1 701.57±54.73,明显高于G1级的1 553.99±57.20 (P＜0.05);组织学类型中浆液性囊腺癌和子宫内膜样癌的蛋白表达量分别为1 723.81±33.20和1 673.81±70.27,明显高于黏液性囊腺癌的1 466.12±94.93(P＜0.05);间皮素的蛋白表达与患者年龄、病理分期及血清CA125的水平均无显著相关性(P＞0.05 ).结论:卵巢上皮性癌组织中间皮素和CA125高表达,且存在共定位表达关系.间皮素表达与卵巢肿瘤的良恶性以及卵巢癌的分级和类型有关.     

血清Mesothelin和CA125联合检测在上皮性卵巢癌诊断中的意义

目的:研究联合检测血清Mesothelin和CA125在上皮性卵巢癌诊断中的临床意义.方法:采用定量酶联免疫吸附试验(ELISA)检测上皮性卵巢癌患者31例,良性卵巢肿瘤32例和正常妇女30例血清中的Mesothelin和CA125水平.结果:上皮性卵巢癌患者的Mesothelin水平明显高于良性卵巢肿瘤患者和正常对照组(P<0.01),良性卵巢肿瘤组患者与正常对照组的差异无显著性(P>0.05).不同类型的上皮性卵巢癌的Mesothelin的差异无显著性(P>0.05).Mesothelin和CA125联合检测对上皮性卵巢癌诊断的灵敏度和正确率明显高于单项检测CA125或Mesothelin(P值均<0.05).结论:血清Mesothelin和CA125联合检测可提高上皮性卵巢癌的早期诊断率.     

DcR3在卵巢癌的表达及意义

[目的]探讨DcR3在卵巢上皮性良性及恶性肿瘤中的表达及其与卵巢癌临床病理特征的关系。[方法]采用免疫组织化学SP法检测106例卵巢上皮性肿瘤中DcR3和CA125的表达。[结果]DcR3在卵巢浆液性囊腺癌(71.0%)、卵巢子宫内膜样癌(44.4%)和卵巢透明细胞癌(83.3%)中出现过表达,并且与CA125的表达正相关(r=0.375,P=0.008)。在卵巢癌中,DcR3表达与患者年龄无相关性(P=0.067),与临床分期和组织分化水平具有相关性(P值分别为0.018、0.032)。[结论]DcR3在卵巢癌的发生发展中可能发挥着重要的作用,其在卵巢癌组织中的高表达,使其可能成为有效的治疗靶点。     

卵巢上皮性癌患者血清无细胞DNA的检测及临床意义

目的：检测循环无细胞DNA中的肿瘤相关cfDNA（ALU247／ALU115）及CA-125基因片段（CA125-cfDNA）在卵巢上皮性癌患者血清中的表达，探讨其是否可作为卵巢上皮性癌早期诊断及病情监测的指标。方法：采用半定量RT-PCR方法检测48例卵巢上皮性癌、16例良性卵巢上皮性肿瘤和12例正常健康对照血清中游离的ALU247、ALU115、CA125、β-actin DNA片段的表达。结果：卵巢上皮性癌患者血清中的肿瘤相关cfDNA（ALU247／ALU115）和CA125-cfDNA的相对水平（CA125-cfDNA／β-actin）明显高于卵巢良性肿瘤患者、正常对照及术后化疗二疗程者的值，晚期患者（Ⅲ-Ⅳ期）血清中的表达明显高于早期患者（Ⅰ-Ⅱ期），早期患者的表达明显高于正常对照组（P〈0．05），该两项指标与病理学类型及病理分级无关。CA125-cfDNA的相对水平与血清CA125的值存在相关性，在晚期卵巢上皮性癌未化疗患者腹水中的值显著高于血清中的值（P〈0．05）。结论：检测血清中ALU247／ALU115及CA125-cfDNA基因片段的水平可作为血清CA125的有效补充指标，用于卵巢上皮性肿瘤良恶性鉴别诊断、早期诊断和病情监测。     

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.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.