经尿道前列腺电切术联合间歇性雄激素阻断治疗晚期前列腺癌

目的探讨经尿道前列腺电切术联合间歇性雄激素阻断治疗晚期前列腺癌的临床效果。方法回顾性总结盐城市中医医院2006年1月至2012年1月行前列腺电切加雄激素阻断治疗晚期前列腺癌并得到有效随访的36例临床资料。结果 36例患者均顺利完成手术。术后3个月检查睾酮水平、前列腺特异抗原、最大尿流率、残余尿量、前列腺症状评分,较术前均显著改善。随访12~36个月,26例患者带瘤生存,排尿无明显异常。结论前列腺电切术联合间歇性雄激素阻断治疗晚期前列腺癌近期疗效肯定,可以明显的改善患者症状,减轻药物毒副作用,提高患者生活质量。     

全雄激素阻断治疗晚期前列腺癌

目的　观察诺雷德 (Zoladex)和氟他胺 (Flutamide)治疗晚期前列腺癌的临床疗效 ,分析影响疗效的有关因素。方法　对 1998年 3月～ 2 0 0 1年 3月收治的 2 3例晚期前列腺癌 ,给予以诺雷德和氟他胺为主治疗 ,并对其疼痛缓解程度、身体功能状况、肿瘤消退情况及血象、肝肾功能等进行观察分析。结果2 3例中完全缓解 (CR) 5例 ,部分缓解 (PR) 8例 ,好转 (MR) 7例 ,缓解率 5 6 .5 % ,有效率 86 .9%。治疗后有 18例身体功能状况改善 ,KPS≥ 5 0分 ,占 78.2 % ,除乳房胀痛外 ,无明显不良反应。临床治疗效果与患者身体功能状况、既往治疗、转移部位及PSA改变等因素有关。结论　全雄激素阻断治疗晚期前列腺癌 ,疗效肯定 ,不良反应轻微 ,对初治和睾丸切除术后复发的前列腺癌均有治疗作用 ,初治较复治效果好。     

间歇性与持续性雄激素阻断治疗晚期前列腺癌的疗效比较

目的比较间歇性和持续性雄激素阻断治疗晚期前列腺癌患者的疗效。方法选取69例晚期前列腺癌患者,按照治疗方法,分为间歇性联合雄激素阻断治疗组（A组,34例）和持续性雄激素阻断治疗组（B组,35例）,分析两组患者疾病进展时间和不良反应发生情况。结果A组患者中位疾病进展时间为31个月,B组为28个月,两组之间的差异无统计学意义（P〉0．05）。A组和B组有骨转移的患者的中位疾病进展时间分别为24个月和18个月,两组之间的差异有统计学意义（P〈0．05）。A组和B组无骨转移患者的中位疾病进展时间分别为39个月和42个月,两组之间的差异无统计学意义（P〉0．05）。A组患者潮热症发生率为20．6％,骨质疏松发生率为11．8％,腹泻发生率为5．9％,各不良反应发生率与B组患者相比,差异均有统计学意义（P〈0．05）。结论对晚期前列腺癌患者采用间歇性联合雄激素阻断治疗,有可能延迟骨转移前列腺癌患者的疾病进展,能够显著降低不良反应发生率,具有临床指导意义。     

睾丸切除加雄激素阻断治疗中晚期前列腺癌的临床效果观察

目的探讨间断性与持续性雄激素阻断治疗中晚期前列腺癌的临床效果。方法将2010年4月-2013年12月行睾丸切除术的128例中晚期前列腺癌患者作为研究对象,其中采用间断性雄激素阻断治疗的60例患者为IAD组,另68例采用持续性雄激素阻断治疗的患者为CAD组,对2组患者治疗后的临床疗效、不良反应以及生活质量进行比较分析。结果 2组患者在治疗效果上没有明显差异,但在治疗后生活质量情况和潮热、头痛等不良反应发生率方面具有明显差异(P<0.05)。结论对于睾丸切除术后中晚期前列腺癌患者,间断性雄激素阻断治疗可在有效控制癌症进展率的基础上,减少不良反应的发生,提高患者的生活质量,总体效果优于持续性雄激素阻断治疗。     

雄激素阻断治疗后前列腺癌组织中肿瘤干细胞比例变化

目的 研究雄激素阻断治疗（androgen deprivation therapy ,ADT）对前列腺癌组织中肿瘤干细胞比例的影响,探讨激素非依赖性前列腺癌形成的机制。方法 实验分为ADT治疗组和无ADT治疗组,应用免疫荧光技术比较两组前列腺癌患者术前术后标本中肿瘤干细胞的比例变化。结果 无ADT组术前穿刺标本和前列腺根治切除术后标本肿瘤干细胞比例差异无统计学意义[（3.56±1.33）%vs. （3.78±1.39）%, n=9, t=-0.686, P=0.512] ,在ADT组,接受雄激素阻断治疗3月后,与穿刺标本比较,根治切除标本中前列腺癌肿瘤干细胞比例明显升高[（3.44±1.81）% vs. （9.22±1.71）% ,n=9,t=-6.353, P=0.000]。在癌旁组织,也可见ADT后干细胞标志的增加。结论 雄激素可能参与前列腺和前列腺癌组织中干细胞的分化;雄激素非依赖性前列腺癌的形成可能与前列腺癌肿瘤干细胞有关。     

联合雄激素阻断治疗前列腺癌所致贫血的研究

目的　研究联合雄激素阻断治疗对前列腺癌患者血红蛋白 (Hb)和红细胞压积 (Ht)的影响。方法　 136例前列腺癌患者采用联合雄激素阻断治疗 (睾丸切除 +氟他胺或福至尔 ,2 5 0mg/次 ,3次 /d)。治疗前及治疗后 1,2 ,3,6 ,9和 12个月分别检测患者的Hb和Ht。 6例贫血症状严重的患者采用重组人红细胞生成素 (RHE)治疗。结果　治疗前及治疗后 1,2 ,3,6 ,9和 12个月患者的Hb分别为 :(136± 14 )g/L、(12 6± 16 )g/L、(12 1± 14 )g/L、(12 0± 15 )g/L、(113± 12 )g/L、(12 1± 13)g/L和 (12 3± 15 )g/L ;Ht分别为 :0 .4 2 4± 0 .0 4 1、0 .390± 0 .0 38、0 .381± 0 .0 4 2、0 .378± 0 .0 38、0 .36 6± 0 .0 4 1、0 .0 384± 0 .0 39和 0 .387± 0 .0 4 0。治疗后与治疗前相比 ,差异均有显著性 (P <0 .0 5 )。贫血严重者 ,RHE治疗后贫血症状改善。结论　联合雄激素阻断治疗可导致贫血 ,对此类患者要定期监测Hb及Ht。重组人促红细胞生成素可用于纠正此类贫血。     

间歇性雄激素抑制:晚期前列腺癌治疗的又一选择

目前晚期前列腺癌内分泌治疗的金标准是持续性雄激素抑制(Continuous androgen suppression,CAS).然而,CAS存在以下缺点:可能导致前列腺癌的雄激素依赖状态迅速丧失,使预后更差;使患者生活质量下降;长期雄激素抑制导致诸多的副作用;维持治疗的费用高昂.因此,人们试图寻找一种更为理想的治疗方式.     

经尿道前列腺切除术联合间歇性或持续性雄激素阻断治疗晚期前列腺癌的疗效比较

目的探讨经尿道前列腺切除术(TUR-P)联合间歇性或持续性雄激素阻断治疗晚期前列腺癌的疗效。方法选取2007年1月至2010年5月间收治的62例晚期前列腺癌患者,按随机排列表法分为观察组和对照组,每组各31例。观察组采取TUR-P联合间歇性雄激素阻断治疗,对照组采取TUER-P联合持续性雄激素阻断治疗,比较两组患者术后3个月国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(RUV)、最大尿流率(Qmax)、3年生存率以及不良反应。结果观察组患者术后IPSS、QOL、3年总生存率分别为(7.01±1.62)分、(1.79±0.46)分和83.9%,对照组患者则分别为(7.92±1.11)分、(2.16±0.34)分和58.1%,观察组明显优于对照组,差异有统计学意义(P<0.05)。观察组患者术后RUV为(25.61±8.21)ml,Qmax为(16.13±2.98)ml/s;对照组患者术后RUV为(26.01±7.51)ml,Qmax为(15.93±3.22)ml/s。观察组患者潮热症、骨质疏松、腹泻不良反应发生率分别为19.35%、12.90%和3.23%,对照组患者分别为61.29%、35.48%和19.35%,两组差异有统计学意义(P<0.05)。结论 TUR-P联合间歇性雄激素阻断治疗晚期前列腺癌能够明显改善患者预后,减少不良反应,值得临床推广。     

经尿道前列腺电汽化加全雄激素阻断治疗合并膀胱出口梗阻的晚期前列腺癌

目的提高合并膀胱出口梗阻的晚期前列腺癌的治疗水平。方法分析22例确诊为合并膀胱出口梗阻晚期前列腺癌病例,同时采取经尿道前列腺电汽化(TUVP)加全雄激素阻断治疗疗效。结果22例手术一次成功,术后3个月随访,IPSS评分平均(9.6±1.5)分,最大尿流率平均(17±2.3)m l,残余尿量平均(12.5±2.3)m l,血清PSA值平均(6.3±2.1)ng/m。l未出现严重并发症。结论TUVP加全雄激素阻断能提高合并膀胱出口梗阻的晚期前列腺癌患者生存质量。     

全雄激素阻断治疗晚期前列腺癌24例临床分析

目的探讨康士德加诺雷德对晚期前列腺癌的治疗效果。方法对24例晚期前列腺癌采用康士德50mg。每日1次，持续口服，腹部皮下注射诺雷德3．6mg，每28天一次，连用6～10次，用药期间每月复查PSA、性激素。待PSA降至正常水平，癌灶缩小，症状改善好转后停用诺雷德。结果24例治疗后，第一年，22例PSA降至正常；第二年，15例病情稳定，9例PSA反跳至17—120ug／L，病情恶化；随访第三年，11例(46％)患者生存，13例(54％)死亡。结论康士德加诺雷德治疗晚期前列腺癌，治疗初PSA很快降至正常者疗效肯定，PSA降低慢，且不能下降至正常或降至正常后又反跳者，早期尚能控制病情，一旦PSA反跳，则提示病情进展。     

乳腺癌患者生存质量的测量量表及其研究进展

乳腺癌是女性最常见的恶性肿瘤,目前人类尚未彻底了解乳腺癌的病因及寻找出有效的预防乳腺癌的手段。因此在我国及世界许多国家乳腺癌发病率仍呈逐渐上升的趋势。在过去30年里随着临床治疗手段及早期诊断技术的进步,其死亡率已呈现下降的趋势。越来越多的乳腺癌患者将保持长期带瘤生存状态,乳腺癌如何影响患者的健康及生活已成为人们关注的主要问题。因此,生存质量(HRQOL)这一概念也就应运而生。鉴于生存质量的研究在我国尚处于起步阶段,本文就肿瘤目前常用的生存质量的测量手段加以介绍。     

睾丸切除联合最大雄激素阻断（MAB）治疗中晚期前列腺癌的疗效观察

目的：比较单纯睾丸切除与睾丸切除后联合最大雄激素阻断（ maximum androgen blockade,MAB）治疗中晚期前列腺癌的临床疗效。方法将38例中晚期前列腺癌患者划分为两组。第一组为单纯睾丸切除治疗,共17例;第二组为睾丸切除加最大雄激素阻断（ MAB）治疗,共21例,比较两组患者的血清前列腺特异性抗原（ PSA）、尿流率、前列腺大小及生存时间和质量。结果睾丸切除联合最大雄激素阻断组治疗后患者的生活质量明显优于单纯睾丸切除治疗组;而且两组在治疗12个月后,尿流率较治疗前均显著增高,血清PSA水平均显著降低,前列腺体积均明显缩小,睾丸切除联合最大雄激素阻断疗法降低血清中PSA水平效果更佳。结论睾丸切除联合最大雄激素阻断治疗中晚期前列腺癌,不仅可延长患者生存时间,还可以提高患者生存质量。     

The Impact of Chemotherapy on the Quality of Life of Breast Cancer Patients

One hundred and thirty-seven breast cancer patients, 102 receiving adjuvant chemotherapy and 35 receiving palliative chemotherapy for metastatic disease underwent a 37-item quality-of-life questionnaire to evaluate the impact of disease and treatment on physical, psychological and social well being. Patient groups were designated as follows — Adj CT: patients undergoing the questionnaire during their adjuvant chemotherapy program; Post Adj CT: patients evaluated 3 to 8 months after termination of adjuvant chemotherapy; Mts CT: patients assessed during palliative chemotherapy for metastatic disease, and Post Mts CT: patients 3 to 8 months after termination of palliative chemotherapy. Physical and social activities were reported as unaltered or normal by 64 to 70% and 52 to 67% of patients, respectively. Psychological status was judged normal by 39 to 45% of patients. No significant differences were observed between the patient groups. In 83 to 90% of cases the patient normally took care of herself. In 62 to 87% of cases time dedicated to recreational activities was reported as unaltered. The majority of patients (84%) judged that their relationship with partner and/or family were good. Severe anxiety was reported in 19 to 28% of patients and severe depression was infrequent (3.9%). Information regarding disease and treatment given by health professionals was considered satisfactory by 80 to 100% of patients. This pilot experience indicates that the majority of breast cancer patients respond normally to the stresses of both adjuvant and palliative chemotherapy; quality of life does not appear to improve 3-8 months after termination of chemotherapy; family support is good in the majority of cases and that a subset of patients with severe anxiety who could benefit from pharmacological and/or psychological intervention can be identified.     

前列腺癌老年患者生活质量与社会支持的相关性研究

[目的]探讨前列腺癌老年患者生活质量与社会支持之间的关系.[方法]采用问卷调查的方式,按照连续研究对象招募法的原则,以2014年8月至2015年8月云南省肿瘤医院泌尿外科收治的200例前列腺癌老年患者为调查对象,在入院时对他们的生活质量与社会支持进行调查.[结果]前列腺癌老年患者的生活质量较差,社会支持较低;社会支持与躯体功能、角色功能、情绪功能、社会功能、总健康状况呈正相关(P＜0.05),与疲倦、疼痛、治疗相关症状呈负相关(P＜0.05).[结论]前列腺癌老年患者的生活质量、社会支持均较低,两者有一定的相关性;医护人员应该重视他们的社会支持系统,拓宽现有的社会支持渠道,从而提高其生活质量.     

Health-Related Quality of Life of Patients with Cervical Cancer According to the Duration of Treatment and Cancer Progression

Objective: The purpose of this study was to assess health-related quality of life (HRQoL) in Korean patients with cervical cancer according to the duration of treatment and cancer progression of cervical cancer. Methods: This study included 452 outpatients with cervical intraepithelial neoplasia (CIN) or invasive cervical cancer from six tertiary hospitals in South Korea. The questionnaire included the EQ-5D-3L instrument, patients’ age, cancer progression (CIN or invasive cervical cancer), treatment duration (<1 year, ≥1 year but <2 years, and ≥2 years), treatment method (surgery, chemotherapy, radiation therapy), and presence of recurrence. HRQoL indices were calculated for these independent factors, and the mean was compared using ANOVA. Multiple regression analysis was performed to analyze factors affecting HRQoL in patients with cervical cancer. Results: The EQ-5D index was 0.93 for patients with CIN, 0.87 for patients with invasive cervical cancer, and 0.78 for patients with recurrent invasive cervical cancer. HRQoL was significantly lower as the CIN progresses to cervical cancer. HRQoL of patients with invasive cervical cancer was lowest within 1 year of treatment in all stages. In addition, the HRQoL of patients with CIN or invasive cervical cancer who received chemotherapy and radiotherapy was lower than that of patients who underwent surgery. Multiple regression analysis showed that the HRQoL decreased significantly as increasing age, the first year of treatment after diagnosis, cancer recurrence, or chemotherapy. Conclusion: The HRQoL of patients with cervical cancer is affected not only by the stage of cancer progression but also by the duration of treatment and the type of treatment. As a result, when trying to apply the quality of life of patients with cervical cancer to cost-utility analysis, it is necessary to consider the duration and the type of treatment they receive.     

Less Satisfaction With Information in Patients With Prostate Cancer Treated With Surgery and Salvage Radiotherapy Compared With Patients Treated With Curative Radiotherapy Alone,Despite Similar Health-Related Quality of Life

BackgroundThis study examined patient perception of information received, satisfaction with that information, and its relation to health-related quality of life (HRQoL) and clinical and demographic variables before, during, and after radiotherapy (RT) for localized prostate cancer.Patients and MethodsIn 2010, 2 questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] and EORTC QLQ information module [QLQ-INFO25]) were sent to 660 consecutive patients with prostate cancer who had undergone or were to undergo RT with curative intent between December 2006 and March 2010.ResultsThe response rate was 92%. Although most patients (69%) were satisfied with the information they received, statistically significant differences were found for all but 2 EORTC QLQ-INFO25 variables, favoring those who were treated with RT alone compared with those treated with both prostatectomy and salvage RT. Statistically significant associations between all HRQoL variables and satisfaction with information were found; higher levels of satisfaction were associated with better functioning and lower levels of symptoms and problems.ConclusionSatisfaction with the information received was studied in patients with prostate cancer with localized disease. Despite the fact that the majority of patients reported being satisfied with the information received, there is room for improvement, especially regarding “the disease,” “other services,” “different places of care,” and “things you can do to help yourself.” Patients treated with both prostatectomy and salvage RT reported significantly lower levels of satisfaction with information received and of having received significantly less information than did patients treated with RT alone.     

甲孕酮合并化疗改善晚期肺癌患者的生活质量

目的 :观察患者服用甲孕酮后改善化疗所致的厌食、体重下降、ECOG下降、骨髓抑制及胃肠道反应的作用 ,同时观察甲孕酮对晚期癌症的止痛作用及促进蛋白同化作用。方法 :130例接受化疗的晚期肺癌患者 ,采用单盲随机分成单用化疗组及化疗 甲孕酮组。结果 :在化疗 甲孕酮组治疗的160个周期中有43 1 %食量增加 ;45%体重增长 ;平均每周期体重增加0 74±1 56kg;血浆白蛋白升高1 2±2 9g/L ;88 1 %疼痛减轻及28 1 ?OG改善。化疗的毒副作用按WHO抗癌药物急性毒性分级标准 ,出现Ⅱ度以上的白细胞下降33 8%、血红蛋白下降15 6 %及胃肠道反应18 1 % ,平均恢复时间分别为6 4±4 6天、5 3±4 1天及1 89±1 2天。以上各项指标与单用化疗组相比均有显著性差异。结论 :甲孕酮如能正确合理地用于晚期癌症的治疗 ,可以全面改善化疗期癌症患者的生活质量     

Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer

Background

Patients with advanced cancer often experience muscle wasting (sarcopenia), yet little is known about the characteristics associated with sarcopenia and the relationship between sarcopenia and patients’ quality of life (QOL) and mood.

Materials and Methods

As part of a randomized trial, we assessed baseline QOL (Functional Assessment of Cancer Therapy‐General [FACT‐G]) and mood (Hospital Anxiety and Depression Scale [HADS]) in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer, and prior to randomization. Using computed tomography scans collected as part of routine clinical care, we assessed sarcopenia at the level of the third lumbar vertebra with validated sex‐specific cutoffs. We used logistic regression to explore characteristics associated with presence of sarcopenia. To examine associations between sarcopenia, QOL and mood, we used linear regression, adjusted for patients’ age, sex, marital status, education, and cancer type.

Results

Of 237 participants (mean age = 64.41 ± 10.93 years), the majority were male (54.0%) and married (70.5%) and had lung cancer (56.5%). Over half had sarcopenia (55.3%). Older age (odds ratio [OR] = 1.05, p = .002) and education beyond high school (OR = 1.95, p = .047) were associated with greater likelihood of having sarcopenia, while female sex (OR = 0.25, p < .001) and higher body mass index (OR = 0.79, p < .001) correlated with lower likelihood of sarcopenia. Sarcopenia was associated with worse QOL (FACT‐G: B = ?4.26, p = .048) and greater depression symptoms (HADS‐depression: B = ?1.56, p = .005).

Conclusion

Sarcopenia was highly prevalent among patients with newly diagnosed, incurable cancer. The associations of sarcopenia with worse QOL and depression symptoms highlight the need to address the issue of sarcopenia early in the course of illness.

Implications for Practice

This study found that sarcopenia, assessed using computed tomography scans acquired as part of routine clinical care, is highly prevalent in patients with newly diagnosed, incurable cancer. Notably, patients with sarcopenia reported worse quality of life and greater depression symptoms than those without sarcopenia. These findings highlight the importance of addressing muscle loss early in the course of illness among patients with incurable cancer. In the future, investigators should expand upon these findings to develop strategies for assessing and treating sarcopenia while striving to enhance the quality of life and mood outcomes of patients with advanced cancer.