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1.
目的:探讨得力生注射液(DLS)联合化疗治疗晚期结肠癌的临床疗效.方法:63例晚期消化道肿瘤患者随机分为化疗组(对照组)和化疗联合得力生组(观察组),其中观察组30例,奥沙利铂85mg/m2 ivgtt d1;亚叶酸钙(CF) 200mg/m2 ivgtt d1-2;氟尿嘧啶(5-FU)400mg/m2 iv d1-2;氟尿嘧啶(5-FU)600mg/m2 CIV 22h d1-2,14天为1周期.化疗当天开始予DLS 20-40ml ivgtt d1-14.对照组33例,化疗方案同治疗组.结果:对照组总有效率和生活质量改善率分别为33.3%和42.4%,观察组分别为63.3%和66.7%,两组比较有显著性差异(P<0.05);对照组WBC减少为74.8%,高于观察组的51.4%;对照组治疗后CD3+、CD4+、CD4+/ CD8+降低,CD8+增高,治疗前后对比有显著性差异(P<0.01);而观察组治疗前后无显著性差异.结论:得力生联合化疗可显著提高化疗疗效,增强免疫力,减轻化疗不良反应,提高患者生活质量和化疗依从性.  相似文献   

2.
目的 观察得力生注射液联合FOLF0X4方案治疗晚期消化道肿瘤的临床疗效.方法 60例晚期消化道肿瘤随机分为得力生注射液联合FOLFOX4方案治疗组(试验组)和单用FOLFOX4方案治疗组(对照组),每组30例.观察近期临床疗效、生活质量、免疫指标、毒副反应等.结果 试验组总有效率和生活质量改善率分别为56.7%、70.0%,对照组分别为40.0%、46.7%,比较差异有统计学意义(P<0.05).试验组化疗毒副反应较轻,与对照组比较差异有统计学意义(P<0.05).结论 得力生注射液联合FOLFOX4方案治疗晚期消化道肿瘤可显著提高疗效,改善患者的生活质量,增强机体免疫功能,降低化疗药物的毒副反应.  相似文献   

3.
目的:观察生脉注射液联合化疗与单纯化疗治疗晚期非小细胞肺癌的近期疗效及对生活质量和化疗毒副反应的作用。方法:将64例晚期非小细胞肺癌患者随机分为治疗组32例和对照组32例。治疗组采用NP方案化疗,并在化疗第1天开始用生脉注射液60ml加入5%GS250ml中静脉滴注,连用10天;对照组单用化疗,方案同治疗组,21天为1周期,疗程为2周期。结果:治疗组近期有效率为46.9%,对照组为40.6%,近期疗效无显著性差异(P>0.05);KPS评分改善的患者在治疗组高于对照组(59.4%vs34.4%,P<0.05);治疗组白细胞下降(≥Ⅱ度)及恶心呕吐反应(≥Ⅱ度)的患者明显低于对照组(P<0.05)。结论:生脉注射液联合化疗可以减轻晚期非小细胞肺癌患者的化疗毒副反应,提高对化疗的耐受能力,改善生活质量。  相似文献   

4.
目的评价得力生注射液联合经肝动脉化疗栓塞术(transcatheterarterialchemoembolization,TACE)治疗原发性肝癌(hepatocelluarcarcinoma,HCC)患者的临床效果及不良反应。方法选择无手术指征的HCC患者62例,随机分为试验组(得力生联合TACE)32例和对照组(单纯TACE)30例,选用FAP肝动脉化疗方案,试验组加用得力生注射液50ml/d静滴,15d~20d。治疗2个周期后观测患者的近期疗效、细胞免疫功能、生活质量及不良反应。结果试验组有效率为56.3%(18/32),对照组为43.3%(13/30),两组之间差异无统计学意义,(P>0.05)。试验组较对照组生活质量(KPS评分)明显提高,(P<0.05)。试验组细胞免疫功能提高,其中NK细胞升高明显,差异有统计学意义,(P<0.05)。试验组化疗毒副反应减轻,与对照组比较无统计学意义,(P>0.05)。结论得力生注射液联合TACE治疗能提高HCC患生存质量,增强患者的细胞免疫功能。  相似文献   

5.
何文杰  赵金奇 《癌症进展》2008,6(4):432-434
观察参芪扶正注射液联合GP方案治疗晚期非小细胞肺癌的疗效和毒副作用。方法治疗组35例,对照组35例,均采用相同的GP化疗方案,即吉西他滨1g/m^3,d1、8,DDP 25mg/m^2 d1~3。治疗组加用参芪扶正注射液250ml静滴,每天1次,连用10天。结果两组疗效无显著性差异(P〉0.05);治疗组血液毒副作用和消化道发生率明显低于对照组,有显著性差异(P〈0.05)。结论参芪扶正注射液联合GP方案治疗晚期非小细胞肺癌可降低化疗对患者的毒副作用,改善患者的生存质量。  相似文献   

6.
TAE术后白介素-2联合生脉注射液治疗肝癌临床观察   总被引:15,自引:0,他引:15  
目的 观察白介素 2合并生脉注射液治疗肝癌栓塞化疗后近期疗效、生存率及免疫功能变化等临床指标。方法 采用已确诊的原发性及转移性肝癌 14 4例 ,随机分为治疗组及对照组各 72例 ,治疗组在采用肝癌栓塞化疗后即用白介素 2 2 0万U肌注 ,5 %GS2 5 0ml 生脉注射液 40ml静脉滴注 ,1/日 ,10~ 15天为 1疗程。对照组仅作栓塞化疗 ,两组病人行栓塞化疗 2~ 6次不等 ,间隔时间视病情而定。结果 治疗组有效率 (CR PR)为 84.7( 61/72 ) ,明显高于对照组( 5 8.3 % ,42 /72 ) ;治疗组 1年、2年、3年生存率分别为 80 .5 %、66.7%、3 5 .4% ,中位生存期为 18个月 ,而对照组分别为 47.2 %、3 1.9%、13 .8% ,中位生存期为 10个月。两组比较有非常显著性差异 (P <0 .0 1) ;自然杀伤细胞 (NK)活性、T细胞亚群 (CD3 、CD4 、CD8、CD4 /CD4 )数值 ,在治疗后治疗组明显提高 ,对照组下降 ,两组有显著差异性 (P <0 .0 5 )。结论 生脉注射液联合白介素 2治疗肝癌栓塞化疗 ,有效率、生存率、中位生存期、免疫指标均较单纯栓塞化疗为高 ,是治疗中晚期肝癌较理想的方法。  相似文献   

7.
化疗联合中药得力生治疗中晚期恶性肿瘤临床疗效观察   总被引:1,自引:0,他引:1  
目的:观察化疗联合得力生注射液治疗中晚期恶性肿瘤的疗效.方法:中晚期恶性肿瘤患者60例作为观察组,同期单纯化疗的65例中晚期恶性肿瘤患者作为对照,对近期疗效、生活质量、外周血常规、消化道反应进行观察.观察组在化疗的基础上加用得力生注射液每次50ml加入5%葡萄糖注射液500ml静脉缓滴,每天一次,连续2周.两组均每3-4周重复,3个周期后评价疗效.结果:观察组和对照组近期有效率分别:65%和59%,差异无显著意义(P>0.05);两组的生活质量改变、外周血象变化及消化道反应相比均有显著性差异,观察组明显优于对照组.结论:得力生注射液联合化疗治疗中晚期恶性肿瘤能减轻化疗相关毒副作用,提高患者的生活质量.  相似文献   

8.
目的:探讨得力生注射液(DLS)联合化疗治疗晚期结肠癌的临床疗效。方法:63例晚期消化道肿瘤患者随机分为化疗组(对照组)和化疗联合得力生组(观察组),其中观察组30例,奥沙利铂85rag/m。ivgttdl;亚叶酸钙(CF)200mg/m2 ivgttdl-2;氟尿嘧啶(5-FU)400mg/m。ivdl-2;氟尿嘧啶(5-FU)600mg/m2 CIV22hd1-2 14天为1周期。化疗当天开始予DLS20-40mlivgttd1-18。对照组33例,化疗方案同治疗组。结果:对照组总有效率和生活质量改善率分别为33.3%和42.4%,观察组分别为63.3%和66.7%,两组比较有显著性差异(P〈0.05);对照组WBC减少为74.8%,高于观察组的51.4%;对照组治疗后CD3+、CD4+、CD4+/CD8+降低,CD8+增高,治疗前后对比有显著性差异(P〈0.01);而观察组治疗前后无显著性差异。结论:得力生联合化疗可显著提高化疗疗效,增强免疫力,减轻化疗不良反应,提高患者生活质量和化疗依从性。  相似文献   

9.
目的 评价周剂量多西紫杉醇联合小剂量顺铂、5-氟脲嘧啶(5-Fu)持续静脉滴注治疗晚期胃癌的临床疗效和毒副反应.方法 48例晚期胃癌随机分为两组,试验组:多西紫杉醇35 mg/(m2·d)静滴,d1,8,15;顺铂 mg/(m2·d),d1~5,d8~12;5-Fu250mg/(m2·d)微量输液泵维持持续静滴,d1~14,3周为1周期.对照组:顺铂75mg/(m2·),d1静滴;5-Fu 1000mg/(m2@d),d1~5>3周为1周期.治疗3~4个周期后评价疗效和毒副反应.结果 试验组总有效率为45.8%;对照组总有效率为37.5%.两组有效率比较差异无统汁学意义(P>0.05).试验组较对照组白细胞下降(79.2%vs 45.8%);试验组腹泻(41.6%vs 20.8%)较对照组明显升高(P<0.05);试验组恶心、呕吐的发生率(33.3%vs 12.5%)低于埘照组,蒡异均有统计学意义(P<0.05).结论 多西紫杉醇联合小剂量顺铂、5-Fu持续静脉滴注治疗晚期胃癌具有较好的疗效,毒剐反应可耐受,是晚期胃癌化疗的有效方案.  相似文献   

10.
王赫  杨光 《现代肿瘤医学》2007,15(11):1648-1649
目的:观察得力生注射液配合肝动脉灌注栓塞治疗原发性肝癌的疗效。方法:33例住院原发性肝癌患者,随机分为治疗组和对照组,治疗组17例,采用得力生注射液配合介入化疗。对照组单用介入化疗,化疗方案相同。得力生注射液给药方案:介入前3天开始得力生注射液50ml/d静脉注射连用3天,然后用EADM60mg、5-Fu1.0,并行MMC20mg、碘化油及明胶碎屑栓塞,同时术后每天静点得力生注射液1次,50ml/次,4周1疗程,28天后重复前方案,共用2疗程。结果:治疗组肿瘤缩小明显优于对照组。治疗组治疗后与治疗前相比CD3、CD4、CD4/CD8均明显升高,且两组治疗后上述指标相比差异显著。治疗组血常规始终维持在正常范围。对照组2例WBC低于3.0×109/L时使用升白药物。结论:得力生注射液与化疗药物同时经肝动脉灌注栓塞治疗原发性肝癌,可明显提高疗效,增强免疫力,减轻化疗副作用,改善患者生活质量。  相似文献   

11.
The medically important dematiaceous fungi and their identification   总被引:5,自引:0,他引:5  
Dematiaceous fungi include a large group of organisms that are darkly pigmented (dark brown, olivaceous, or black). In most cases the pigment is melanin, and specifically, dihydroxynaphthalene melanin. The diseases produced include chromoblastomycosis, eumycotic mycetoma, and phaeohyphomycosis. Phaeohyphomycosis is a new classification for a diverse group of previously known entities grouped together on the basis of finding dematiaceous hyphal and/or yeast-like forms in tissue; tissue involvement may be superficial, cutaneous and corneal, subcutaneous, or systemic. Identification of these fungi is based mostly upon morphology. Important structures include annellides (Phaeoannellomyces, Exophiala), phialides (Phialophora, Wangiella), adelophialides (Phialemonium without collarettes, Lecythophora with collarettes), differentiation of conidiophores (Xylohypha versus Cladosporium) and conidial hilum, septation and germination (Bipolaris, Drechslera, Exserohilum). Useful laboratory tests include the 12% gelatin test (controversial), nitrate assimilation (W. dermatitidis is negative, most other species are positive), and determination of temperature maxima (especially 37 degrees C for E. jeanselmei, 40 degrees C for W. dermatitidis and B. spicifera, 42 degrees C for X. bantiana, and 45 degrees C for Dactylaria constricta var. gallopava and Scedosporium inflatum).  相似文献   

12.
Zusammenfassung: An der Studie zur Wirksamkeit und Anwendungssicherheit von Ketoconazol nahmen 27 Männer im Alter von 20 bis 80 (Median: 57) Jahre, davon 18 mit Onychomykosen und 9 als KontroUen bei den Laborwertbestimmungen, teil. Während des ersten Behandlungsmonats erhielten je 9 Patienten 200 mg und 400 mg Ketoconazol täglich. Danach wurden beide Gruppen 6 Monate mit 200 mg/d weiterbehandelt. Die klinische Beurteilung sowie hämatologische, biochemische und Plasmaspiegeluntersu-chungen erfolgten mindestens monafich, mykologische Untersuchungen wurden vor Aufnahme und bei Beendigung der Therapie vorgenommen. Erne letzte klinische Unter-suchung erfolgte 1 Jahr nach Beginn der Studie. Nach 7 Monaten Behandlung wurden 23 von 30 Nägeln mit “gebessert” bis “stark gebessert” beurteilt, nach dem behandlungsfreien Intervall galt dies für 28 von 30 Nägeln. Die Plasmaspiegel waren mit 200 mg/d ausreichend und uber den Behandlungszeit-raum konstant. Dies spricht für gute orale Resorption und Abwesenheit von Enzyminduktion. Die Laborwerte zeigten im Vergleich zu den Kontrollen und den Werten vor Behandlung keine signifikanten Abweichungen, so daß myelo-, nephro- und hepatotoxische Wirkungen von 400 bzw. 200 mg/d ausgeschlossen werden können. Der Lipidhaushalt wurde nicht beeinfluat und es trat unter Therapie als Folge der Ketoconazolwirkung lediglich Lanosterin im Serum auf. Nach Beendigung der Therapie ging der Lanosteringehalt schnell zurück. Damit erweist sich Ketoconazol in den angewandten Dosen als ein gut verträgliches und zur Langzeitbehandlung von Onychomykosen geeignetes Antimykotikum. Summary: Twenty-seven males with a median age of 57 (range: 20 to 80) years took part in this study on the efficacy and safety of ketoconazole. Eighteen men suffered from onychomycosis; nine served as controls in the safety evaluation. During the first month of treatment, nine patients received 200 mg and the nine other 400 mg ketoconazole daily. Then the treatment was uniformly continued with 200 mg/d for 6 months. Clinical evaluation and haematological, biochemical and plasma level investigations were carried out at least at monthly intervals; mycological controls were performed at the start and end of therapy. A final clinical evaluation was carried out one year after the start of the study. After 7 months of treatment, moderate or definite clinical improvement was obtained in 23 out of 30 nails. After 5 more months without antimycotic treatment this was the case in 28 of 30 nails. Plasma levels obtained with 200 mg ketoconazole daily were adequate and constant during the entire treatment period. This indicates a good oral resorption as well as the absence of induction of hepatic enzymes. The laboratory values did not show significant deviations as compared with the controls or with the pretreatment values. This excludes myelo-, nephro- and hepatotoxic effects of 400 and 200 mg ketoconazole daily. The lipid metabolism was not influenced, the only difference was the occurrence of lanosterol in the serum, which is a result of the mechanism of action of ketoconazole. After the medication period the lanosterol levels subsided rapidly. In the applied doses ketoconazole is a well-tolerated and effective drug for the systemic long-term treatment of onychomycosis.  相似文献   

13.
Dr.  W. Dittmar  N. Jovi 《Mycoses》1987,30(7):326-342
Summary: Short-term experiments on excised skin (human, pig) gave the following results: 1. In the tissue activity test with direct inoculation (D-TAT) commercial preparations of the non-azole antimycotics ciclopiroxolamine, tolnaftate and naftifine, produced higher inhibitory activity against Trichophyton mentagrophytes (standard strain) in various levels of the horny layer than were produced by the azole antimycotics econazole, miconazole, clotrimazole, oxiconazole and bifonazole. Fast drying solutions of antimycotics invariably gave higher inhibitory activities than creams. In the ultrafiltration tissue activity test (UFT- TAT) against Candida albicans (2 strains), antimycotic agents ranked in order of effectiveness as follows: ciclopiroxolamine – most of the azole antimycotics – bifonazole and naftifine. 2. In tests of fungicidal activity against T. mentagrophytes (2 strains) and Microsporum gypseum (1 strain) the first step was to inoculate the skin surface. After the horny layer had been penetrated by fungal mycelia, antimycotic agents of documented fungicidal potency, chiefly in the form of creams, were applied to the skin surface and left to act for up to 18 hours. The horny layer and epidermis were then scraped off and the concentration of viable fungi was determined. Ciclopiroxolamine cream and lotion produced by far the greatest diminution in viable fungi; creams containing oxiconazole and naftifine were moderately effective and those containing tioconazole and bifonazole produced a relatively small decrease in viable fungi. To avoid erroneous results it is important to homogenize and dilute the skin scrapings; if this is not done certain antimycotics will give misleadingly high fungal killing rates. At this early stage the scatter of results is still wide and minor differences in efficacy cannot as yet be detected with certainty. 3. From the results of various comparative tests it is evident that pig skin can be used as a substitute for human skin in the tests listed under 1. and 2. above. This discovery may make a valuable contribution towards limiting the need for experiments on living animals and trials on human beings. Zusammenfassung: In Kurzzeitversuchen an exzidierter Haut (Mensch, Schwein) wurde gefunden: 1. Im Gewebeaktivitätstest mit direkter Inokulation (D-GAT) wurde mit Handelspräparaten der Nichtazol-Antimykotika Ciclopiroxolamin, Tolnaftat und Naftifin in verschiedenen Hornschichtniveaus eine höhere Hemmaktivität gegenüber Trichophyton mentagrophytes (Standard-Stamm) erzielt als mit solchen der Azol-Antimykotika Econazol, Miconazol, Clotrimazol, Oxiconazol und Bifonazol. Rasch trocknende Lösungen von Antimykotika ergaben durchweg höhere Hemmaktivitäten als Cremes. Im Ultrafiltrations-Gewebeaktivitätstest (UFT-GAT) gegenüber Candida albicans (2 Stämme) ergab sich nach erzielter Wirksamkeit die Rangfolge Ciclopiroxolamine – Mehrzahl der Azolantimykotika – Bifonazol und Naftifin. 2. In Fungizidie-Testen gegenüber T. mentagrophytes (2 Stämme) und Microsporum gypseum (1 Stamm) wurde zunächst die Hautoberfläche inokuliert. Nach Durchdringung der Hornschicht mit Pilzmyzelien wirkten auf die Hautoberfläche bis zu 18 Stunden lang überwiegend Cremes von als fungizid publizierten Antimykotika ein. Während sich in abgeschabter Hornschicht und Epidermis der so bearbeiteten Hautoberflächen mit Ciclopiroxolamin-Creme und -Lotion die weitaus höchste Verminderung lebensfähiger Keime ergab, bewirkten Cremes mit Oxiconazol und Naftifin eine mittlere und solche mit Tioconazol und Bifonazol eine relativ niedrige Keimeliminierung. Zur Vermeidung von fehlerhaften Ergebuissen mußten Homogenisierung und Verdünnung der Hautschabsel erfolgen, anderenfalls bei mehreren Antimykotika eine zu hohe Keimabtötung vorgetäuscht worden wäre. Wegen der vorerst noch hohen Streuung der Ergebnisse können kleinere Wirksamkeitsunterschiede noch nicht sicher erfaßt werden. 3. Nach dem Ergebnis verschiedener Vergleichstests kann in den Testen zu 1. und 2. Schweinehaut als Ersatz für Haut vom Menschen dienen und dürfte damit wesentlich zur Einschränkung von Versuchen am lebenden Tier und von Prüfungen am Menschen beitragen.  相似文献   

14.
Mycotic immunodiagnosis was performed in 186 hospitalized patients with different respiratory diseases, mostly considered as tuberculosis and others with a doubtful diagnosis. Crude histoplasmin, coccidioidin, paracoccidioidin, blastomycin, candidin, aspergillin, and sporotrichin, as well as purified polysaccharide-protein complexes (PPC) of Histoplasma capsulatum, Coccidioides immitis, and Paracoccidioides brasiliensis were used as antigens. Immune tests used included skin test (ST), gel immunodiffusion (ID), counterimmunoelectrophoresis (CIE), complement fixation (CF), and ELISA. A possible association with candidosis was observed in 17% of patients with tuberculosis and diabetes; one presumptive paracoccidioidomycosis, one confirmed aspergillosis, and six cases of active histoplasmosis were determined. Candidin ST showed 29% of positive reactions with an increased frequency in patients between 31 and 55 years of age. CF test showed the highest positivity percentages with crude antigens, specially for Candida antigen (26.3%) and histoplasmin (18.2%). Cross reactions were evident with crude antigens but decreased when PPC's were used in ELISA.  相似文献   

15.
Summary. A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum , two with candidoses of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (TravogenR, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3–4 weeks. In 15 (31%) of the remaining patients treatment was required for 5–6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.
Zusammenfassung. Insgesamt 54 Patienten mit kulturell gesicherter Dermatomykose, (23 unterschiedliche Dermatophytosen, eine Trichosporon beigelii - und eine Geotrichum candidum -Fußinfektion, 2 Candidosen der Leistengegend und 27 Pityriasis versicolor) wurden in einer klinischen Wirksamkeits-studie mit 1% iger Isoconazol-Creme (TravogenR, Schering, Berlin, Deutschland) behandelt. Fünf Patienten waren nicht auswertbar. Eine klinische und mykologische Heilung wurde bei 47 von 49 Patienten (96%) erreicht. Bei 29 patienten (59%) wurde die Heilung bereits nach 3–4 Wochen Behandlung erreicht. Weitere 15 Patienten (31%) benötigten 5–6 Wochen und drei Patienten 8 Wochen Behandlungsdauer. Zwei Mykosesituationen erwiesen sich als therapieresistent.  相似文献   

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Ilya Shmulevich 《癌症》2014,(8):369-370
The recent effort by The Cancer Genome Atlas (TCGA) Network has revealed that gastric cancer, which is a leading cause of cancerrelated deaths worldwide with a 5-year survival rate less than 25%, is a much more heterogeneous disease than previously thought. And yet, conventional treatment approaches and clinical trials have assumed it is a single disease. Although it is well known that under the microscope, gastric cancer cells appear quite different, the current classification scheme recognizes two main categories of gastric cancer: diffuse and intestinal.  相似文献   

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To improve prognosis in recurrent glioblastoma we developed a treatment protocol based on a combination of drugs not traditionally thought of as cytotoxic chemotherapy agents but that have a robust history of being well-tolerated and are already marketed and used for other non-cancer indications. Focus was on adding drugs which met these criteria: a) were pharmacologically well characterized, b) had low likelihood of adding to patient side effect burden, c) had evidence for interfering with a recognized, well-characterized growth promoting element of glioblastoma, and d) were coordinated, as an ensemble had reasonable likelihood of concerted activity against key biological features of glioblastoma growth. We found nine drugs meeting these criteria and propose adding them to continuous low dose temozolomide, a currently accepted treatment for relapsed glioblastoma, in patients with recurrent disease after primary treatment with the Stupp Protocol. The nine adjuvant drug regimen, Coordinated Undermining of Survival Paths, CUSP9, then are aprepitant, artesunate, auranofin, captopril, copper gluconate, disulfiram, ketoconazole, nelfinavir, sertraline, to be added to continuous low dose temozolomide. We discuss each drug in turn and the specific rationale for use- how each drug is expected to retard glioblastoma growth and undermine glioblastoma''s compensatory mechanisms engaged during temozolomide treatment. The risks of pharmacological interactions and why we believe this drug mix will increase both quality of life and overall survival are reviewed.  相似文献   

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As nearly 5% of all endometrial cancers occur because of a predisposition, this possibility has systematically to be explored. The hallmarks of predisposition, a young age at diagnosis, a personal or a familial history of cancer, have to be searched systematically. The identification of a predisposition in a family has a major impact on the management of the proband or his relatives. The endometrial cancer main predisposition is Lynch's syndrome. In this review, we will focus on this condition and describe its clinical manifestations, the underlying molecular mechanisms, the cancer risks and the management guidelines. We will also get onto some far less frequent other predispositions.  相似文献   

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