Anti-neutrophil antibodies (anti-MPO-ANCAs) are associated with poor prognosis in breast cancer patients

Anti-neutrophil antibodies are capable of activating neutrophils in sterile environments, releasing extracellular traps containing myeloperoxidase (MPO) and anti-MPO antibodies (MPO-ANCAs or anti-MPO-ANCAs), which have been implicated in the pathogenesis of several diseases. The present study evaluated systemic and tumor tissue levels of anti-MPO-ANCAs breast cancer patients, and its relation to clinicopathological characteristics. Anti-MPO-ANCAs were measured in serum and tissue samples of 150 patients by enzyme-linked immunoassay. Samples were pooled according to clinicopathological characteristics of patients. Higher anti-MPO-ANCAs levels were detected in groups presenting negative clinicopathological characteristics, such as high histological grade tumors and risk factors such as body mass index, menopausal status and early onset at diagnosis. The present data highlights anti-MPO-ANCAs as associated to poor prognosis in breast cancer, a role beyond its actually discussed role in autoimmunity and vasculitis.     

阿来替尼治疗ALK基因融合重排NSCLC脑转移瘤的临床疗效分析

  目的  探讨阿来替尼治疗ALK融合重排非小细胞肺癌（non-small cell lung cance，NSCLC）脑转移患者的疗效及不良反应。  方法  回顾性分析2016年8月至2019年10月天津医科大学肿瘤医院34例以脑转移为首发的ALK基因融合重排NSCLC患者的临床资料，其中13例（38.2%）患者接受阿来替尼单药一线治疗。男性7例（53.8%），女性6例（46.2%），中位年龄51（35~72）岁。应用Kaplan-Meier分析其生存情况。  结果  阿来替尼治疗ALK基因融合重排肺癌脑转移瘤，颅内中位无进展生存期（median progression-free survival，mPFS）为24.5个月。药物不良反应较轻。  结论  在颅内可测量病灶得到局部治疗的基础上，阿来替尼作为ALK基因融合重排NSCLC脑转移患者的一线治疗方案，显著延长患者无进展生存期（progression-free survival，PFS）。      

非小细胞肺癌新辅助靶向及免疫治疗研究进展和展望

肺癌是全球发病率和死亡率最高的恶性肿瘤。近年来,随着新型药物的出现和治疗模式的优化,肺癌患者的预后已有一定改善。新辅助治疗是指对潜在可接受手术切除的患者,先给予术前抗肿瘤治疗后再行手术治疗。新辅助治疗通过术前治疗可以缩小肿瘤体积,降低肿瘤分期;并且可以杀灭患者机体中循环肿瘤细胞及微转移病灶,令患者远期生存获益。靶向治疗及免疫治疗已被应用于晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的一线治疗。因此,有临床试验尝试将以上两种治疗手段应用于早期可切除NSCLC患者的新辅助治疗。本文针对新辅助靶向及免疫治疗对早期可切除NSCLC患者的疗效、治疗中的潜在风险予以综述,并探讨新辅助治疗的未来发展方向。     

Risk of lymph node metastasis and prognostic outcome in early gastric cancer patients with mixed histologic type

BackgroundWhether early gastric cancer with mixed histologic type should be considered for endoscopic submucosal dissection (ESD) remains controversial. The objective of this study was to evaluate the risk of lymph node metastasis (LNM) and prognostic significance for early gastric cancer with mixed histologic type.MethodsWe retrospectively reviewed clinicopathologic and survival data of 302 patients who underwent surgical resection for early gastric cancer. Based on the histologic components, all patients were classified as pure differentiated type, pure undifferentiated type and mixed histologic type. The prognostic differences between different types were compared and predictive factors for LNM were evaluated.ResultsHistopathologically, the proportion of mixed histologic type was 12.3% in early gastric cancer. In terms of LNM, mixed histologic type had a more frequent incidence than pure differentiated type (32.4% vs 11.1%, P < 0.01). However, there was no significant difference between mixed type and pure undifferentiated type for LNM (32.4% vs 21.1%, P = 0.139). Multivariate analysis revealed that tumor size >2 cm (odds ratio [OR]: 2.153, 95% confidence interval [CI]: 1.113-4.164, P < 0.05), submucosal invasion (OR: 3.881, 95%CI: 1.832-8.222, P < 0.001), lymphovascular invasion (OR: 8.797, 95% CI: 2.643-29.277, P < 0.001), undifferentiated type (OR: 3.146, 95% CI: 1.352-7.320, P < 0.01), and mixed histologic type (OR: 3.635, 95% CI: 1.272-10.390, P < 0.05) were independent risk factors for LNM in early gastric cancer patients. However, mixed histologic type did not affect the survival outcome of these patients (hazard ratio: 0.629, 95% CI: 0.074-5.311, P > 0.05).ConclusionMixed histologic type was an independent risk factor for lymph node metastasis in early gastric cancer patients. The decisions regarding endoscopic submucosal dissection for mixed histologic type should be carefully considered.     

医用粘胶相关性皮肤损伤的文献计量学分析

目的: 应用文献计量学方法,分析国内外医用粘胶相关性皮肤损伤（Medical adhesive-related skin injuries,MARSI）文献的研究主题和热点。方法: 检索Cochrane Library、PubMed、EMbase、Web of science、sinoMed、CNKI、Wanfang、VIP等数据库MARSI相关文献,检索时限为建库至2019年5月。采用SPSS 22.0 软件进行文献计量分析,利用gCLUTO统计对国内外高频主题词进行聚类分析。结果: 共纳入论文103篇,其中外文文献占总文献量的27.18%,中文文献占总文献量的72.82%。聚类分析将国内外高频主题词聚为4大类,依次为皮肤损伤及损伤类型、相关危险因素、风险评估及风险管理、护理干预措施。结论: MARSI仍是国内外研究的热点,其发病机制研究仍处于探索阶段,目前尚缺乏有效的预防策略,研究领域较局限。在今后的研究中,应加强MARSI预防的研究、注重多学科合作。     

应用放射组学和剂量学特征预测食管癌放射治疗后的两年生存情况

  目的  使用放射组学与剂量学特征参数，建立机器学习预测模型，预测食管癌患者放射治疗后两年的生存情况。  方法  回顾性分析2013年1月至2017年12月在天津医科大学肿瘤医院接受放射治疗的食管癌患者共579例。从食管癌患者的放射治疗计划中提取GTV的放射组学和剂量学的特征，使用最大相关最小冗余与人工方法对特征参数进行筛选，分别选取14项放射组学和14项剂量学特征，并将特征变量进行标准化归一至[0, 1]范围。建立支持向量机、逻辑回归和随机森林等机器学习模型，先使用14项放射组学特征，再使用28项放射组学和剂量学混合特征参数进行训练和测试，来预测食管癌放射治疗患者的两年生存情况。  结果  仅使用放射组学特征预测放射治疗后两年生存情况时，支持向量机、逻辑回归和随机森林模型的准确率分别为84.98%、85.92%和84.51%。使用放射组学和剂量学的混合特征参数进行预测时，支持向量机、逻辑回归和随机森林模型的准确率分别为86.32%、83.02%和90.01%。在放射组学特征参数基础上，增加剂量学特征，支持向量机和随机森林模型的预测准确性得到有效提高。  结论  针对支持向量机和随机森林模型，使用放射组学和放射治疗剂量学特征参数放射治疗，可有效提高对食管癌患者放射治疗后两年生存情况预测评估的准确性。      

食管癌根治性放疗剂量研究进展

同步放化疗是不可手术局部晚期食管癌的标准治疗模式,国际推荐根治性放疗剂量为50.0~50.4Gy,但中国食管癌与西方国家在病理类型、生物学行为等方面大有不同,行根治性放疗剂量仍倾向于60Gy。增加放疗剂量能否带来生存获益成为临床亟待解决的问题。有研究认为高剂量放疗可提高局控率、改善生存,但也有研究认为提高剂量未能带来生存获益,且可增加不良反应事件发生率。因此,本文就食管癌根治性放疗剂量对预后的影响进行探讨,并通过放化疗后疗效评估对放疗剂量做出适当调整,以期达个体化放疗。     

Clinical oncology—A new era

Rapid growth in biomedical research coupled with dramatic advancement in biotechnology has significantly improved our understanding of the molecular basis involving cancer development and progression. This improvement has led to the discovery of new molecular markers for cancer diagnosis and prognosis as well as new molecular targets for cancer treatment and intervention. Continuous emergence of some new developing area in molecular profiling, new therapeutic agents, tissue microenvironment and systems biology have made significant progress in clinical oncology. Clinical research and investigation that focus on these new developments have begun to show exciting results that indicate future promises in improving patient management and survival.